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Kim SH, Moon JY, Kim T, Jung JH, Han K, Min KH, Lee H. Increased risk of suicide among individuals with chronic obstructive pulmonary disease: A nationwide cohort study in Korea. J Affect Disord 2025; 381:507-513. [PMID: 40189064 DOI: 10.1016/j.jad.2025.04.022] [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: 12/13/2024] [Revised: 03/30/2025] [Accepted: 04/02/2025] [Indexed: 04/14/2025]
Abstract
BACKGROUND Previous studies have established that individuals with chronic obstructive pulmonary disease (COPD) have an increased risk of suicidal behaviors. However, it is uncertain which subgroups of individuals with COPD are at higher risk of suicide. METHOD We analyzed data from the Korean National Health Insurance Service. The exposure was COPD, and the outcome was death by suicide. Participants were followed until their date of death by suicide, the censoring date, or December 31, 2021, whichever came first. A Fine-Gray proportional hazards model for subdistribution was used to determine the associations between COPD and death by suicide. RESULTS During a median follow-up of 11.3 years (interquartile range, 11.1-11.6 years), individuals with COPD had an increased risk of death by suicide compared to those without (adjusted subdistribution hazard ratio [aSHR] = 1.20, 95 % confidence interval [CI] = 1.08-1.32). When stratified by the presence or absence of potential risk factors and COPD, the risk of suicide was highest in the COPD population with current smoking habits ≥20 PY (aSHR = 1.71, 95 % CI = 1.39-2.12), depression (aSHR = 2.46, 95 % CI = 1.97-3.08), and anxiety (aSHR = 2.71, 95 % CI = 1.87-3.92) compared to their corresponding reference groups (non-COPD population without the corresponding potential risk factors). CONCLUSIONS COPD increased the risk of death by suicide. This risk was particularly pronounced when current heavy smoking habits, depression, and anxiety coexisted with COPD.
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Affiliation(s)
- Sang Hyuk Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Taehee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jin-Hyung Jung
- Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hoon Min
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang Medical Center, Hanyang University College of Medicine, Seoul, Republic of Korea.
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Lee AR, Choi SM, Baik M, Sun JY, Lee SM, Paik JW. Inpatient suicide trends and prevention: Insights from a South Korean nationwide study. Asian J Psychiatr 2025; 107:104479. [PMID: 40185048 DOI: 10.1016/j.ajp.2025.104479] [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: 12/10/2024] [Revised: 03/27/2025] [Accepted: 03/28/2025] [Indexed: 04/07/2025]
Abstract
OBJECTIVE Inpatient suicide is a significant problem, accounting for the third-highest ratio(17.8 %) of suicides in South Korea in 2017. We aimed to investigate the characteristics of inpatient suicides using national data, evaluate risk factors, and provide recommendations for suicide prevention. METHODS This nationwide case-control study utilized national data on all inpatient suicides from police investigations between 2013 and 2017. A total of 4998 individuals were included, comprising 833 inpatient suicides and 4165 controls. Inpatient suicide risk factors were assessed through cross-tabulations and logistic regression analyses. RESULTS Among eight hundred thirty-three individuals died by suicide in hospitals; most were male (74.9 %), older than 60 years (61.3 %), married (43.0 %), and unemployed (85.1 %). The primary method of inpatient suicide were jumping from a height (49 %), followed by hanging (39.7 %). Major depressive disorder was the most prevalent psychiatric diagnosis among inpatient suicides. The risk of inpatient suicide was significantly higher in patients with schizophrenia, dementia, and alcohol use disorder. CONCLUSIONS Effective management of hospital facilities and environments is essential to prevent inpatient suicides. Nursing hospitals treating patients with dementia require more rigorous psychiatric evaluations and facility safety standards. We recommend implementing crisis interventions and comprehensive psychiatric assessments to prevent inpatient suicide.
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Affiliation(s)
- Ah Rah Lee
- Department of Psychiatry, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Sung Moon Choi
- Department of Psychiatry, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Myungjae Baik
- Department of Psychiatry, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Je Young Sun
- Department of Psychiatry, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea; WELT Corp., 132 Teheran-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Psychiatry, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
| | - Jong-Woo Paik
- Department of Psychiatry, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
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Saracino RM, Polacek LC, Tutino R, Pessin H, Lynch KA, Atkinson TM, Nelson CJ. Cognitive interviewing of the older adults with cancer - depression scale (OAC-D): A patient-reported outcome (PRO). Palliat Support Care 2025; 23:e98. [PMID: 40260490 PMCID: PMC12090222 DOI: 10.1017/s1478951525000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2025]
Abstract
OBJECTIVES This study aimed to refine the content of a new patient-reported outcome (PRO) measure via cognitive interviewing techniques to assess the unique presentation of depressive symptoms in older adults with cancer (OACs). METHODS OACs (≥ 70years) with a history of a depressive disorder were administered a draft measure of the Older Adults with Cancer - Depression (OAC-D) Scale, then participated in a semi-structured cognitive interview to provide feedback on the appropriateness, comprehensibility, and overall acceptability of measure. Interviews were audio-recorded and transcribed, and qualitative methods guided revision of scale content and structure. RESULTS OACs (N = 10) with a range of cancer diagnoses completed cognitive interviews. Participants felt that the draft measure took a reasonable amount of time to answer and was easily understandable. They favored having item prompts and response anchors repeated with each item for ease of completion, and they helped identify phrasing and wording of key terms consistent with the authors' intended constructs. From this feedback, a revised version of the OAC-D was created. SIGNIFICANCE OF RESULTS The OAC-D Scale is the first PRO developed specifically for use with OACs. The use of expert and patient input and rigorous cognitive interviewing methods provides a conceptually accurate means of assessing the unique symptom experience of OACs with depression.
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Affiliation(s)
- Rebecca M Saracino
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura C Polacek
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rebecca Tutino
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hayley Pessin
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathleen A Lynch
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thomas M Atkinson
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian J Nelson
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Komura Y, Inoue K, Ishimura N, Taura D, Harada N, Inagaki N, Kondo N. Diabetes and suicide: a nationwide longitudinal cohort study among the Japanese working-age population. J Epidemiol Community Health 2025; 79:340-346. [PMID: 39603686 DOI: 10.1136/jech-2024-222701] [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] [Received: 07/01/2024] [Accepted: 11/12/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND Although the mental health burden of diabetes has received substantial attention, there is limited evidence on whether the risk of suicide-a severe consequence of mental health problems-increases among individuals with diabetes. Therefore, this study investigated the association between diabetes and suicide in Japan. METHODS This nationwide longitudinal cohort study included adults aged 18-74 years, who were enrolled in the Japan Health Insurance Association's health insurance programme between 2015 and 2022. Individuals newly diagnosed with diabetes were matched in a 1:1 ratio with those without diabetes, based on age and sex. We employed multivariable Cox proportional hazard models to estimate the hazard ratios for suicide in relation to the diagnosis of diabetes, adjusting for potential confounders, such as sociodemographic characteristics, history of psychiatric disorders, physical measurements, health behaviours and laboratory data. RESULTS Among 4 210 272 individuals in the matched-pair cohort, we observed 337 deaths by suicide among those with diabetes and 250 deaths by suicide among those without diabetes. After conditioning on potential confounders, diabetes diagnosis was linked to an increased risk of suicide (HR (95% CI) = 1.25 (1.06 to 1.47)). The association tended to be larger among those aged younger than 40 years and among women (among those aged 18-39 years, HR=1.69 (95% CI 1.05 to 2.73); among women, HR=1.56 (95% CI 0.92 to 2.64)). CONCLUSION Diabetes diagnosis may increase suicide risk among the working-age population, even after conditioning on potential confounders. Our findings underscore the importance of psychosocial support following a diagnosis.
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Affiliation(s)
- Yoshikazu Komura
- Department of Social Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Kosuke Inoue
- Department of Social Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
- The Hakubi Project, Kyoto University, Kyoto, Kyoto, Japan
| | - Nana Ishimura
- Department of Social Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Daisuke Taura
- Faculty of Medicine, Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Norio Harada
- Department of Endocrinology and Metabolism, University of Fukui School of Medical Sciences, Yoshida-gun, Fukui, Japan
| | - Nobuya Inagaki
- Faculty of Medicine, Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
- Kitano Hospital Medical Research Institute, Osaka, Osaka, Japan
| | - Naoki Kondo
- Department of Social Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
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Nakamura ZM, Small BJ, Zhai W, Ahles TA, Ahn J, Artese AL, Bethea TN, Breen EC, Cohen HJ, Extermann M, Graham D, Irwin MR, Isaacs C, Jim HSL, Kuhlman KR, McDonald BC, Patel SK, Rentscher KE, Root JC, Saykin AJ, Tometich DB, Van Dyk K, Zhou X, Mandelblatt JS, Carroll JE. Depressive symptom trajectories in older breast cancer survivors: the Thinking and Living with Cancer Study. J Cancer Surviv 2025; 19:568-579. [PMID: 37924476 PMCID: PMC11068856 DOI: 10.1007/s11764-023-01490-2] [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] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE To identify trajectories of depressive symptoms in older breast cancer survivors and demographic, psychosocial, physical health, and cancer-related predictors of these trajectories. METHODS Recently diagnosed nonmetastatic breast cancer survivors (n = 272), ages 60-98 years, were evaluated for depressive symptoms (Center for Epidemiological Studies Depression Scale, CES-D; scores ≥16 suggestive of clinically significant depressive symptoms). CES-D scores were analyzed in growth-mixture models to determine depression trajectories from baseline (post-surgery, pre-systemic therapy) through 3-year annual follow-up. Multivariable, multinomial logistic regression was used to identify baseline predictors of depression trajectories. RESULTS Survivors had three distinct trajectories: stable (84.6%), emerging depressive symptoms (10.3%), and recovery from high depressive symptoms at baseline that improved slowly over time (5.1%). Compared to stable survivors, those in the emerging (OR = 1.16; 95% CI = 1.08-1.23) or recovery (OR = 1.26; 95% CI = 1.15-1.38) groups reported greater baseline anxiety. Greater baseline deficit accumulation (frailty composite measure) was associated with emerging depressive symptoms (OR = 3.71; 95% CI = 1.90-7.26). Less social support at baseline (OR = 0.38; 95% CI = 0.15-0.99), but greater improvement in emotional (F = 4.13; p = 0.0006) and tangible (F = 2.86; p = 0.01) social support over time, was associated with recovery from depressive symptoms. CONCLUSIONS Fifteen percent of older breast cancer survivors experienced emerging or recovery depressive symptom trajectories. Baseline anxiety, deficit accumulation, and lower social support were associated with worse outcomes. IMPLICATIONS FOR CANCER SURVIVORS Our results emphasize the importance of depression screening throughout the course of cancer care to facilitate early intervention. Factors associated with depressive symptoms, including lower levels of social support proximal to diagnosis, could serve as intervention levers.
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Affiliation(s)
- Zev M Nakamura
- Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, Campus Box #7160, Chapel Hill, NC, 27599, USA.
| | - Brent J Small
- School of Aging Studies, University of South Florida, and Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Wanting Zhai
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Ashley L Artese
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Traci N Bethea
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Elizabeth C Breen
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Harvey J Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Martine Extermann
- Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Deena Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Michael R Irwin
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Claudine Isaacs
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kate R Kuhlman
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychological Science, University of California, Irvine, CA, USA
- Institute for Interdisciplinary Salivary Bioscience Research, School of Social Ecology, University of California, Irvine, CA, USA
| | - Brenna C McDonald
- Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sunita K Patel
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Kelly E Rentscher
- Department of Psychiatry and Behavioral Medicine, MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Danielle B Tometich
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kathleen Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Xingtao Zhou
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Jeanne S Mandelblatt
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Judith E Carroll
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
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Reilev M, Møller JJK, Stenager E, Christiansen E. Burden of psychiatric and somatic comorbidities in individuals with suicidal behavior: a nationwide Danish registry-based, observational study. Eur Psychiatry 2025; 68:e23. [PMID: 39834204 PMCID: PMC11822957 DOI: 10.1192/j.eurpsy.2024.1781] [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: 06/09/2024] [Revised: 08/27/2024] [Accepted: 09/01/2024] [Indexed: 01/22/2025] Open
Abstract
BACKGROUND Many psychiatric and somatic comorbidities increase the risk of suicidal behavior, but the effect of co-existing comorbidities is sparsely elucidated. We described co-existence of psychiatric and somatic comorbidities and the influence of the combined comorbidity burden on the risk of suicidal behavior. METHODS We defined two case populations above 10 years in the Danish health registries: those who 1) died by suicide (2010-2020) and 2) had an incident suicide attempt (2010-2021). Co-existing somatic and psychiatric comorbidities and relative odds of suicidal behavior at increasing comorbidity burden were assessed. RESULTS Among 5.9 million Danish citizens (2021), 6,257 individuals died by suicide whereas 30,570 had an incident suicide attempt. More than half had ≥2 co-existing psychiatric and/or somatic comorbidities. Of those who died by suicide, 18% had co-existing mood disorders and stress disorders, while 5% had both mood disorders and cancer. An 88-fold increase of odds for attempting suicide and a 35-fold increase of odds for suicide were observed among those with the highest combined burden of somatic and psychiatric comorbidities relative to those without. The presence of somatic comorbidities seemed to protect against suicide in older individuals. CONCLUSIONS Psychiatric and somatic comorbidities commonly co-exist in individuals with suicidal behavior. Higher combined burden of psychiatric and somatic comorbidities increased the odds of suicidal behavior, though the presence of somatic diseases had a potential protective effect on the risk of suicide in older individuals. This warrants collaboration and enhanced awareness of suicidal behavior risks across somatic and psychiatric departments.
