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Lee JK, Lee J, Chung MK, Shin T, Park JY, Lee KJ, Lim HS, Hwang S, Urtnasan E, Jo Y, Kim MH. Childhood adversity and suicidal ideation in older Korean adults: unraveling the mediating mechanisms of mental health, physical health, and social relationships. BMC Psychiatry 2024; 24:485. [PMID: 38956575 PMCID: PMC11221153 DOI: 10.1186/s12888-024-05919-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 06/18/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Suicide rates in older adults are much higher than those in younger age groups. Given the rapid increase in the proportion of older adults in Korea and the high suicide rate of this age group, it is worth investigating the mechanism of suicidal ideation for older adults. Generally, adverse childhood experiences are positively associated with suicidal ideation; however, it is not fully understood what mediating relationships are linked to the association between these experiences and current suicidal ideation. METHODS The data from 685 older Korean adults were analyzed utilizing logistic regression, path analyses, and structural equation modeling. Based on our theoretical background and the empirical findings of previous research, we examined three separate models with mental health, physical health, and social relationship mediators. After that, we tested a combined model including all mediators. We also tested another combined model with mediation via mental health moderated by physical health and social relationships. RESULTS The univariate logistic regression results indicated that childhood adversity was positively associated with suicidal ideation in older adults. However, multivariate logistic regression results demonstrated that the direct effect of childhood adversity became nonsignificant after accounting all variables. Three path models presented significant mediation by depression and social support in the association between childhood adversity and suicidal ideation. However, combined structural equation models demonstrated that only mediation by a latent variable of mental health problems was statistically significant. Social relationships moderated the path from mental health problems to suicidal ideation. CONCLUSIONS Despite several limitations, this study has clinical implications for the development of effective strategies to mitigate suicidal ideation. In particular, effectively screening the exposure to adverse childhood experiences, early identification and treatment of depressive symptoms can play a crucial role in weakening the association between childhood adversity and suicidal ideation in older adults.
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Affiliation(s)
- Jin-Kyung Lee
- Institute for Poverty Alleviation and International Development, Yonsei University, Mirae Campus, Wonju, Republic of Korea
| | - Jinhee Lee
- Department of Psychiatry, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Moo-Kwon Chung
- Institute for Poverty Alleviation and International Development, Yonsei University, Mirae Campus, Wonju, Republic of Korea
- Department of Global Public Administration, Yonsei University, Mirae Campus, Wonju, Republic of Korea
| | - Taeksoo Shin
- Department of Business Administration, Yonsei University, Mirae Campus, Wonju, Republic of Korea
| | - Ji Young Park
- Department of Social Welfare, Sangji University, Wonju, Republic of Korea
| | - Kyoung-Joung Lee
- Department of Biomedical Engineering, Yonsei University, Mirae Campus, Wonju, Republic of Korea
| | - Hyo-Sang Lim
- Department of Computer & Telecommunications Engineering, Yonsei University, Mirae Campus, Wonju, Republic of Korea
| | - Sangwon Hwang
- Department of Precision Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Erdenebayar Urtnasan
- Artificial Intelligence Bigdata Medical Center, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Yongmie Jo
- Department of Global Public Administration, Yonsei University, Mirae Campus, Wonju, Republic of Korea
| | - Min-Hyuk Kim
- Department of Psychiatry, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea.