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Affiliation(s)
- Mette Reilev
- Centre for Suicide Research, Odense, Denmark
- Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
- The Research Unit in Psychiatry – Child and Adults, Psychiatry in the Region of Southern Denmark, Aabenraa, Denmark
| | - Jens-Jakob Kjer Møller
- OPEN – Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Elsebeth Stenager
- The Research Unit in Psychiatry – Child and Adults, Psychiatry in the Region of Southern Denmark, Aabenraa, Denmark
| | - Erik Christiansen
- Centre for Suicide Research, Odense, Denmark
- The Research Unit in Psychiatry – Child and Adults, Psychiatry in the Region of Southern Denmark, Aabenraa, Denmark
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Lu N, Wen TJ, Huang KC. Risk of Suicide Among Patients With Major Physical Disorders Considering Comorbidities of Mental Disorders: An Instrumental Variable Analysis. OMEGA-JOURNAL OF DEATH AND DYING 2025:302228241312744. [PMID: 39754563 DOI: 10.1177/00302228241312744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
Suicide is an important health concern. Excepting cancer, the association between physical disorders and suicidal risk is comparatively less explored. Instrumental variable analysis has been suggested as a powerful technique to deal with possible bias caused by unmeasured confounders in observational research. This population-based study set out to assess the suicidal risk of patients with major physical disorders by employing the instrumental variable analysis. Data were retrieved from the National Health Insurance Research Database and the Death Certification Registry in Taiwan (years 2010-2018). The Cox proportional hazards model with an instrumental variable estimator was performed, adjusting for comorbidities of mental disorders and other covariates. Analytical results showed that compared to their counterparts, patients with major physical disorders had an elevated risk of death by suicide within one year and three years after diagnosis of physical illness. Only did epilepsy not demonstrate a statistically significant impact on the risk of suicide.
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Affiliation(s)
- Ning Lu
- Governors State University, Illinois, IL, USA
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Hammarbäck S, Wiklund Gustin L, Bremer A, Holmberg M. Navigating oneself through the eyes of the other - meanings of encountering ambulance clinicians while being in a suicidal process. Int J Qual Stud Health Well-being 2024; 19:2374751. [PMID: 38954758 PMCID: PMC11221472 DOI: 10.1080/17482631.2024.2374751] [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: 01/14/2024] [Accepted: 06/27/2024] [Indexed: 07/04/2024] Open
Abstract
PURPOSE The suicidal process contains both observable and non-observable phases, and patients have described the process as characterized by loneliness and darkness. Ambulance clinicians encounter patients in all phases of the suicidal process but little is known on what meaning this encounter has to the patients. The aim of this study was to elucidate meanings of encountering ambulance clinicians while being in a suicidal process. METHODS Data were collected through fifteen individual interviews with eight participants who had lived experiences of encountering ambulance clinicians. Inductive design using phenomenological hermeneutical approach was used. FINDINGS Patients are impacted by the clinicians, both in how they find their value in the situation, but also in expected trajectory. Three themes; 'Being impacted by representatives of society', 'Being unsure of one´s own value' and 'Regaining hope in moments of togetherness' generated the main theme ´Navigating oneself through the eyes of the other´. CONCLUSION The way ambulance clinicians communicate impacts how patients navigate themselves in the ambivalence about living or dying, and the encounter either consolidate a feeling of being a burden, or instil hope of an endurable life. Through conversation, clinicians could support the patients in taking the first steps in the journey of recovery.
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Affiliation(s)
- Staffan Hammarbäck
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Centre of Interprofessional Collaboration Within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Department of Ambulance Service, Region Sörmland, Katrineholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Lena Wiklund Gustin
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås, Sweden
- Department of Health and Care Sciences, UiT/The Arctic University of Norway, Narvik, Norway
| | - Anders Bremer
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Centre of Interprofessional Collaboration Within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
| | - Mats Holmberg
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Centre of Interprofessional Collaboration Within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Department of Ambulance Service, Region Sörmland, Katrineholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
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9
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Lutzman M, Sommerfeld E. Mental pain as a mediator in the association between avoidant attachment and suicidal ideation among older men. Aging Ment Health 2024; 28:1278-1285. [PMID: 38456825 DOI: 10.1080/13607863.2024.2323957] [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: 05/19/2023] [Accepted: 02/22/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES In the present study, our aim was to deepen the understanding of suicidality in older men by adopting a biopsychosocial approach. The study focused on older men as they face an elevated risk of suicide, surpassing not only other age groups but also exhibiting higher rates compared to women. We examined the contribution of mental pain as a mediator in the association between attachment avoidance and suicidal ideation among older men, taking into consideration the severity of their physical illnesses. METHODS Participants were 200 men in Israel, aged ≥65 years, living in the community and without cognitive impairment. Data collection was based on self-report measures of suicidal ideation (Beck Scale for Suicidal Ideation, BSSI), attachment (Experience in Close Relationships, ECR-R), mental pain (Orbach and Mikulincer Mental Pain Scale, OMMP), and the severity of physical illnesses (Cumulative Illnesses Rating Scale, CIRS). RESULTS Mental pain was found to mediate the association between attachment avoidance and suicidal ideation, but only among participants with higher levels of physical illnesses. CONCLUSIONS Mental pain should be considered as a complication of an avoidant coping strategy, which increases the risk of suicide among older men, especially those suffering from significant physical illnesses. The theoretical and clinical implications of these findings are discussed.
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Affiliation(s)
- Mira Lutzman
- Department of Psychology, Ariel University, Ariel, Israel
- Sheba Medical Center, Tel Hashomer, Israel
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10
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Passini JN, Oancea SC. A History of Heart Attack and Experiencing Frequent Mental Distress Among US Veterans and Adult Civilians: A 2019 National Level Cross-Sectional Study. Am J Lifestyle Med 2024; 18:512-526. [PMID: 39262883 PMCID: PMC11384838 DOI: 10.1177/15598276231175424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
Introduction Frequent mental distress (FMD) is poor mental health for ≥14 days in the past month. Prevalence and risk for depression and suicide are higher among US veterans (USV) than US civilians (USC). Limited research has been done among USV regarding FMD. Anyone can experience mental distress without being clinically depressed-examining FMD more broadly captures health burden of poor mental state. This study's purpose was to examine the association between having a history of heart attack (HHHA) and FMD among USV vs USC. Methods This cross-sectional study used the 2019 Behavioral Risk Factor Surveillance System (n = 274 352) data. Weighted and adjusted logistic regression models were conducted overall and by USV/USC status. Results HHHA increases weighted adjusted odds (WAO) of FMD. Among insured not obese USV with HHHA, the WAO of FMD were 1.4x significantly greater (P < .05) than among insured not obese USV without HHHA. Among uninsured obese USC with HHHA, the WAO of FMD were 3.2x significantly greater (P < .0001) than among uninsured obese USC without HHHA, and significantly lower among USV. Conclusions Study findings suggest a distinction in FMD among USV/USC with HHHA. Understanding this association can inform policy for FMD screening post-heart attack as another potential intervention to prevent/reduce suicide among USV/USC.
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Affiliation(s)
- Jessica N Passini
- Department of Population Health, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA
| | - S Cristina Oancea
- Department of Population Health, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA
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Saracino RM, Park EY, Demirjian C, Jutagir DR, McConnell KM, Schofield E, Raue PJ, Lejuez CW, Nelson CJ. Protocol for a randomized controlled trial of brief behavioral activation among older adult cancer survivors. J Geriatr Oncol 2024; 15:101719. [PMID: 38342735 PMCID: PMC11153038 DOI: 10.1016/j.jgo.2024.101719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION As many as 35% of older adult cancer survivors (OACS; i.e., ≥65 years old) have clinically significant depression. OACS often experience fatigue, mild cognitive impairment, and increased medical comorbidities post-cancer that make them susceptible to depression. Behavioral activation (BA) is an empirically supported depression treatment in geriatric psychiatry that guides individuals to reengage in pleasurable and rewarding activities and has great potential for addressing the needs of OACS. This manuscript presents the protocol for a pilot randomized controlled trial (RCT) testing the efficacy of a brief BA intervention adapted to address the needs of OACS (BBA-OACS) by telephone and videoconference delivery. MATERIALS AND METHODS An RCT will be conducted at Memorial Sloan Kettering Cancer Center (MSK) in New York City. Participants will be randomized to either BA as a target intervention or supportive psychotherapy (SP) as a standard of care control intervention for outpatient oncology. The target intervention includes 10 weekly sessions of BA consisting of psychoeducation about depression and the rationale for BA, life areas and values assessment, compilation of a list of enjoyable and important activities across values, activity scheduling, and self-monitoring of satisfaction and mood. The standard of care control intervention includes 10 weekly sessions of SP consisting of reassurance, guidance, encouragement, and support for patients with cancer. OACS who have a history of cancer, report elevated depressive symptoms, are fluent in English, and can communicate via telephone or videoconference will be recruited from the MSK Survivorship Clinics across all disease types. Seventy participants will be recruited for the study (10 training cases, 30 in each RCT arm). The primary aim is to evaluate implementation outcomes (i.e., acceptability, feasibility, and fidelity) of BA, relative to SP, for cancer survivorship. The secondary aim is to determine the preliminary effects of BA on depressive symptoms (primary outcome), anxiety, coping, and increased activity level (secondary outcomes) compared to SP. Participants will be asked to complete a set of three surveys pre- and post-intervention. DISCUSSION If successful, BBA-OACS would provide frontline clinicians with an accessible, evidence-based treatment for OACS. Future research will evaluate the efficacy of BA in a larger trial and its impact on depression and other healthcare outcomes. TRIAL REGISTRATION This study is registered under ClinicalTrials.gov (ID NCT05574127).
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Affiliation(s)
- Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Avenue, 4(th) Floor, New York, NY 10017, USA.
| | - Ellen Y Park
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Avenue, 4(th) Floor, New York, NY 10017, USA
| | - Caraline Demirjian
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Avenue, 4(th) Floor, New York, NY 10017, USA
| | - Devika R Jutagir
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Avenue, 4(th) Floor, New York, NY 10017, USA
| | - Kelly M McConnell
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Avenue, 4(th) Floor, New York, NY 10017, USA
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Avenue, 4(th) Floor, New York, NY 10017, USA
| | - Patrick J Raue
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195, USA
| | - Carl W Lejuez
- Department of Psychology, Stony Brook University, 407 Administration Building, New York, NY 11794, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Avenue, 4(th) Floor, New York, NY 10017, USA
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12
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Ramm M, Jedamzik J, Lenz P, Jürgens L, Heuft G, Conrad R. Older adults coping with critical life events - results of the revised demoralization scale in a representative sample of older adulthood. Front Psychiatry 2024; 15:1389021. [PMID: 38800056 PMCID: PMC11116776 DOI: 10.3389/fpsyt.2024.1389021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Background High suicide rates in older adults are a relevant public health concern. Social isolation or widowhood as well as physical decline play a crucial role for suicidality in older adulthood. Previous evidence suggested that demoralization is an important risk factor for suicide. Whether demoralization is a relevant phenomenon in older adulthood which possibly could account for high suicide rates remains unclear. Methods Demoralization Scale II (DS-II) scores assessed in a survey of the German general population were investigated with respect to older adults (aged ≥ 65 years). DS-II scores were compared between older (≥ 65 years) and younger (< 65 years) adulthood and between young-old (65-74y), middle-old (75-84y), and old-old (85+y) individuals. We tested the impact of sociodemographic factors on DS-II scores within older adults. Results The sample comprised N = 545 adults ≥ 65 years and N = 1922 adults < 65 years. DS-II scores increased in older compared to younger adults (F(1,2465) = 6.1; p = 0.013; d = 0.09) and further from young-old to old-old (Mdiff = 2.7; 95% CI 0.45, 5.46; p = 0.034). One-fourth of individuals ≥ 65 years and almost half of old-old individuals reported DS-II scores above the cut-off > 5. Living with a partner protected from demoralization in old-old individuals. Discussion This study provides first evidence for an increased rate of demoralization in very old adults, in particular women, which is partly related to partnership status. We suggest that demoralization is considered as a crucial entity in older adulthood which can be missed by standard psychological screenings.
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Affiliation(s)
- Markus Ramm
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Johanna Jedamzik
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Philipp Lenz
- West German Cancer Center, University Hospital Münster, Münster, Germany
- Institute of Palliative Care, University Hospital Münster, Münster, Germany
| | - Lara Jürgens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Gereon Heuft
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
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Porter AC, Carrasquillo KD, Ashrafioun L. Differences in the relation of binge drinking and prescription drug misuse to suicide ideation and attempts between college-aged adults and adults above the age of 25: Findings from the 2015-2019 National Survey on Drug Use and Health (NSDUH). J Psychiatr Res 2024; 173:281-285. [PMID: 38555675 DOI: 10.1016/j.jpsychires.2024.03.009] [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: 08/02/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To clarify the role of age in risk associated with drug misuse and binge drinking, this study examines the differential relations of binge drinking and prescription drug misuse to risk of suicidal ideation and attempts in young adults of college age (18-24) compared to those above the age of 25. METHODS We used data from the National Survey on Drug Use and Health (NSDUH) for the years 2015 through 2019 (N = 269,078). RESULTS The study found that, for adults above college age, the presence of any past-month binge drinking was associated with a higher likelihood of past-year suicide ideation (b = 0.427, OR = 1.532, 95%CI [1.388, 1.692]) and attempts (b = 0.637, OR = 1.891, 95%CI [1.271, 2.813]) compared to college-aged adults. Similarly, past-month prescription drug misuse showed stronger associations with past-year suicide ideation (b = 0.831, OR = 2.297, 95%CI [1.952, 2.701]) and attempts (b = 0.539, OR = 1.715, 95%CI [1.264, 2.327]) in adults above college age. CONCLUSION These findings highlight that binge drinking and prescription drug misuse appears to become more strongly associated with suicide ideation and attempts after adults age beyond young adulthood.
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Affiliation(s)
- Andrew C Porter
- University of Rochester, 500 Wilson Blvd, Rochester, NY, 14620, USA.
| | | | - Lisham Ashrafioun
- University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY, 14642, USA; VA Center of Excellence for Suicide Prevention, 400 Fort Hill Ave, Canandaigua, NY, 14424, USA.
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14
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Song A, Koh EJ, Lee WY, Chang S, Lim J, Choi M, Ki M. Suicide risk of chronic diseases and comorbidities: A Korean case-control study. J Affect Disord 2024; 349:431-437. [PMID: 38190857 DOI: 10.1016/j.jad.2024.01.037] [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: 09/28/2023] [Revised: 12/06/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024]
Abstract
OBJECTIVES Chronic diseases including mental disorders have been associated with suicide. This study broadens the approach by incorporating a comprehensive list of chronic diseases and a context of comorbidities and explored their associations with suicide. METHODS Data-linkage between death registry and Korean National Health Insurance data was conducted. Suicide cases (n = 64,099) between 2009 and 2013 were 1:4 matched for gender and age to an alive control (n = 256,396). A total of 92 individual diseases of 9 broad categories were identified from insurance claims data. Conditional logistic regression was applied to assess the associations, adjusting for mental and behavioral disorders and socioeconomic status. RESULTS Suicide cases frequently experienced chronic diseases (90.0 %) and comorbidities (74.6 %). Chronic diseases greatly increased suicide risk and, among these, mental and behavioral disorders showed the highest suicide risk (OR = 7.53, 95 % CI = 7.32-7.74) followed by cardiovascular (OR = 3.36, 95 % CI = 3.26-3.47). For individual diseases, gastritis and duodenitis were most prevalent (68.1 %) among suicide cases but depressive disorder showed the highest risk (OR = 4.95, 95 % CI = 4.79-5.12). Suicide risk was strong in comorbid status sometimes comparable to odds for mental and behavioral disorder alone (e.g., OR for cardiovascular and eye vision-related diseases = 4.01, 95 % CI = 3.86-4.17). LIMITATIONS Differentiation of comorbidity was limited to pairs between major disease categories, neglecting the heterogeneity within categories. CONCLUSION Chronic diseases, in particular comorbidity, showed strong associations with suicide. This suggests that those with comorbidities feel that they are pushed to the extreme line, supporting comprehensive interventions for them to address wider reasons including psychological and social problems, besides medical problems.
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Affiliation(s)
- Areum Song
- Program in Public Health, Graduate School, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Emily Jiali Koh
- Program in Public Health, Graduate School, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Weon-Young Lee
- Department of Preventive Medicine, Chung-Ang University College of Medicine, 84 Heukseok-Ro, Dongjak-Gu, Seoul 156-756, Republic of Korea
| | - Shusen Chang
- Department of Public Health, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Zhongzheng Dist., Taipei, Taiwan
| | - Jiseun Lim
- Department of Preventive Medicine, Eulji University, 77 Gyeryong-ro 771beon-gil, Yongdu-dong, Jung-gu, Daejeon, Republic of Korea
| | - Minjae Choi
- Department of Preventive Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Myung Ki
- Program in Public Health, Graduate School, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea; Department of Preventive Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea; BK21FOUR R&E Center for Learning Health Systems, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul, Republic of Korea.
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15
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Liu L, Xiao Y, Wei D, Wang Q, Zhang JK, Yuan L, Bai GQ. Development and validation of a nomogram for predicting suicide risk and prognostic factors in bladder cancer patients following diagnosis: A population-based retrospective study. J Affect Disord 2024; 347:124-133. [PMID: 38000463 DOI: 10.1016/j.jad.2023.11.086] [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: 06/07/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 11/26/2023]
Abstract
This study sought to identify independent risk factors associated with suicide following a diagnosis of bladder cancer and to develop a predictive model with the potential to contribute to suicide rate reduction. Harnessing data from the Surveillance, Epidemiology, and End Results (SEER) database, we identified bladder cancer patients diagnosed between 2004 and 2015, randomly assigning them to training and validation cohorts. The Cox proportional hazard model was employed to identify relevant predictors, leading to the construction of prediction nomogram models. Validation of prognostic nomograms involved assessing the consistency index (C-index), receiver operating characteristic (ROC) curve, and calibration curve. A total of 109,961 eligible bladder cancer patients were enrolled, randomly divided into training and validation sets. Multivariate Cox regression analysis revealed that sex, marital status, tumor local status (T Stage), and lymph node metastatic conditions (N Stage) were independent predictors for suicide in bladder cancer patients. Evaluation of the nomogram's accuracy through the C-index and ROC curve demonstrated acceptable performance in both training and validation sets. Moreover, the calibration plot indicated moderate accuracy of the nomogram in both datasets. Overall, this study successfully identified risk factors for suicide among bladder cancer patients and developed a nomogram, offering individualized diagnosis, intervention, and risk assessment to mitigate the risk of suicide in this patient population.
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Affiliation(s)
- Liang Liu
- Department of Urology, Baoding No.1 Central Hospital, Baoding 071000, Hebei, China; Prostate & Andrology Key Laboratory of Baoding, Baoding 071000, Hebei, China.
| | - Yu Xiao
- Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu 610036, Sichuan, China; Psychosomatic Medical Center, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 610036, Sichuan, China
| | - Dong Wei
- Department of Surgery and Urology, Hebei General Hospital, Shijiazhuang 050051, China
| | - Qiang Wang
- Department of Urology, Baoding No.1 Central Hospital, Baoding 071000, Hebei, China; Prostate & Andrology Key Laboratory of Baoding, Baoding 071000, Hebei, China
| | - Jin-Ku Zhang
- Department of Pathology, Baoding No.1 Central Hospital, Baoding 071000, Hebei, China
| | - Lei Yuan
- Department of Urology, Baoding No.1 Central Hospital, Baoding 071000, Hebei, China
| | - Gui-Qing Bai
- Department of Urology, Baoding No.1 Central Hospital, Baoding 071000, Hebei, China
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16
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Mai AS, Chao Y, Xiao B, Zhou Z, Yong JH, Lee ARYB, Tan EK. Risk of Suicidal Ideation and Behavior in Individuals With Parkinson Disease: A Systematic Review and Meta-Analysis. JAMA Neurol 2024; 81:10-18. [PMID: 37955917 PMCID: PMC10644251 DOI: 10.1001/jamaneurol.2023.4207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/08/2023] [Indexed: 11/14/2023]
Abstract
Importance Suicide risk may be increased in patients with Parkinson disease (PD), a common neurodegenerative condition. Mood disorders, especially depression, are prevalent in patients with PD who report suicidality. Objective To address inconsistent results from studies of suicidal ideation and behavior in patients with PD. Data Sources The study team searched MEDLINE and Embase from inception to June 14, 2023, and further screened the bibliographies of relevant studies to ensure a comprehensive search. Study Selection Original studies, published in English, discussing either suicidal ideation, behavior, or both in adults with PD were included. Accepted study designs included cross-sectional, case-control, and cohort studies. Studies that only included patients with PD after deep brain stimulation were excluded. Data Extraction and Synthesis This meta-analysis was conducted in line with the PRISMA guidelines. Two authors reviewed each study and extracted the data independently, with discrepancies referred to a third independent author. Main Outcomes and Measures Outcomes included the prevalence of suicidal ideation and behavior, measured as proportions, and the risk of suicidal behavior in patients with PD relative to controls, measured in both odds ratio (OR) and hazards ratio (HR). Results A total of 28 studies comprising 505 950 PD patients were included in the final analysis. The prevalence of suicidal ideation was evaluated in 14 studies (22.2%; 95% CI, 14.6-32.3) and suicidal behavior in 21 studies (1.25%; 95% CI, 0.64-2.41). Excluding 4 outliers, prevalence of suicidal behavior was significantly higher in prospective studies (1.75%; 95% CI, 1.03-2.95) than retrospective studies (0.50%; 95% CI, 0.24-1.01). Excluding 1 outlier, OR of suicidal behavior was pooled across 10 studies and significant (OR, 2.15; 95% CI, 1.22-3.78; P = .01). HR of suicidal behavior was assessed in 9 studies (HR, 1.73; 95% CI, 1.40-2.14; P < .001). Conclusions and Relevance This meta-analysis involving more than 500 000 patients with PD found 22.2% and 1.25% of patients with PD to have suicidal ideation and behavior, respectively. Patients with PD had 2 times the risk of suicidal behavior than controls. Early recognition and management of suicidality in PD can help reduce mortality.
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Affiliation(s)
- Aaron Shengting Mai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yinxia Chao
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
| | - Bin Xiao
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
| | - Zhidong Zhou
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
| | - Jung Hahn Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Eng-King Tan
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
- Neuroscience and Behavioral Disorders, Duke-NUS Medical School, Singapore
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MacDonald C, Caimino C, Burns-O’Connell G, Hartley D, Lockwood J, Sereda M, Whitmer W, Cima R, Turton L, Hoare DJ. Tinnitus, Suicide, and Suicidal Ideation: A Scoping Review of Primary Research. Brain Sci 2023; 13:1496. [PMID: 37891863 PMCID: PMC10605905 DOI: 10.3390/brainsci13101496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Tinnitus (the perception of sound in the absence of any corresponding external source) is highly prevalent and can be distressing. There are unanswered questions about how tinnitus, suicidal thoughts, and suicidal behaviours co-occur and interact. To establish the extent of scientific literature, this scoping review catalogued primary reports addressing the associations between tinnitus, suicidal ideation, attempted suicide, and death by suicide. We searched OvidSP, Medline, EMBASE, PsycINFO, CINAHL, Google Scholar, EThoS, and ProQuest for all studies and case reports on ideation and/or attempted and/or completed suicide in the context of tinnitus. Twenty-three studies were included, and data were charted according to study type. Several epidemiological and other observational studies gave evidence of risk factors and an association between suicidal ideation, suicidal behaviour, and tinnitus. However, there was no evidence of the direction of causality. Qualitative studies are indicated to explore the patient's experience and understand the dynamics of any interaction between tinnitus and suicidal thoughts and behaviours. A theory-informed model of tinnitus and suicide needs to be developed to inform the development of interventions and how tinnitus patients are supported clinically.
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Affiliation(s)
- Carol MacDonald
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK (D.J.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Department of Psychology, University of Stirling, Stirling FK9 4LA, UK
| | | | | | - Douglas Hartley
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK (D.J.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - Joanna Lockwood
- NIHR MindTech MedTech Co-Operative, Institute of Mental Health, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK;
| | - Magdalena Sereda
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK (D.J.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - William Whitmer
- Hearing Sciences: Scottish Section, Glasgow, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK;
| | - Rilana Cima
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven University, 3000 Leuven, Belgium;
- Tinnitus Center of Expertise, Centre of Expertise in Rehabilitation and Audiology, Adelante, 6432 CC Hoensbroek, The Netherlands
- Experimental Health Psychology, Faculty of Psychology and Neurosciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | | | - Derek J. Hoare
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK (D.J.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
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Manning FM, Mughal F, Ismail HASM, Baines LM, Chew-Graham CA, Paskins Z, Prior JA. Osteoporosis and fracture as risk factors for self-harm and suicide: a systematic review and meta-analysis. Br J Gen Pract 2023; 73:e735-e743. [PMID: 37722857 PMCID: PMC10523335 DOI: 10.3399/bjgp.2023.0035] [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] [Received: 01/16/2023] [Accepted: 07/03/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Increase in presentations of self-harm to primary care, a risk factor of suicide, has led to a growing interest in identifying at-risk populations. AIM To examine whether osteoporosis or fractures are risk factors for self-harm, suicidal ideation, and suicide. DESIGN AND SETTING This was a systematic review of observational studies in adults (>18 years) that had examined the role of osteoporosis and/or fractures in subsequent self-harm, suicidal ideation, and/or suicide. METHOD Six databases were searched from inception to July 2019. Additional citation tracking of eligible studies was undertaken in November 2022. Screening, data extraction, and quality assessment of full-text articles were performed independently by at least two authors. Where possible, meta-analysis was run on comparable risk estimates. RESULTS Fifteen studies were included: two examined the outcome of self-harm, three suicidal ideation, and 10 suicide. In approximately half of studies on osteoporosis, the risk of suicidal ideation and suicide remained significant. However, pooling of adjusted odds ratios from three studies indicated no association between osteoporosis and suicide (1.14, 95% confidence interval = 0.88 to 1.49). Nine studies examined the risk of a mixture of fracture types across different outcomes, limiting comparisons. However, all studies examining vertebral fracture (n = 3) reported a significant adjusted negative association for self-harm and suicide. CONCLUSION Patients with vertebral fractures, a risk potential factor for suicide, may benefit from clinical case finding for mood disorders with personalised primary care management. However, because of the limited number and quality of studies and mixed findings, further examination of these associations is warranted.
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Affiliation(s)
- Fay M Manning
- School of Medicine, Keele University, Keele, and Department of Medical Imaging, University of Exeter, Exeter, UK
| | - Faraz Mughal
- School of Medicine, Keele University, Keele; Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, Manchester; and honorary clinical research fellow, Warwick Medical School, Warwick, UK
| | | | | | | | - Zoe Paskins
- Keele University, Keele, and Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stoke-on-Trent, UK
| | - James A Prior
- School of Medicine, Keele University, Keele, and Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stoke-on-Trent, UK
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Hammarbäck S. Ambulance clinicians' responsibility when encountering patients in a suicidal process. Nurs Ethics 2023; 30:857-870. [PMID: 37026403 PMCID: PMC10637079 DOI: 10.1177/09697330221149102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Even though the traditional focus in emergency care is on life-threatening medical crisis, ambulance clinicians frequently encounter patients with mental illness, including suicidal ideation. A suicide is preceded by a complex process where most of the suicidal ideation is invisible to others. However, as most patients seek healthcare in the year before suicide, ambulance clinicians could have an important part to play in preventing suicide, as they encounter patients in different phases of the suicidal process. AIM The aim of this study was to describe ambulance clinicians' conceptions of responsibility when encountering patients in a suicidal process. RESEARCH DESIGN A qualitative inductive design using a phenomenographic approach was used. PARTICIPANTS AND RESEARCH CONTEXT Twenty-seven ambulance clinicians from two regions in southern Sweden were interviewed. ETHICAL CONSIDERATIONS The study was approved by the Swedish Ethical Review Authority. FINDINGS Three categories of descriptions captured a movement from responding to a biological being to responding to a social being. Conventional responsibility was perceived as a primary responsibility for emergency care. In conditional responsibility, the patient's mental illness was given only limited importance and only if certain conditions were met. Ethical responsibility was perceived to have its primary focus on the encounter with the patient and listening to the patient's life story. CONCLUSIONS An ethical responsibility is favourable regarding suicide prevention in ambulance care, and competence development in mental illness and conversation skills could enable ambulance clinicians to have conversations with patients about suicidal ideation.
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Affiliation(s)
- Staffan Hammarbäck
- Staffan Hammarbäck, Department of Health and Caring Sciences, Linnaeus University, 1245, hus K, Växjö 35195, Sweden.