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Mohd Salleh Sahimi H, Midin M, Lim JTY, Anwar MWA, Abdul Samad FD, Mohamad Kamal NA. An elderly patient with depression and a suicide attempt during the COVID-19 pandemic: a case report. Front Psychiatry 2023; 14:1151482. [PMID: 37840789 PMCID: PMC10568006 DOI: 10.3389/fpsyt.2023.1151482] [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: 01/26/2023] [Accepted: 09/04/2023] [Indexed: 10/17/2023] Open
Abstract
Objective Elderly individuals are among the age groups with the highest risk of suicide. The coronavirus (COVID-19) pandemic forced isolation and resulted in an increased risk of depression, hopelessness, and perceived burdensomeness among the elderly, thereby increasing the risk of suicide. Methods This is a case report of an elderly single retired school principal with obsessive-compulsive personality traits who developed depression with psychotic symptoms after being isolated following the movement control order (MCO) during the COVID-19 pandemic. The social isolation led to feelings of loneliness and hopelessness. The patient's depressive symptoms worsened after he developed physical illnesses, such as eye floaters, that affected his daily activities. This caused him to have suicidal ideation to the extent that he attempted suicide by ingesting 90 mL of pesticide. Two weeks prior to the attempt, he updated his will and asked his friend to keep it. After the suicide attempt, he vomited and had diarrhea and epigastric pain. He called his friend, who brought him to the hospital emergency room (ER). He was resuscitated and subsequently admitted to the intensive care unit (ICU). After being medically stabilized, he was transferred to the psychiatric ward, where further treatment was administered for his depression. His depressive symptoms and suicidal ideation improved after he was administered antidepressants and psychotherapy. Results The impact of the COVID pandemic has led to a surge in mental health issues such as anxiety and depression. The elderly are among the highest-risk groups of individuals to contract or die of COVID-19 infection, and they are also the most likely to develop mental health issues related to the pandemic. Furthermore, the risk of death by suicide is highest in this age group due to physical illness, social isolation, and the lack of a support system. This case also highlights the need for awareness of suicidal ideation screening among non-medical healthcare professionals and religious organizations to avoid the treatment gap. Conclusion It is essential to enhance suicide risk assessment and management among the elderly after the COVID-19 pandemic.
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Affiliation(s)
- Hajar Mohd Salleh Sahimi
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
- Hospital Canselor Tuanku Muhriz, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Marhani Midin
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
- Hospital Canselor Tuanku Muhriz, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Jane Tze Yn Lim
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
- Hospital Canselor Tuanku Muhriz, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Mohd Wafiy Ariffin Anwar
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
- Hospital Canselor Tuanku Muhriz, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Farah Deena Abdul Samad
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
- Hospital Canselor Tuanku Muhriz, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Nurul Ain Mohamad Kamal
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
- Hospital Canselor Tuanku Muhriz, Bandar Tun Razak, Kuala Lumpur, Malaysia
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Christensen M, Chan HY, Chan YY, Cheng KY, Cheung TY, Li TY, Situ JL, Tam PL, Tse CC, Ma H. Suicide ideation in older people: a qualitative review and Meta-aggregation of Asian studies. Front Psychiatry 2023; 14:1169820. [PMID: 37671288 PMCID: PMC10475554 DOI: 10.3389/fpsyt.2023.1169820] [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: 02/20/2023] [Accepted: 07/10/2023] [Indexed: 09/07/2023] Open
Abstract
Aims To appraise and synthesize qualitative studies examining older Asian people's experiences of suicidal ideation. Design Qualitative review and meta-aggregation. Data sources Four databases were accessed to retrieve papers published between 1990 and 2022 including the grey literature, hand-searching of reference lists of retrieved papers and key journals. The phenomenon of interest included participants older than 60 years old, must have experienced a form of suicidal ideation and/or an unsuccessful attempt, had actively thought about harming themselves and be of Asian ethnicity. Review methods This review was conducted according to Consolidated Criteria for Reporting Qualitative Research and the Joanna Briggs Institute's System for the Unified Management of the Assessment and Review of Information. Results Of the 289 potential studies, seven papers met the inclusion criteria. Two synthesized findings resulted from this review-The Suffering Situation: A Life without Meaning in Older Age and The Healing Situation: A Life Worth Living. The experiences of older Asian people varied from feelings of loneliness, despair and isolation to wanting to live a fruitful life into old age. Conclusion Suicidal ideation in the older person is a growing concern especially with the rise in suicide in this age group. Rising health care costs and erosion of traditional family values means that the older person views themselves as a burden. However, because of the limited number of qualitative studies from an Asian perspective it is difficult to ascertain the full extent of the issues surrounding suicide in older people.