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Hedna K, Jonson M, Sigström R, Åberg M, Wilhelmson K, Waern M. Healthcare visits for mental disorders and use of psychotropic medications before and after self-harm in a cohort aged 75. Aging Ment Health 2023; 27:2052-2060. [PMID: 36803189 DOI: 10.1080/13607863.2023.2179974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/05/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Non-fatal self-harm (SH) is a major risk factor for late-life suicide. A better knowledge of the clinical management of older adults who self-harm is needed to establish where improvements could be made for the implementation of effective suicide prevention interventions. We therefore assessed contacts with primary and specialised care for mental disorders and psychotropic drug use during the year before and after a late-life non-fatal SH episode. METHOD Longitudinal population-based study in adults aged ≥75 years with SH episode between 2007 and 2015 retrieved from the regional database VEGA. Healthcare contacts for mental disorders and psychotropic use were assessed during the year before and after the index SH episode. RESULTS There were 659 older adults who self-harmed. During the year before SH, 33.7% had primary care contacts with a mental disorder, 27.8% had such contacts in specialised care. Use of specialised care increased sharply after the SH, reaching a maximum of 68.9%, but this figure dropped to 19.5% by the end of the year. Use of antidepressants increased from 41% before to 60% after the SH episode. Use of hypnotics was extensive before and after SH (60%). Psychotherapy was rare in both primary and specialised care. CONCLUSION The use of specialised care for mental disorders and antidepressant prescribing increased after SH. The drop in long-term healthcare visits should be further explored to align primary and specialised healthcare to the needs of older adults who self-harmed. The psychosocial support of older adults with common mental disorders needs to be strengthened.
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Affiliation(s)
- Khedidja Hedna
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Statistikkonsulterna AB, Gothenburg, Sweden
| | - Mattias Jonson
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Affective Clinic, Gothenburg, Sweden
| | - Robert Sigström
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Cognition and Old Age Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Åberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Regionhälsan, Gothenburg, Sweden
| | - Katarina Wilhelmson
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margda Waern
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
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21
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Choi NG, Choi BY, Marti CN. Physical Health Problems as a Suicide Precipitant: Associations With Other Risk Factors and Suicide Methods in Three Age Groups of Older Decedents. Innov Aging 2023; 7:igad073. [PMID: 37554949 PMCID: PMC10406434 DOI: 10.1093/geroni/igad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Indexed: 08/10/2023] Open
Abstract
Background and Objectives Physical health problems are a significant late-life suicide precipitant. This study's purpose was to examine differences in (i) other suicide precipitants and psychiatric/substance use problems, and (ii) suicide methods (firearms, hanging/suffocation, and poisoning) in 3 age groups (55-64, 65-74, and 75+) of older suicide decedents who had physical health problems as a suicide precipitant. Research Design and Methods Data came from the 2017-2019 U.S. National Violent Death Reporting System (N = 34,912; 27,761 males [79.5%] and 7,151 females [20.5%]). Generalized linear models for a Poisson distribution with a log link were used to examine the study questions. Results Physical health problems were a suicide precipitant for 25.8%, 41.9%, and 57.7% of the 55-64, 65-74, and 75+ age groups, respectively, and were associated with a higher likelihood of having had depressed mood (IRR = 1.38, 95% CI: 1.33-1.43) and other substance use problems (IRR = 1.22, 95% CI: 1.13-1.31). Interaction effects showed that when job/finance/housing problems, depressed mood, or any psychiatric disorders were co-present with physical health problems, the age group differences in the predicted rates of physical health problems were diminished. Physical health problems were also positively associated with firearm and poisoning use, but negatively associated with hanging/suffocation. Interaction effects indicated that the predicted rates of firearm and poisoning use significantly increased among those aged 55-64 with than without physical health problems. Discussion and Implications In all 3 age groups of older suicide decedents, physical health problems were the predominant suicide precipitant, and those with physical health problems had elevated depressed mood. Assessment of suicide risk, affordable and accessible health, and mental health services, restriction of access to lethal suicide methods, and policy-based suicide prevention approaches for older adults with physical health problems are needed.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
- Department of Emergency Medicine, BayHealth, Dover, Delware, USA
| | - C Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
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22
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Potter AL, Haridas C, Neumann K, Kiang MV, Fong ZV, Riddell CA, Pope HG, Yang CFJ. Incidence, Timing, and Factors Associated With Suicide Among Patients Undergoing Surgery for Cancer in the US. JAMA Oncol 2023; 9:308-315. [PMID: 36633854 PMCID: PMC9857808 DOI: 10.1001/jamaoncol.2022.6549] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/22/2022] [Indexed: 01/13/2023]
Abstract
Importance The risk and timing of suicide among patients who undergo surgery for cancer remain largely unknown, and, to our knowledge, there are currently no organized programs in place to implement regular suicide screening among this patient population. Objective To evaluate the incidence, timing, and factors associated with suicide among patients undergoing cancer operations. Design, Setting, and Participants This retrospective population-based cohort study used data from the Surveillance, Epidemiology, and End Results Program database to examine the incidence of suicide, compared with the general US population, and timing of suicide among patients undergoing surgery for the 15 deadliest cancers in the US from 2000 to 2016. A Fine-Gray competing risks regression model was used to identify factors associated with an increased risk of suicide among patients in the cohort. Data were analyzed from September 2021 to January 2022. Exposures Surgery for cancer. Main Outcomes and Measures Incidence, compared with the general US population, timing, and factors associated with suicide after surgery for cancer. Results From 2000 to 2016, 1 811 397 patients (74.4% female; median [IQR] age, 62.0 [52.0-72.0] years) met study inclusion criteria. Of these patients, 1494 (0.08%) committed suicide after undergoing surgery for cancer. The incidence of suicide, compared with the general US population, was statistically significantly higher among patients undergoing surgery for cancers of the larynx (standardized mortality ratio [SMR], 4.02; 95% CI, 2.67-5.81), oral cavity and pharynx (SMR, 2.43; 95% CI, 1.93-3.03), esophagus (SMR, 2.25; 95% CI, 1.43-3.38), bladder (SMR, 2.09; 95% CI, 1.53-2.78), pancreas (SMR, 2.08; 95% CI, 1.29-3.19), lung (SMR, 1.73; 95% CI, 1.47-2.02), stomach (SMR, 1.70; 95% CI, 1.22-2.31), ovary (SMR, 1.64; 95% CI, 1.13-2.31), brain (SMR, 1.61; 95% CI, 1.12-2.26), and colon and rectum (SMR, 1.28; 95% CI, 1.16-1.40). Approximately 3%, 21%, and 50% of suicides were committed within the first month, first year, and first 3 years after surgery, respectively. Patients who were male, White, and divorced or single were at greatest risk of suicide. Conclusions and Relevance In this cohort study, the incidence of suicide among patients undergoing cancer operations was statistically significantly elevated compared with the general population, highlighting the need for programs to actively implement regular suicide screening among such patients, especially those whose demographic and tumor characteristics are associated with the highest suicide risk.
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Affiliation(s)
- Alexandra L. Potter
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston
| | - Chinmay Haridas
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston
| | - Krista Neumann
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - Zhi Ven Fong
- Department of Surgery, Massachusetts General Hospital, Boston
| | - Corinne A. Riddell
- Division of Epidemiology, School of Public Health, University of California, Berkeley
- Division of Biostatistics, School of Public Health, University of California, Berkeley
| | - Harrison G. Pope
- Biological Psychiatry Laboratory and Psychiatric Epidemiology Research Program, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston
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23
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Adviento BA, Regan EA, Make BJ, Han MK, Foreman MG, Iyer AS, Bhatt SP, Kim V, Bon J, Soler X, Kinney GL, Hanania NA, Lowe KE, Holm KE, Yohannes AM, Shinozaki G, Hoth KF, Fiedorowicz JG. Clinical Markers Associated With Risk of Suicide or Drug Overdose Among Individuals With Smoking Exposure: A Longitudinal Follow-up Study of the COPDGene Cohort. Chest 2023; 163:292-302. [PMID: 36167120 PMCID: PMC10083129 DOI: 10.1016/j.chest.2022.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/11/2022] [Accepted: 09/03/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Studies have shown that COPD and smoking are associated with increased suicide risk. To date, there are no prospective studies examining suicide risk among individuals with smoking exposure along a spectrum of pulmonary diseases ranging from normal spirometry to severe COPD. RESEARCH QUESTION Which clinical variables predict death by suicide or overdose of indeterminate intent in a large cohort of individuals with smoking exposure within the Genetic Epidemiology of COPD (COPDGene) study? STUDY DESIGN AND METHODS We studied data from 9,930 participants involved in COPDGene, a multisite, prospective cohort study of individuals with smoking exposure. Primary cause of adjudicated deaths was identified by using death certificates, family reports, and medical records. Time to death by suicide/overdose was examined as the primary outcome in Cox regression models including age, sex, race, BMI, pack-years, current smoking status, airflow limitation (FEV1 % predicted), dyspnea (modified Medical Research Council scale score ≥ 2), 6-min walk distance, supplemental oxygen use, and severe exacerbations in the prior year with time-varying covariates and other causes of death as a competing risk. RESULTS The cohort was 47% female and 33% Black (67% White); they had a mean ± SD age of 59.6 ± 9.0 years and a mean FEV1 % predicted of 76.1 ± 25.5. Sixty-three individuals died by suicide/overdose. Factors associated with risk of suicide/overdose were current smoking (hazard ratio [HR], 6.44; 95% CI, 2.64-15.67), use of sedative/hypnotics (HR, 2.33; 95% CI, 1.24-4.38), and dyspnea (HR, 2.23; 95% CI, 1.34-3.70). Lower risk was associated with older age (per-decade HR, 0.45; 95% CI, 0.31-0.67), higher BMI (HR, 0.95; 95% CI, 0.91-0.99), and African-American race (HR, 0.41; 95% CI, 0.23-0.74). Severity of airflow limitation (FEV % predicted) was not associated with suicide risk. INTERPRETATION In this well-characterized cohort of individuals with smoking exposure with and without COPD, risk factors for suicide/overdose were identified that emphasize the subjective experience of illness over objective assessments of lung function.
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Affiliation(s)
- Brigid A Adviento
- Department of Psychiatry, University of Iowa, Iowa City, IA; Department of Internal Medicine, University of Iowa, Iowa City, IA
| | - Elizabeth A Regan
- Division of Rheumatology, Department of Medicine, National Jewish Health, Denver, CO
| | - Barry J Make
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO; Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Marilyn G Foreman
- Pulmonary and Critical Care Medicine Division, Morehouse School of Medicine, Atlanta, GA
| | - Anand S Iyer
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Jessica Bon
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Xavier Soler
- Department of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX
| | - Katherine E Lowe
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Kristen E Holm
- Division of Neurology and Behavioral Health, National Jewish Health, Denver, CO; Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado, Aurora, CO
| | | | - Gen Shinozaki
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa, Iowa City, IA; Iowa Neuroscience Institute, University of Iowa, Iowa City, IA.
| | - Jess G Fiedorowicz
- Ottawa Hospital, Ottawa Hospital Research Institute, and University of Ottawa, Ottawa, Ontario, Canada
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24
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Thiruvalluru RK, Edgcomb JB, Brooks JO, Pathak J. Risk of suicide attempts and self-harm after 1.4 million general medical hospitalizations of men with mental illness. J Psychiatr Res 2023; 157:50-56. [PMID: 36436428 PMCID: PMC10395648 DOI: 10.1016/j.jpsychires.2022.10.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/17/2022] [Accepted: 10/17/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The short-term risk of suicide after medical hospital discharge is four times higher among men compared with women. As previous work has identified female-specific antecedents of suicide-related behavior after medical hospitalization of women with serious mental illness, we examined predictors among a similar population of men with multimorbidity. METHODS Classification and regression tree (CART) models were developed and validated using electronic health records (EHRs) from 1,423,161 medical (non-psychiatric) hospitalizations of men ≥ 18-years-old with an existing diagnosis of a depressive disorder, bipolar disorder, or chronic psychosis. Hospitalizations occurred between 2009 and 2017. Risk groups were evaluated using an independent testing set. The primary outcome was readmission within one year associated with ICD-9 or -10 code for self-harm or attempt. RESULTS The 1-year readmission rate for intentional self-harm and suicide attempt was 3.9% (55,337/1,423,161 hospitalizations). The classification model discriminated risk with area under the curve (AUC) 0.73 (Confidence Interval [95%CI] 0.68-0.74), accuracy 0.82 (95%CI 0.71-0.83), sensitivity 82.6% (95%CI 81.2-84), and specificity 83.1% (95%CI 81.7-84.5). Strongest predictors were medical comorbidity, prior self-harm, age, and prior hospitalization. Men with greater medical comorbidity burden and prior self-harm were at highest risk (Odds Ratio [OR] 3.10, 95%CI 3.02-3.18), as were men < 62-years-old with few medical comorbidities (OR 1.11 95%CI 1.08-1.13). LIMITATIONS The study focused on medical hospitalizations for suicide attempt and thus captured only severe attempts resulting in hospitalization. CONCLUSIONS After medical hospitalization, men with serious mental illness experienced a high risk of self-harm (1:25 hospitalizations). Risk was particularly elevated among younger patients without prior medical conditions and older patients with medical comorbidity and prior self-harm.
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Affiliation(s)
- Rohith Kumar Thiruvalluru
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, 402 E. 67th St., New York, NY, 10065, USA
| | - Juliet Beni Edgcomb
- UCLA-Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, 760 Westwood Plz, Los Angeles, CA, 90095, USA.
| | - John O Brooks
- UCLA-Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, 760 Westwood Plz, Los Angeles, CA, 90095, USA
| | - Jyotishman Pathak
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, 402 E. 67th St., New York, NY, 10065, USA
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25
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Conwell Y. "My Work is Done. Why Wait?" Lessons Learned from Older Adults Who Died by Suicide. Am J Geriatr Psychiatry 2022; 30:1339-1341. [PMID: 36210263 DOI: 10.1016/j.jagp.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 01/25/2023]
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26
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Marlow NM, Xie Z, Tanner R, Jacobs M, Hogan MK, Joiner TE, Kirby AV. Association between functional disability type and suicide-related outcomes among U.S. adults with disabilities in the National Survey on Drug Use and Health, 2015-2019. J Psychiatr Res 2022; 153:213-222. [PMID: 35841817 PMCID: PMC9811968 DOI: 10.1016/j.jpsychires.2022.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/26/2022] [Accepted: 07/02/2022] [Indexed: 01/07/2023]
Abstract
While research on suicidal behavior for people with disability (PWD) suggests they experience higher risk than people without disability, less is known about variations among individuals with different disability types. This nationally representative, cross-sectional study compared differences in suicide-related outcomes (ideation, planning, attempts) among PWD by functional disability type (hearing, vision, cognitive, mobility, complex activity) and number. Secondary analysis of adult PWD in the 2015-2019 National Survey on Drug Use and Health (unweighted N = 35,544; representing 47,723,378 PWD, weighted) was used to estimate relationships between suicide-related outcomes and disability type and number. Most respondents were female (55.9%), and 36.0% were aged ≥65 years. Adjusted odds ratios (AORs) from multivariable logistic regression indicated that suicidal ideation and suicide attempt, respectively, were significantly more likely among individuals with cognitive (AOR = 1.71, 95% CI = 1.24-2.35; AOR = 2.54, 95% CI = 1.31-4.91), complex activity (AOR = 1.96, 95% CI = 1.37-2.81; AOR = 2.67, 95% CI = 1.32-5.41), and ≥2 limitations (AOR = 2.02, 95% CI = 1.52-2.69; AOR = 3.46, 95% CI = 1.84-6.50) than hearing limitation. Also, relative to other disability types, suicide-related outcomes were significantly more likely among individuals with cognitive limitation and complex activity limitation (p < 0.001). Additionally, suicide-related outcomes elevated in likelihood as the number of limitations increased, with the largest associations among those with ≥5 limitations for suicidal ideation (AOR = 2.31, 95% CI = 1.46-3.66), suicide planning (AOR = 3.34, 95% CI = 1.97-5.68), and suicide attempt (AOR = 6.37, 95% CI = 3.76-10.79). Subgroup analyses showed that presence of cognitive limitation and multiple limitations differentiated between suicidal ideators and suicide attempters. Further research is needed to identify causes of these risks and develop suicide prevention efforts for these particularly vulnerable groups.
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Affiliation(s)
- Nicole M Marlow
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.
| | - Zhigang Xie
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Rebecca Tanner
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Molly Jacobs
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Michaela K Hogan
- Department of Family, Community and Health Systems Science, University of Florida, Gainesville, FL, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Anne V Kirby
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, USA
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27
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Kim E, Yi JS. Factors Related to Suicidal Ideation and Prediction of High-Risk Groups among Youngest-Old Adults in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10028. [PMID: 36011664 PMCID: PMC9408520 DOI: 10.3390/ijerph191610028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
(1) Background: The suicide of older adults shows different factors between the youngest-old adults and the old-old adults. This study aimed to identify factors predicting suicidal ideation among youngest-old adults (ages 65 to 74 years) and predict high-risk groups’ characteristics. (2) Methods: The subjects of this study were 970 youngest-old adults who participated in the Korean National Health and Nutrition Examination Survey (KNHANES VIII Year 1, 2019). Logistic regression analysis identified factors related to suicidal ideation, and decision tree analysis identified combined characteristics among high-risk groups. Data were analyzed using SPSS 27.0. (3) Results: Suicidal ideation became more common among those with relatively lower income levels (OR = 1.48, 95% CI = 1.04−2.12), those whom had experienced depression (OR = 9.28, 95% CI = 4.57−18.84), those with relatively higher stress levels (OR = 2.42, 95% CI = 1.11−5.28), and those reporting a relatively worse perceived health (OR = 1.88, 95% CI = 1.23−3.11). Complex characteristics that combined depression, low personal income level, and low perceived health predicted a high risk of suicidal ideation (64.6%, p < 0.05). (4) Conclusions: The findings indicate that this high-risk group should be prioritized when developing suicide prevention strategies.
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Affiliation(s)
- Eungyung Kim
- Department of Nursing, Chungbuk National University, Cheongju 28644, Korea
| | - Jee-Seon Yi
- College of Nursing, Gyeongsang National University, Jinju 52727, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju 52727, Korea
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28
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Tang WK, Tsoi KKF, Chung CP, Kim JS. Risk of self-harm in post TIA patients: A population-based cohort study. J Psychosom Res 2022; 159:110937. [PMID: 35605442 DOI: 10.1016/j.jpsychores.2022.110937] [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] [Received: 11/22/2021] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether individuals who have experienced a transient ischemic attack (TIA) have an increased risk of self-harm behaviors. METHODS In this matched cohort study, we reviewed the electronic health records of all patients admitted for any reason to Hong Kong public hospitals between January 1, 1993, and December 31, 2019. We selected a post-TIA cohort consisting of 37,356 patients and a comparison cohort comprising 37,352 subjects. All participants enrolled in this study were followed up until a diagnosis of self-harm, death from other causes, or the end of 2020, whichever occurred first. Univariate Cox proportional hazards regression models were used to calculate the risk of self-harm since the onset of TIA. RESULTS Throughout the 27-year study period, the number of individuals exhibiting self-harm behavior in the TIA and comparison groups was 1031 (2.76%) and 512 (1.37%), respectively. The TIA group had a higher proportion of subjects with self-harm (χ2 = 178, p < .001). The incidence rates of self-harm were 33.94 and 19.27 per 10,000 person-years in TIA patients and comparators, respectively. Compared with the comparators, the adjusted hazard ratio for self-harm in TIA patients was 1.63 (95% confidence interval, 1.46-1.82). CONCLUSIONS TIA is associated with an increased risk of self-harm. Healthcare professionals should help identify patients at heightened risk and provide efficient and targeted prevention strategies for this population.
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Affiliation(s)
- Wai Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - Kelvin K F Tsoi
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, SAR, China; Stanley Ho Big Data Decision Analytics Research Centre, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Chih-Ping Chung
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; College of Medicine, National Yang Ming Chiao Tung University, Hsin-Chu, Taiwan
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
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29
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Kim S, Jeon H, Park J. The Association of Physical and Mental Illness and Self-Harm Resulting in Hospitalization: A Population-Based Study of Older Adults in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148303. [PMID: 35886166 PMCID: PMC9319923 DOI: 10.3390/ijerph19148303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/22/2022] [Accepted: 07/03/2022] [Indexed: 02/06/2023]
Abstract
Self-harm injury among older adults is a pressing problem that demands social attention in South Korea. This study sought to identify the association between physical and mental illness and hospitalization following self-harm injuries, compared to non-self-harm injuries, among older adults living in Korea. We analyzed individuals aged 65 and older who were admitted to hospitals either for self-harm or non-self-harm from a population-based survey of the Korea National Hospital Discharge In-depth Injury Survey (KNHDIS). A logistic regression analysis was performed. Compared with non-self-harm-related hospitalization, self-harm hospitalization was associated with higher odds of depression, other disorders of the nervous system, malignancies, alcohol misuse and dependence, and drug-related dependence. Dementia, anxiety disorder, diabetes, arthritis, cerebral palsy, and other paralytic syndromes had a lower likelihood of leading to self-harm than non-self-harm hospitalization. The findings of this study can inform medical professionals to identify older adults with a heightened risk of self-harming behavior leading to hospitalization.
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Affiliation(s)
- Sangmi Kim
- Department of Health Management, Jeonju University, Jeonju-si 55069, Korea;
| | - Haesang Jeon
- Department of Social Welfare, Jeonju University, Jeonju-si 55069, Korea
- Correspondence:
| | - Joonhyeog Park
- Department of Social Welfare, Seoul National University, Seoul 08826, Korea;
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30
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A scoping review exploring the ‘grey area’ of suicide-related expression in later life: Developing a conceptual framework for professional engagement. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
As the body of research on suicide in later life has developed, so has its vocabulary. This has generated a high level of overlap in concepts and terminology used to articulate suicide and how it might present, as well as ‘grey area’ behavioural terms that are both specific to older adults and less well-defined (e.g. ‘hastening of death’ or ‘completed life’). A better understanding of individual experiences and pathways to suicide can help to inform assessment and interventions, and increase the potential to relate any theoretical concepts to the implementation of such. Here, we adopted a scoping review to search systematically literature on specific presentation, features, circumstances and outcomes of these grey areas of suicide in later life. Fifty-three articles (quantitative, qualitative and theoretical) were reviewed. A narrative approach was used to merge and translate this body of knowledge into a new conceptual framework based on four key themes: (a) a sense of completed life or existential loneliness; (b) death thoughts, wishes and ideation; (c) death-hastening behaviour and advanced directives; and (d) self-destructive or self-injurious behaviour. We discuss the importance of integrating this understanding into current knowledge and suicide prevention strategies for older adults. Recommendations are made for unifying research with policy themes on healthy ageing, person-centredness within service provision and citizen participation.
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Park J, Lee O, McKee M. Association between hearing loss and suicidal ideation among middle-aged and older adults. Aging Ment Health 2022; 26:1287-1294. [PMID: 33979563 DOI: 10.1080/13607863.2021.1919991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Hearing loss (HL) is regarded as a major risk factor for late-life depression. This study aims to further examine the association between HL and suicidal ideation (SI) among middle-aged and older adults using a nationally representative sample. METHOD The study sample comprised 34,142 adults (aged 50+) drawn from the 2015 to 2018 National Survey on Drug Use and Health. SI was measured by response to the question, 'At any time in the past year, did you seriously think about trying to kill yourself?' HL was assessed by asking respondents whether they were deaf or had serious difficulty hearing. Multivariate logistic regression analyses were conducted to examine the association between HL and SI after adjusting for a comprehensive list of covariates. RESULTS Compared to those without HL, middle-aged and older adults with HL experienced significant health disparities regarding history of hospitalization, poor perceived health, higher prevalence of chronic diseases, depression, substance use, and SI. HL was positively associated with SI in the past year in both middle-aged (aOR = 1.59, 95% CI [1.14, 2.21], p < .001) and older adult groups (aOR = 1.58, 95% CI [1.07, 2.33], p < .001), controlling for depression, substance use, health status, and sociodemographic variables. CONCLUSION Given the high prevalence of hearing loss (HL) in aging populations, this study aimed to expand our knowledge of the relative strength of association between HL and SI. Findings implied that healthcare providers should consider screening for SI in those with HL.
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Affiliation(s)
- Junghyun Park
- Silver School of Social Work, New York University, New York, NY, USA
| | - Othelia Lee
- School of Social Work, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Michael McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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Yoo JI, Cha Y, Kim JT, Park CH, Choy W, Koo KH. Orthopedic Patients with Mental Disorder: Literature Review on Preoperative and Postoperative Precautions. Clin Orthop Surg 2022; 14:155-161. [PMID: 35685973 PMCID: PMC9152889 DOI: 10.4055/cios21156] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/28/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022] Open
Abstract
Because of the increasing global trend of patients with mental disorders, orthopedic surgeons are more likely to encounter orthopedic patients with mental disorders in clinical settings. Identifying the characteristics of these patients and implementing psychiatric management can affect the clinical outcome of orthopedic treatment. Thus, orthopedic surgeons need to assess the psychiatric medical history of orthopedic patients with mental disorders before surgery and understand the psychological and behavioral patterns of patients with mental disorders. In addition, appropriate psychiatric consultations and evaluations are necessary to prevent worsening of mental disorders before and after surgery.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Chan Ho Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Wonsik Choy
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Jeong SH, Hoon Kim S, Lee DW, Park EC, Jang SY. Association between new-onset Parkinson's disease and suicide risk in South Korea: a nationwide cohort study. BMC Psychiatry 2022; 22:341. [PMID: 35581575 PMCID: PMC9115980 DOI: 10.1186/s12888-022-03990-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is an increasingly common neurodegenerative disease in an aging society. Whether PD is associated with an increased suicide risk is unclear. Thus, we investigated the effect of new-onset PD on suicide. METHODS Using the National Health Insurance Service Senior Sample Cohort of South Korea, 17,143 incident PD patients and 17,143 risk set controls, matched by propensity score, were selected for follow-up. The incidence rate of suicide and 95% confidence interval (CI) were calculated based on a generalized linear model of the Poisson distribution. Effect sizes were expressed as hazard ratios (HRs) using the Cox proportional hazards model with a robust variance estimator that incorporated clustering within matched pairs. RESULTS The incidence rate of suicide was 206.7 cases per 100,000 person-years (95% CI, 172.8-246.9) among the PD cohort. Compared to the matched controls, patients with PD were 2.64 times (HR, 2.64; 95% CI, 1.31-5.30) more likely to commit suicide during the first 180 days of follow-up and 2.47 times (HR, 2.47; 95% CI, 1.42-4.28) within the first 365 days of follow-up. During the entire follow-up period, patients with PD were 2.26 times more likely to commit suicide than were their matched controls (HR, 2.26; 95% CI, 1.67-3.06). CONCLUSION Our findings indicated an increased risk of suicide in patients with new-onset PD, regardless of the period after diagnosis. Incorporating mental health care with social and environmental interventions into primary care and PD-specialized care can help reduce suicide risk in people with PD, improving suicide prevention, identification, and risk assessment.
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Affiliation(s)
- Sung Hoon Jeong
- grid.15444.300000 0004 0470 5454Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Seung Hoon Kim
- grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Doo Woong Lee
- grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk-Yong Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea. .,Department of Healthcare Management, Graduate School of Public Health, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Roncero C, Pérez J, Molina J, Quintano JA, Campuzano AI, Pérez J, Miravitlles M. Frequency and Associated Factors of Suicidal Ideation in Patients with Chronic Obstructive Pulmonary Disease. J Clin Med 2022; 11:2558. [PMID: 35566685 PMCID: PMC9101437 DOI: 10.3390/jcm11092558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023] Open
Abstract
We aimed to examine the prevalence of suicidal ideation in patients with chronic obstructive pulmonary disease (COPD) and the association between demographic and clinical variables and the occurrence of suicidal thoughts. This was a cross-sectional study. Sociodemographic and clinical data were recorded, and questionnaires were used to assess depressive symptoms (Beck Depression Inventory), comorbidities (Charlson Index), cognitive performance (Mini Mental State Examination), and quality of life (EuroQoL-5 dimensions and CAT). Specific questions about suicide-related behavior were included. Multivariate logistic regression analysis identified the significant factors associated with previous suicidal ideation and suicide attempts. The analysis included 1190 subjects. The prevalence of suicidal ideation and suicide attempts were 12.1% and 2.5%, respectively. Severely depressed patients had the highest prevalence of suicide-related behavior. The adjusted logistic model identified factors significantly associated with suicidal ideation: sex (odds ratio (OR) for women vs. men = 2.722 (95% confidence interval (CI) = 1.771-4.183)), depression score (OR = 1.163 (95% IC = 1.127-1.200)), and Charlson Index (OR 1.228 (95% IC 1.082-1.394)). Suicidal ideation is common in COPD patients, especially in women. While addressing suicidal ideation and suicide prevention, clinicians should first consider the management of depressive symptomatology and the improvement of coping strategies.
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Affiliation(s)
- Carlos Roncero
- Psychiatric Service, University of Salamanca Health Care Complex, 37007 Salamanca, Spain;
- Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, 37007 Salamanca, Spain
| | - Joselín Pérez
- Medical Department, Grupo Ferrer, 08029 Barcelona, Spain; (J.P.); (A.I.C.)
| | - Jesús Molina
- Centro de Salud Francia, Dirección Asistencial Oeste, 28993 Madrid, Spain;
| | | | | | - Javier Pérez
- Psychiatric Service, University of Salamanca Health Care Complex, 37007 Salamanca, Spain;
- Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, 37007 Salamanca, Spain
| | - Marc Miravitlles
- Department of Pneumology, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
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Wang G, Jia C, Ma Z, Zhou L. Physical diseases and elderly suicide in rural China: A case-control psychological autopsy study. Aust N Z J Psychiatry 2022; 56:560-568. [PMID: 33726535 DOI: 10.1177/0004867421998804] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Physical diseases are well-established risk factor for suicide, particularly among older adults. However, little is known about the underlying mechanism of the association. This study aimed to describe the prevalence of physical diseases and their influences on the elderly in rural China and to examine the underlying mechanisms of the relationship between physical diseases and suicide. METHODS This matched case-control psychological autopsy study was conducted from June 2014 to September 2015. Consecutive suicide cases (242) among people aged 60 years or above were identified in three Chinese provinces. The suicide cases were 1:1 matched with living comparisons based on age, gender and residential area. Two informants for each participant were interviewed to collect data on their demographic characteristics, the severity index of physical diseases, depressive symptoms, feelings of hopelessness, mental disorders and social support. RESULTS A significant difference was found between suicide cases and living comparisons regarding the prevalence of physical diseases (83.5% vs 66.5%, p < 0.001) and their severity (11.3 ± 6.2 vs 6.7 ± 5.3, p < 0.001). Independent risks of suicide included the following: not currently married (OR = 2.81, 95% CI = [1.04, 7.62]), mental disorders (OR = 7.18, 95% CI = [1.83, 28.13]), depressive symptoms (OR = 1.15, 95% CI = [1.05, 1.26]) and feelings of hopelessness (OR = 1.51, 95% CI = [1.20, 1.90]). The structural equation model indicated that the relationship between the severity index of physical diseases and suicide was mediated by depressive symptoms, feelings of hopelessness and mental disorders. CONCLUSION The severity and number of physical diseases were found to be correlated with suicide among the elderly in rural China, after controlling for demographic characteristics. Physical diseases elevate one's suicide risk by increasing depressive symptoms, feelings of hopelessness and mental disorders. Efforts for suicide prevention should be integrated with strategies to treat physical diseases along with psychological interventions.
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Affiliation(s)
- Guojun Wang
- Shenzhen Graduate School, Peking University, Shenzhen, China.,Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, China
| | - Cunxian Jia
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Zhenyu Ma
- Department of Social Medicine, School of Public Health, Guangxi Medical University, Nanning, China
| | - Liang Zhou
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
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Kim YC, Um YH, Kim SM, Kim TW, Seo HJ, Hong SC, Jeong JH. Suicide Risk in Patients With Diabetes Varies by the Duration of Diabetes: The Korea National Health and Nutrition Examination Survey (2019). Psychiatry Investig 2022; 19:326-332. [PMID: 35500906 PMCID: PMC9058264 DOI: 10.30773/pi.2021.0396] [Citation(s) in RCA: 5] [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: 12/29/2021] [Accepted: 03/01/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The objectives of this study were to investigate the suicide risk in diabetes patients and evaluate the variations in suicide risk by the duration of diabetes using a large population sample in South Korea. METHODS Data from 6,296 adults in the 2019 Korea National Health and Nutrition Examination Survey were included. The suicidal ideation, suicide plans, and suicidal behavior of diabetes patients were compared to the general population. After classifying the patients into ≤1 year, 2 to 9 years, and ≥10 years of diabetes duration, we evaluated the relationship between the duration of diabetes and the suicide risk. RESULTS Diabetes patients had higher prevalences of suicidal ideation (9.1%, p<0.001) and suicide plans (3.6%, p<0.001) than the general population. After adjusting for potential confounding factors, suicide plans (adjusted odds ratio [aOR]=2.926, 95% confidence interval [CI]=1.325-6.463) were significantly associated with diabetes. In the 2 to 9 years group of diabetes patients, we found an increase in the risk of suicidal ideation (aOR=2.035, 95% CI=1.129-3.670), suicide plans (aOR=3.507, 95% CI=1.538-7.996), and suicidal behavior (aOR=7.130, 95% CI=2.035-24.978) after adjusting for the covariates. However, no increases in suicide risk were observed ≤1 year and ≥10 years after diabetes diagnosis. CONCLUSION In adults, diabetes is associated with an increase in suicide risk. Suicide risk in diabetes patients showed an inverted U-shaped depending upon the duration of diabetes.
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Affiliation(s)
- Young-Chan Kim
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoo Hyun Um
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Min Kim
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Won Kim
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho-Jun Seo
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung-Chul Hong
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Tang W, Zhang WQ, Hu SQ, Shen WQ, Chen HL. Incidence and risk factors of suicide in patients with lung cancer: a scoping review. Support Care Cancer 2022; 30:2945-2957. [PMID: 34628516 DOI: 10.1007/s00520-021-06604-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore the high-risk period of the occupation of suicide after diagnosis; and clarify the risk factors of suicidal behaviors (suicidal ideation, suicide attempt, and suicidal death) behind the lung cancer patients during the cancer cure process. METHODS This scoping review was conducted through the whole month of April 2021. We extracted data of the suicide mortality after diagnosis and latent risk factors of suicidal behaviors among lung cancer patients where we used to study from the two online databases which are PubMed and Web of Science. Two online databases were searched and written in English without age restriction. To note that the standardized mortality ratio (SMR), person-years, and odds ratio (OR) associated with lung cancer were documented. RESULTS Out of 570 records, 23 studies mentioned suicidal behaviors and lung cancer met the included criteria. Eleven (n = 47.8%) of the selected publications reported changes in suicide mortality. None of them reported suicidal ideation or suicide attempt after diagnosis. The individuals with lung cancer have significantly higher rates of suicidal death (SMR, 2.04-13.4) during the first years after diagnosis and decrease over subsequent years (SMR, 0.66-3.17). The median time from cancer diagnosis to suicide death was around 7 months. Across all studies with the 22 studies that examined factors, we extracted the data of the suicidal ideation (n = 3), suicide attempt (n = 1), and suicidal death (n = 18) in individuals. For patients with suicidal ideation, there was a significantly higher incidence in males than in females. Among patients who attempted suicide, the incidence of mental illness is greater than the incidence of physical illness. Factors for suicidal death, including gender (male, 56.3-100%), prognosis tumors (poor, 25.8-66.3%), marital status (widowhood or unmarried, 19-75.7%), and age of patients (> 70 years, 24.5-47%) with lung cancer, play a vital role. Treatment of lung cancer is expected to affect a patient in his/her mental state. CONCLUSION Overall, our finding indicates that lung cancer patients have been presented with a higher incidence of suicide death in a specific period, especially the early years after diagnosis. Discovering risk factors for suicide helps prevent potential suicide. It is essential to screen lung cancer patients for suicidal ideation, especially those with high-risk factors. Future prospective studies are necessary to confirm these findings to support care.
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Affiliation(s)
- Wen Tang
- School of Medicine, Nantong University, Nantong, China
| | | | - Shi-Qi Hu
- School of Medicine, Nantong University, Nantong, China
| | - Wang-Qin Shen
- School of Medicine, Nantong University, Nantong, China.
| | - Hong-Lin Chen
- School of Public Health, Nantong University, 9# Seyuan Road, Nantong, 226000, Jiangsu, China.
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Shen YS, Lung SCC, Cui S. Exploring multiple pathways and mediation effects of urban environmental factors for suicide prevention. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 294:118642. [PMID: 34883145 DOI: 10.1016/j.envpol.2021.118642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/27/2021] [Accepted: 12/03/2021] [Indexed: 06/13/2023]
Abstract
Public health is threatened by air pollution and high temperature, especially in urban areas and areas impacted by climate change. Well-designed urban forms have co-benefits on promoting human health and mediating atmospheric environment-related threats (e.g., high temperature and air pollution). Previous studies overlooked these mediating effects of urban form on suicide mortality. This study used partial least squares modeling and countywide data in Taiwan to identify the crucial influences and pathways of urban environment, socioeconomic status, and diseases on suicide mortality. The model considered the impact of the characteristics of urban form (i.e., urban development intensity, land mix, and urban sprawl), urban industrial status (i.e., industrial level), urban greening (i.e., green coverage), disease (i.e., important diseases morbidity of human immunodeficiency virus [HIV], cerebrovascular disease [CVD], chronic liver disease and cirrhosis [CLDC], nephritis, nephrotic syndrome and nephrosis [NNSN], malignant tumor [MT]), socioeconomic status (i.e., income level and aging population rate), and the atmospheric environment (i.e., air pollution and high temperature) on suicide mortality. Optimizing land mix and minimizing urban development intensity and urban sprawl have been found to reduce suicide mortality. The mediating effect of urban form on suicide mortality originated from air pollution and high temperature, and mediating air pollution was greater than high temperature. Furthermore, industrial level, important diseases (HIV, CVD, CLDC, NNSN, and MT) morbidity, an aging population rate, air pollution, and high temperature were associated with an increase in suicide mortality, whereas green coverage and income level were associated with a reduction in suicide rates. The findings demonstrate that appropriate urban policy and urban planning may lower suicide mortality, be useful strategies for suicide prevention, and be a foundation for building a healthy city. Moreover, this study provides clarity on the complex relationship of suicide and the urban environment while identifying crucial factors.
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Affiliation(s)
- Yu-Sheng Shen
- Key Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen, China; Xiamen Key Lab of Urban Metabolism, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen, China; University of Chinese Academy of Sciences, Beijing, China
| | - Shih-Chun Candice Lung
- Research Center for Environmental Changes, Academia Sinica, Taipei, Taiwan; Department of Atmospheric Sciences, Taiwan University, Taipei, Taiwan; Institute of Environmental Health, Taiwan University, Taipei, Taiwan
| | - Shenghui Cui
- Key Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen, China; Xiamen Key Lab of Urban Metabolism, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen, China; University of Chinese Academy of Sciences, Beijing, China.
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Fernandez-Rodrigues V, Sanchez-Carro Y, Lagunas LN, Rico-Uribe LA, Pemau A, Diaz-Carracedo P, Diaz-Marsa M, Hervas G, de la Torre-Luque A. Risk factors for suicidal behaviour in late-life depression: A systematic review. World J Psychiatry 2022; 12:187-203. [PMID: 35111588 PMCID: PMC8783161 DOI: 10.5498/wjp.v12.i1.187] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/17/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suicide is a leading cause of preventable death worldwide, with its peak of maximum incidence in later life. Depression often puts an individual at higher risk for suicidal behaviour. In turn, depression deserves particular interest in old age due to its high prevalence and dramatic impact on health and wellbeing. AIM To gather integrated evidence on the potential risk factors for suicide behaviour development in depressive older adults, and to examine the effects of depression treatment to tackle suicide behaviour in this population. METHODS A systematic review of empirical studies, published from 2000 onwards, was conducted. Suicidal behaviour was addressed considering its varying forms (i.e., wish to die, ideation, attempt, and completed suicide). RESULTS Thirty-five papers were selected for review, comprising both clinical and epidemiological studies. Most of studies focused on suicidal ideation (60%). The studies consistently pointed out that the risk was related to depressive episode severity, psychiatric comorbidity (anxiety or substance use disorders), poorer health status, and loss of functionality. Reduced social support and loneliness were also associated with suicide behaviour in depressive older adults. Finally, the intervention studies showed that suicidal behaviour was a robust predictor of depression treatment response. Reductions in suicidal ideation were moderated by reductions in risk factors for suicide symptoms. CONCLUSION To sum up, common and age-specific risk factors seem to be involved in suicide development in depressive older adults. A major effort should be made to tackle this serious public health concern so as to promote older people to age healthily and well.
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Affiliation(s)
| | - Yolanda Sanchez-Carro
- Department of Psychiatry, Universidad Autonoma de Madrid, Madrid 28046, Spain
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
| | - Luisa Natalia Lagunas
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid 28046, Spain
| | - Laura Alejandra Rico-Uribe
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
- Department of Psychology, La Rioja International University, Logrono 26006, Spain
| | - Andres Pemau
- Department of Psychology, Universidad Complutense de Madrid, Madrid 28223, Spain
| | | | - Marina Diaz-Marsa
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid 28046, Spain
- Institute of Psychiatry and Mental Health, San Carlos Clinical Hospital, Madrid 28040, Spain
| | - Gonzalo Hervas
- Department of Psychology, Universidad Complutense de Madrid, Madrid 28223, Spain
| | - Alejandro de la Torre-Luque
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid 28046, Spain
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Jang SY, Cha Y, Kim KJ, Kim HY, Choy WS, Koo KH. Nested Case Control Study on the Risk of Suicide Death in Elderly Patients with Pelvic Fractures Using a Nationwide Cohort. Clin Orthop Surg 2022; 14:344-351. [PMID: 36061852 PMCID: PMC9393277 DOI: 10.4055/cios21190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 11/06/2022] Open
Abstract
Background The aim of this study was to investigate the incidence rate of suicide deaths in elderly patients with pelvic fractures using a nationwide database and to analyze change in the risk of suicide death overtime after pelvic fractures compared to controls. Methods We used the National Health Insurance Service-Senior cohort (NHIS-Senior) of South Korea. Cases and controls were matched for sex, age, history of hospital admission within 1 year, and presence of depression on the date of suicide death. Controls were collected by random selection at a 1 : 5 ratio from patients at risk of becoming cases when suicide cases were collected. Incident pelvic fractures were identified from the NHIS-Senior as follows: first admission during the observational period (2002–2015) to an acute care hospital with a diagnostic code of International Statistical Classification of Diseases and Related Health Problems, 10th revision S321, S322, S323, S324, S325, or S328 and age 65–99 years. Conditional logistic regression analysis was performed to evaluate the association between pelvic fractures and the risk of suicide death. Results A total of 2,863 suicide cases and 14,315 controls were identified. Suicide case patients had been more frequently exposed to steroids (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.21–1.45), benzodiazepines (OR, 1.76; 95% CI, 1.61–1.93), and non-steroidal anti-inflammatory drugs (OR, 1.18; 95% CI, 1.07–1.29). Pelvic fractures within 1 year from the date of suicide death were statistically significantly associated with increased risk of suicide (adjusted OR [AOR], 2.65; 95% CI, 1.29–5.45; p = 0.008) compared to controls. The risk of suicide death declined as the incidence date of pelvic fracture was more remote from the date of suicide death: AORs of 2.59 (95% CI, 1.33–5.04; p = 0.005) within 2 years and 2.13 (95% CI, 1.15–3.95; p = 0.017) within 3 years. However, there was no statistical significance in the increased risk of suicide death for pelvic fractures that had occurred ≥ 4 years ago (p > 0.05). Conclusions Pelvic fractures in the elderly population increased the risk of suicide death within 3 years, suggesting the need for psychiatric support among elderly patients with pelvic fractures.
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Affiliation(s)
- Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Daejeon, Korea
| | - Kap-Jung Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Daejeon, Korea
| | - Ha-Yong Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Daejeon, Korea
| | - Won-Sik Choy
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Daejeon, Korea
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King K, Dow B, Keogh L, Feldman P, Milner A, Pierce D, Chenhall R, Schlichthorst M. "Is Life Worth Living?": The Role of Masculinity in the Way Men Aged Over 80 Talk About Living, Dying, and Suicide. Am J Mens Health 2021; 14:1557988320966540. [PMID: 33118444 PMCID: PMC7607797 DOI: 10.1177/1557988320966540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Men aged 85 years and over have the highest rate of suicide of any age or gender group in Australia. However, little is known about their trajectory toward suicide. The objective of this study was to understand the role of masculine norms and other life factors in the suicidality of older men. Thirty-three men aged 80 years or more took part in a semistructured focus group or interview, and/or completed a survey. Participants were asked about the issues facing older men, well-being and aging, physical health challenges, social support, mental health and help-seeking, and suicide and suicide prevention. Five themes emerged: "finding out we're not invincible," "active and tough," "strong silent types," "decision makers," and "right to die." Participants spoke about masculine norms that had influenced their lives as providers and decision makers, and now influenced how they coped with aging and their journey toward death. For some participants, suicide was seen to be a rational alternative to dependence in their final years. Suicide prevention should adopt a gendered approach and be cognizant of the influence of gender roles and masculinity in older men's lives. Further research and prevention efforts should be mindful of the impact of masculine norms of self-reliance and control on an older man's decision to end his life. Suicide prevention efforts should work to reduce stigma around the challenges of aging, maximize opportunities for control, facilitate social connection, and improve residential aged care.
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Affiliation(s)
- Kylie King
- The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Briony Dow
- National Ageing Research Institute, Melbourne, Australia
| | - Louise Keogh
- School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Peter Feldman
- School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Allison Milner
- School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - David Pierce
- Department of Rural Health, The University of Melbourne, Parkville, VIC, Australia
| | - Richard Chenhall
- School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Marisa Schlichthorst
- School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
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Śmigielski W, Małek K, Jurczyk T, Korczak K, Gajda R, Cicha-Mikołajczyk A, Piwoński J, Śmigielska-Kolańska J, Śmigielski J, Drygas W, Gałecki P. Suicide Risk Factors among Polish Adults Aged 65 or Older in 2000-2018 Compared with Selected Countries Worldwide. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9921. [PMID: 34574845 PMCID: PMC8465742 DOI: 10.3390/ijerph18189921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
The aim of this study was to determine the tendencies of change in suicide frequency among Polish adults aged 65 or older, recognize the importance of available socio-demographic data (age, sex, marital status, and education attainment level) and provide an in-depth psychological understanding of the obtained results. We analysed the influence of education and marital status on suicide risk in the Polish adult population aged 65 or older, which has not been previously presented in publications related to the Central Statistical Office or any other research. Our results indicated that male adults aged 65 or older that were single or divorced and with a lower education had a higher risk of death by suicide. In female adults aged 65 or older, those with higher education and who were divorced or married had a higher risk of fatal suicide behaviour meanwhile, single women and widows had a lower risk. The dominant method of suicide among Polish older adults was suicide by hanging, regardless of sex; female older adults were more likely to die by suicide by poisoning or jumping from a height, and male older adults were more likely to die by shooting with a firearm. Although data from recent years highlights a downward trend for suicide rates in Polish older adults, the problem cannot be considered solved.
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Affiliation(s)
- Witold Śmigielski
- Department of Demography, University of Lodz, 41, Rewolucji 1905 St., 90-214 Lodz, Poland
- Department of Epidemiology Cardiovascular Disease Prevention and Health Promotion, The Cardinal Stefan Wyszyński National Institute of Cardiology, 42 Alpejska St., 04-628 Warsaw, Poland; (A.C.-M.); (J.P.); (W.D.)
| | - Karolina Małek
- Faculty of Psychology, Warsaw University, 26/28 Krakowskie Przedmieście St., 00-927 Warsaw, Poland;
- The Specialist Family Clinic of Bemowo District in the Capital City of Warsaw, Gen. T. Pełczyńskiego 28 E. St., 01-471 Warsaw, Poland;
| | - Tomasz Jurczyk
- The Specialist Family Clinic of Bemowo District in the Capital City of Warsaw, Gen. T. Pełczyńskiego 28 E. St., 01-471 Warsaw, Poland;
| | - Karol Korczak
- Department of Computer Science in Economics, University of Lodz, 41 Rewolucji 1905 St., 90-214 Lodz, Poland;
| | - Robert Gajda
- Center for Sports Cardiology at the Gajda-Med Medical Center in Pułtusk, Piotra Skargi 23/29 St., 06-100 Pułtusk, Poland;
| | - Alicja Cicha-Mikołajczyk
- Department of Epidemiology Cardiovascular Disease Prevention and Health Promotion, The Cardinal Stefan Wyszyński National Institute of Cardiology, 42 Alpejska St., 04-628 Warsaw, Poland; (A.C.-M.); (J.P.); (W.D.)
| | - Jerzy Piwoński
- Department of Epidemiology Cardiovascular Disease Prevention and Health Promotion, The Cardinal Stefan Wyszyński National Institute of Cardiology, 42 Alpejska St., 04-628 Warsaw, Poland; (A.C.-M.); (J.P.); (W.D.)
| | - Joanna Śmigielska-Kolańska
- Specialist Psychiatric Health Center in Lodz, Babiński Hospital, 159 Aleksandrowska St., 91-229 Lodz, Poland;
| | - Janusz Śmigielski
- Department of Health Sciences, State University of Applied Sciences in Konin, 1 Przyjaźni St., 62-510 Konin, Poland;
| | - Wojciech Drygas
- Department of Epidemiology Cardiovascular Disease Prevention and Health Promotion, The Cardinal Stefan Wyszyński National Institute of Cardiology, 42 Alpejska St., 04-628 Warsaw, Poland; (A.C.-M.); (J.P.); (W.D.)
- Department of Preventive and Social Medicine, Medical University of Lodz, 4 Tadeusza Kościuszki St., 90-419 Lodz, Poland
| | - Piotr Gałecki
- Department of Adult Psychiatry, Medical University of Lodz, 4 Tadeusza Kościuszki St., 90-419 Lodz, Poland;
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Jang SY, Cha Y, Lee JC, Kim H, Kim KJ, Choy W. Population-based Analysis for Risk of Suicide Death in Elderly Patients after Osteoporotic Fracture: a Nested Case-Control Study. J Korean Med Sci 2021; 36:e225. [PMID: 34519185 PMCID: PMC8438184 DOI: 10.3346/jkms.2021.36.e225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/25/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The purpose of study was to investigate the incidence rate of suicide in elderly patients with osteoporotic fractures in a nested case-control model and to analyze the change in the risk of suicide death over time after each osteoporotic fracture. METHODS We used the National Health Insurance Service-Senior cohort of South Korea. Suicide cases and controls were matched based on sex and age at the index date. Controls were randomly selected at a 1:5 ratio from the set of individuals who were at risk of becoming a case at the time when suicide cases were selected. Conditional logistic regression analysis was performed to evaluate the association between each type of osteoporotic fracture and the risk of suicide death. RESULTS Three thousand seventy suicide cases and 15,350 controls were identified. Patients with hip fracture showed an increased risk of suicide death within 1 year of fracture (adjusted odds ratio [aOR] = 2.64; 95% confidence interval [CI], 1.57-4.46; P < 0.001) compared to controls. However, the increased risk of suicide death in patients with hip fracture lasted up to 2 years (aOR = 1.59; 95% CI, 1.04-2.41; P = 0.031). Spine fracture increased the risk of suicide deaths for all observation periods. There was no evidence that humerus fracture increased the risk of suicide death during the observational period. Radius fracture increased only the risk of suicide death within 2 years of fracture (aOR = 1.43; 95% CI, 0.74-2.77; P = 0.282). CONCLUSION There were noticeable differences in both degree and duration of increased suicide risks depending on the type of osteoporotic fracture. Mental stress and suicide risk in elderly patients after osteoporotic fracture should be assessed differently depending on the types of fracture.
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Affiliation(s)
- Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
| | - Je Chan Lee
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Hayong Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Kap-Jung Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Wonsik Choy
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
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Olfson M, Stroup TS, Huang C, Wall MM, Crystal S, Gerhard T. Suicide Risk in Medicare Patients With Schizophrenia Across the Life Span. JAMA Psychiatry 2021; 78:876-885. [PMID: 34037667 PMCID: PMC8156163 DOI: 10.1001/jamapsychiatry.2021.0841] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/15/2021] [Indexed: 11/14/2022]
Abstract
Importance Although adults with schizophrenia have an increased risk of suicide, sample size limitations of previous research have hindered characterizations of suicide risk across the life span. Objective To describe suicide mortality rates and correlates among adults with schizophrenia across the life span and standardized mortality ratios (SMRs) for suicide compared with the general US population. Design, Setting, and Participants Five national retrospective longitudinal cohorts of patients with schizophrenia in the Medicare program from January 1, 2007, to December 31, 2016, were identified by age: 18 to 34, 35 to 44, 45 to 54, 55 to 64, and 65 years or older. Death record information was obtained from the National Death Index. The total cohort included 668 836 Medicare patients with schizophrenia, 2 997 308 years of follow-up, and 2218 suicide deaths. Data were analyzed from September 30, 2020, to March 10, 2021. Main Outcomes and Measures For each age group, suicide mortality rates per 100 000 person-years and adjusted hazard ratios (aHRs) with 95% CIs of suicide were determined. Suicide SMRs were estimated for the total cohort and by sex and age cohorts standardized to the general US population by age, sex, and race/ethnicity. Results The study population of adults 18 years and older included 668 836 Medicare recipients with schizophrenia (52.5% men, 47.5% women). The total suicide rate per 100 000 person-years was 74.00, which is 4.5 times higher than that for the general US population (SMR, 4.54; 95% CI, 4.35-4.73) and included a rate of 88.96 for men and 56.33 for women, which are 3.4 (SMR, 3.39; 95% CI, 3.22-3.57) and 8.2 (SMR, 8.16; 95% CI, 7.60-8.75) times higher, respectively, than the rates for the general US population. Suicide rates were significantly higher for men (aHR, 1.44; 95% CI, 1.29-1.61) and those with depressive (aHR, 1.32; 95% CI, 1.17-1.50), anxiety (aHR, 1.15; 95% CI, 1.02-1.30), drug use (aHR, 1.55; 95% CI, 1.36-1.76), and sleep disorders (aHR, 1.22; 95% CI, 1.07-1.39), suicidal ideation (aHR, 1.41; 95% CI, 1.22-1.63), and suicide attempts or self-injury (aHR, 2.48; 95% CI, 2.06-2.98). The adjusted hazards of suicide were lower for Hispanic patients (aHR, 0.66; 95% CI, 0.54-0.80) or Black patients (aHR, 0.29; 95% CI, 0.24-0.35) than White patients. The suicide rate declined with age, from 141.95 (SMR, 10.19; 95% CI, 9.29-11.18) for patients aged 18 to 34 years to 24.01 (SMR, 1.53; 95% CI, 1.32-1.77) for patients 65 years or older. The corresponding declines per 100 000 person-years were from 153.80 (18-34 years of age) to 34.17 (65 years or older) for men and from 115.70 (18-34 years of age) to 18.66 (65 years or older) for women. In the group aged 18 to 34 years, the adjusted hazards of suicide risk were significantly increased for patients with suicide attempt or self-injury (aHR, 2.57; 95% CI, 18.20-2.04) and with comorbid drug use disorders (aHR, 1.48; 95% CI, 1.17-1.88), but not with comorbid depressive disorders (aHR, 0.99; 95% CI, 0.38-1.26) during the year before the start of follow-up. Conclusions and Relevance In this cohort study of adult Medicare patients with schizophrenia, suicide risk was elevated, with the highest absolute and relative risk among young adults. These patterns support suicide prevention efforts with a focus on young adults with schizophrenia, especially those with suicidal symptoms and substance use.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York
- Mailman School of Public Health, Columbia University, New York, New York
| | - T. Scott Stroup
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York
| | - Cecilia Huang
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Melanie M. Wall
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York
- Mailman School of Public Health, Columbia University, New York, New York
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Tobias Gerhard
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey
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Erlangsen A, Banks E, Joshy G, Calear AL, Welsh J, Batterham PJ, Conwell Y, Salvador-Carulla L. Physical, mental, and social wellbeing and their association with death by suicide and self-harm in older adults: a community-based cohort study. Int J Geriatr Psychiatry 2021; 36:647-656. [PMID: 33166417 DOI: 10.1002/gps.5463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/01/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess associations between physical, mental, and social well-being and suicide and self-harm in a community-based sample of older adults. METHODS Using a cohort design, questionnaire data from 102,880 individuals aged 65 years or older living in New South Wales, Australia during 2006-2009 were linked to hospital and cause-of-death databases until 2017. Poisson regressions obtained adjusted incidence rate ratios (IRRs). RESULTS One hundred nine suicides and 191 deliberate self-harm (DSH) events occurred. Compared to those reporting excellent/good overall health, older adults reporting fair overall health had higher suicide rates (IRR = 2.8, 95% confidence interval: 1.8-4.4). Also, suffering from physical limitations was associated with higher rates of suicide. A fair versus excellent/good memory was associated with higher rates of suicide (IRR = 2.0, 1.3-3.3). Male erectile dysfunction was linked to self-harm (IRR = 2.8, 1.0-7.7). Suicide rates were elevated with baseline Kessler-10 scores of 20-50 versus 10-15 (IRR = 5.0, 2.9-8.9); the corresponding IRR for DSH was 2.9 (1.8-4.8). Elevated rates were observed for both self-reported depression and anxiety. Poor versus excellent/good quality of life was associated with suicide (IRR = 4.3, 1.7-10.7) and achieving less than desired to due to emotional problems was linked to self-harm (IRR = 1.8 1.3-2.4). Rates of suicide ande DSH were lower in those with ≥5 people to depend on versus one (suicide: IRR = 0.5, 0.3-0.9; DSH: IRR = 0.5, 0.3-0.7). CONCLUSIONS Older adults experiencing health problems, including those relating to overall health or memory, and those with psychological distress had elevated rates of suicidal behavior. Rates of subsequent self-harm and/or death by suicide were elevated in participants with small social networks.
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Affiliation(s)
- Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Copenhagen Research Centre For Mental Health, Capital Region of Denmark, Denmark.,Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Grace Joshy
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Jennifer Welsh
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Yeates Conwell
- Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, New York, USA
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
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Lins GODA, Lima NADS, Sousa GSD, Guimarães FJ, Frazão IDS, Perrelli JGA. Validity and reliability of Kessler Psychological Distress Scale for Brazilian elderly: a cross-sectional study. Rev Bras Enferm 2021; 74Suppl 2:e20200365. [PMID: 33759942 DOI: 10.1590/0034-7167-2020-0365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/01/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to verify the validity and reliability of the Psychological Distress Scale for screening mental distress. METHODS a cross-sectional study with 75 elderly people. Psychological Distress scale and Self Reporting Questionnaire were used. Criterion validity was verified using Spearman's correlation and diagnostic accuracy measures. Cronbach's alpha coefficient was used to investigate reliability. RESULTS the total internal consistency of the Psychological Distress Scale was α=0.844. Concurrent validity between this instrument and the Self Reporting Questionnaire was ρ=0.722 (p<0.001). The best cut-off point for screening mental distress among elderly people was a total score greater than 14, with sensitivity equal to 75.47% and specificity equal to 85.0%. CONCLUSIONS the scale was robust for screening mental distress, given its high reliability, in terms of homogeneity, and adequate criterion validity, whose best cut-off point for screening was a score greater than 14.
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Lafont C, Chah Wakilian A, Lemogne C, Gouraud C, Fossey-Diaz V, Orvoen G, Lhuillier N, Paillaud E, Bastuji-Garin S, Zebachi S, Hanon O, Goldwasser F, Boudou-Rouquette P, Canouï-Poitrine F. Diagnostic Performance of the 4-Item Geriatric Depression Scale for Depression Screening in Older Patients with Cancer: The ELCAPA Cohort Study. Oncologist 2021; 26:e983-e991. [PMID: 33683759 DOI: 10.1002/onco.13746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/24/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In older patients with cancer, depression is difficult to assess because of its heterogeneous clinical expression. The 4-item version of the Geriatric Depression Scale (GDS-4) is quick and easy to administer but has not been validated in this population. The present study was designed to test the diagnostic performance of the GDS-4 in a French cohort of older patients with cancer before treatment. MATERIALS AND METHODS Our cross-sectional analysis of data from the Elderly Cancer Patient cohort covered all patients with cancer aged ≥70 years and referred for geriatric assessment at two centers in France between 2007 and 2018. The GDS-4's psychometric properties were evaluated against three different measures of depression: the geriatrician's clinical diagnosis (based on a semistructured interview), the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, and a cluster analysis. The scale's sensitivity, specificity, positive and negative likelihood ratios, and area under the receiver operating characteristic curve (AUROC) were calculated. RESULTS In a sample of 2,293 patients (median age, 81 years; women, 46%), the GDS-4's sensitivity and specificity for detecting physician-diagnosed depression were, respectively, 90% and 89%. The positive and negative likelihood ratios were 8.2 and 0.11, and the AUROC was 92%. When considering the subset of patients with data on all measures of depression, the sensitivity and specificity values were, respectively, ≥90% and ≥72%, the positive and negative likelihood ratios were, respectively, ≥3.4 and ≤ 0.11, and the AUROC was ≥91%. CONCLUSION The GDS-4 appears to be a clinically relevant, easy-to-use tool for routine depression screening in older patients with cancer. IMPLICATIONS FOR PRACTICE Considering the overlap between symptoms of cancer and symptoms of depression, depression is particularly difficult to assess in older geriatric oncology and is associated with poor outcomes; there is a need for a routine psychological screening. Self-report instruments like the 4-item version of the Geriatric Depression Scale appears to be a clinically relevant, easy-to-use tool for routine depression screening in older patients with cancer. Asking four questions might enable physicians to screen older patients with cancer for depression and then guide them toward further clinical evaluation and appropriate care if required.
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Affiliation(s)
- Charlotte Lafont
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, F-94010, Créteil, France
| | | | - Cédric Lemogne
- Université de Paris, AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, INSERM, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, Paris, France
| | - Clément Gouraud
- AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, Paris, France
| | | | - Galdric Orvoen
- AP-HP, Hôpital Broca, Service de Gériatrie, F-75013, Paris, France
| | - Nathalie Lhuillier
- AP-HP, Hôpital Cochin, Service d'Oncologie Médicale, ARIANE, F-75014, Paris, France
| | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,AP-HP, HEGP, Service de Gériatrie, F-75015, Paris, France
| | - Sylvie Bastuji-Garin
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, F-94010, Créteil, France
| | - Sonia Zebachi
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
| | - Olivier Hanon
- AP-HP, Hôpital Broca, Service de Gériatrie, F-75013, Paris, France
| | - François Goldwasser
- AP-HP, Hôpital Cochin, Service d'Oncologie Médicale, ARIANE, F-75014, Paris, France
| | | | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, F-94010, Créteil, France
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Chen YY, Yu S, Hu YH, Li CY, Artaud F, Carcaillon-Bentata L, Elbaz A, Lee PC. Risk of Suicide Among Patients With Parkinson Disease. JAMA Psychiatry 2021; 78:293-301. [PMID: 33326004 PMCID: PMC7745139 DOI: 10.1001/jamapsychiatry.2020.4001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Parkinson disease (PD) is an increasingly common neurodegenerative disorder in many aging societies. Although comorbidities with mental disorders are common in PD, whether PD is associated with an increased risk of suicide is unclear. OBJECTIVE To use a large national representative PD cohort to compare the risk of suicide in patients with PD and control participants and identify potential risk factors. DESIGN, SETTING, AND PARTICIPANTS This nationwide population-based cohort study used linked data from Taiwan's National Health Insurance data set and Taiwan Death Registry between January 2002 and December 2016. Patients with incident PD diagnosed between January 2005 and December 2014 were followed up until December 2016. Four control participants from the general population were randomly selected by risk set sampling and were matched on age, sex, and residence to each affected individual. Data analysis occurred from June 2019 to October 2020. EXPOSURES Diagnosis of PD retrieved from the National Health Insurance data set. MAIN OUTCOMES AND MEASURES Suicide was recorded in the Taiwan Death Registry. Cox proportional models and hazard ratios (HRs) were used to estimate the association between PD and the risk of suicide over the follow-up period. RESULTS Over 11 years, 35 891 patients with PD were followed up (17 482 women [48.7%]; mean [SD] age, 72.5 [10.1] years) and matched to 143 557 control participants (69 928 women [48.7%]; mean [SD] age, 72.5 [10.1] years). A total of 151 patients with PD (cumulative incidence, 66.6 per 100 000 [95% confidence limits [CL], 78.1-91.7]) and 300 control participants (cumulative incidence, 32.3 per 100 000 [95% CL, 36.2-40.5]) died by suicide. The risk of suicide was higher (HR, 2.1 [95% CL, 1.7-2.5]) in patients with PD than control participants, after adjustment for markers of socioeconomic position, medical comorbidities, and dementia. After controlling for mental disorders, the association between PD and suicide risk remained (HR, 1.9 [95% CL, 1.6-2.3]). Compared with control participants who died by suicide, those who died by suicide in the PD group were slightly younger (mean [SD] age: patients with PD, 74.0 [10.4] years vs control participants, 76.0 [10.2] years; P = .05) and more likely to be urban dwelling (medium urbanization, 39 patients with PD [25.8%] vs 115 control participants [38.3%]; high urbanization, 84 patients with PD [55.6%] vs 136 control participants [45.3%]; P = .03), have mental disorders (depression, 15 of 151 patients with PD [9.9%] vs 15 of 300 control participants [5.0%]; other mental disorders, 12 patients with PD [8.0%] vs 11 control participants [3.7%]; P = .02), and adopt jumping as a method of suicide (21 patients with PD [13.9%] vs 16 control participants [5.3%]; P < .01). CONCLUSIONS AND RELEVANCE In this population-based cohort study, Parkinson disease, a common neurodegenerative disorder common in elderly persons, was independently associated with an increased risk of suicide. Integrating mental health care into primary care and PD specialty care, along with socioenvironmental interventions, may help decrease the risk of suicide in patients with PD.
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Affiliation(s)
- Ying-Yeh Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan,Institute of Public Health, Department of Public Health, National Yang-Ming University, Taipei City, Taiwan
| | - Sun Yu
- Department of Neurology, En Chu Kong Hospital, Sanxia District, New Taipei City, Taiwan
| | - Ya-Hui Hu
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan,Department of Health Care Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Fanny Artaud
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Sud, Institut National de la Santé et de la Recherche Médicale Unité 1018, Team “Exposome, Heredity, Cancer and Health,” Center for Research in Epidemiology and Population Health, Villejuif, France
| | | | - Alexis Elbaz
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Sud, Institut National de la Santé et de la Recherche Médicale Unité 1018, Team “Exposome, Heredity, Cancer and Health,” Center for Research in Epidemiology and Population Health, Villejuif, France
| | - Pei-Chen Lee
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan,Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan,Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Sud, Institut National de la Santé et de la Recherche Médicale Unité 1018, Team “Exposome, Heredity, Cancer and Health,” Center for Research in Epidemiology and Population Health, Villejuif, France
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49
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Olfson M, Cosgrove C, Altekruse SF, Wall MM, Blanco C. Deaths Of Despair: Adults At High Risk For Death By Suicide, Poisoning, Or Chronic Liver Disease In The US. Health Aff (Millwood) 2021; 40:505-512. [PMID: 33646867 DOI: 10.1377/hlthaff.2020.01573] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Discourse on deaths of despair, which include suicide, poisoning, and chronic liver disease, has focused on middle-aged White working-class adults with less than a college education. Yet longitudinal research has not examined what groups are at highest risk for these causes of death. Respondents to the 2008 American Community Survey were followed through 2015 for mortality from suicide, poisoning, or chronic liver disease. The overall mortality rate for deaths of despair was 41.3 per 100,000 person-years. The highest-risk groups were adults with functional disabilities (102.8 per 100,000 person-years), American Indian/Alaska Native people (102.6), working-age adults who are not employed (77.3), separated or divorced people (76.5), people with net income losses (70.6), and people with military service (67.0). Most of these groups remained at increased risk after several potential confounders were controlled for. These findings offer a deeper perspective on which adults are at highest risk for deaths of despair.
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Affiliation(s)
- Mark Olfson
- Mark Olfson is the Elizabeth K. Dollard Professor of Psychiatry, Medicine, and Law in the Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University; a professor of epidemiology in the Mailman School of Public Health, Columbia University; and a research psychiatrist at the New York State Psychiatric Institute, all in New York, New York
| | - Candace Cosgrove
- Candace Cosgrove is a statistician in the Mortality Research Group at the Census Bureau, in Washington, D.C
| | - Sean F Altekruse
- Sean F. Altekruse is a program officer in the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute, in Bethesda, Maryland
| | - Melanie M Wall
- Melanie M. Wall is a professor of biostatistics (in psychiatry) in the Department of Biostatistics, Mailman School of Public Health, Columbia University; and director of Mental Health Data Science in the Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University
| | - Carlos Blanco
- Carlos Blanco is the director of the Division of Epidemiology, Services, and Prevention Research at the National Institute on Drug Abuse, in Rockville, Maryland
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50
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Suicidal ideation during COVID-19 lockdown in Greece: Prevalence in the community, risk and protective factors. Psychiatry Res 2021; 297:113713. [PMID: 33450472 PMCID: PMC9754738 DOI: 10.1016/j.psychres.2021.113713] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/25/2020] [Indexed: 12/22/2022]
Abstract
The aim of this study was to investigate the prevalence of suicidal ideation in the community as well as the risk and protective factors of suicidal ideation during restriction measures in Greece, after the outbreak of the COVID-19 pandemic. Α web-based anonymous survey was conducted during the first lockdown period. Participants completed the Generalized Anxiety Disorder scale (GAD-2), the Patient Health Questionnaire (PHQ-2), the Systemic Clinical Outcome and Routine Evaluation (SCORE-15), the Connor-Davidson Resilience Scale (CD-RISK-2), and a self-report questionnaire for COVID-19 pandemic-related data. From a total of 5,116 adults included in the study, 5.20% reported suicidal thoughts, 14.17% were potential clinical cases of anxiety, and 26.51% of depression. Participants presented significantly higher suicidal ideation rates during the last two weeks of the lockdown compared to its previous two weeks. Unmarried or divorced marital status, mental health history, poor perceived quality of physical health, impaired family functioning, anxiety and depression symptoms were independently associated with higher odds of suicidal ideation, whereas higher resilience, positive feelings with regard to the lockdown measures, relationship with friends, and faith in a Supreme Being were associated with lower suicidal ideation odds. According to the findings, suicidal ideation prevalence might be considered elevated and its increase during the lockdown period alarming. The risk and protective factors identified in the study offer valuable information for the development of preventive strategies against suicidal ideation, especially in times of crisis.
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