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Affiliation(s)
- Martin Christensen
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
- Interdisciplinary Centre for Qualitative Research, School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Hiu Yin Chan
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Yuen Yi Chan
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Ka Yee Cheng
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Tsz Yan Cheung
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Tsz Yan Li
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Jia Ling Situ
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Po Lam Tam
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Cheuk Chi Tse
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Haixia Ma
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
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Jeong KH, Yoon JY, Lee S, Cho S, Woo HJ, Kim S. Changes in the Suicide Rate of Older Adults According to Gender, Age, and Region in South Korea from 2010 to 2017. Healthcare (Basel) 2022; 10:2333. [PMID: 36421657 PMCID: PMC9690192 DOI: 10.3390/healthcare10112333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND South Korea's suicide rates are the highest among Organization for Economic Co-operation and Development (OECD) countries, making it one of the most important societal issues in South Korea. METHODS the statistics on causes of death and resident registration central population (RRCP) provided by the National Statistical Office were used to calculate the suicide rate among older adults in Korea. We examined gender (male, female), age (young-old, old-old), and region (urban, rural) by conducting latent growth modeling to estimate changes in the overall older adult suicide rate and verify its relationship. RESULTS over a period of 8 years, the older adult suicide rate was 104.232 on average in 2010 and it decreased by approximately 10.317 every year, and the rate of decrease gradually slowed down. The initial value of the older adult suicide rate was found to be higher among males, the old-old group, and those living in rural regions. In the quadratic function change rate, only males and the old-old group were statistically significant. CONCLUSION in this study, the direction of and the rate of change in the older adult suicide rates and the relationship between gender, age, and region were examined. It is expected that this study will provide basic data to assist in establishing older adult suicide prevention policies, considering the gender, age, and region of the aging population.
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Affiliation(s)
- Kyu-Hyoung Jeong
- Department of Social Welfare, Semyung University, Jecheon 27136, Republic of Korea
| | - Ji-Yeon Yoon
- Institute for Life and Culture, Sogang University, Seoul 04100, Republic of Korea
| | - Seoyoon Lee
- Interdisciplinary Graduate Program in Social Welfare Policy, Yonsei University, Seoul 03722, Republic of Korea
| | - Sunghwan Cho
- School of Social Work, Virginia Commonwealth University, Richmond, VA 23223, USA
| | - Hyun-Jae Woo
- Health & Welfare Committee, Seoul Metropolitan Council, Seoul 04519, Republic of Korea
| | - Sunghee Kim
- Interdisciplinary Graduate Program in Social Welfare Policy, Yonsei University, Seoul 03722, Republic of Korea
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Wang J, Ma Z, Jia C, Wang G, Zhou L. Suicide among young-old and old-old adults in rural China: A case-control psychological autopsy study. Int J Geriatr Psychiatry 2022; 37. [PMID: 36226326 DOI: 10.1002/gps.5819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/29/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Late-life suicide is a vital public health concern. Though gerontological research suggested the young-old and old-old phases were heterogeneous, age differences in the elderly suicide have not been well studied due to the lack of comparable control groups and small samples. The study aimed to examine the age-specific suicidal characteristics and risk factors among the young-old (60-79) and old-old (over 80) elderly. METHODS Two hundred and forty two suicide decedents and 242 living comparisons were enrolled in a 1:1 matched case-control psychological autopsy study in rural China: 173 young-old and 69 old-old in each group. Suicidal characteristics, demographic characteristics, living arrangements, physical health, mental disorder, and psychosocial factors were collected. We used logistic regression models to assess risk factors of suicide and test for interactions between age and each risk factor. RESULTS Pesticide suicide was more prevalent among young-old suicides than old-old suicides (56.07% vs. 40.58%, p = 0.029). Non-currently married, unemployment, mental disorder, higher disability in physical activities of daily living, higher hopelessness and higher depressive symptom were significantly associated with suicide among older adults. The effect of poor function in physical activities of daily living on suicide was significantly greater during younger ages (p for interaction = 0.038). CONCLUSIONS Findings indicated that most suicidal characteristics and risk factors for completed suicide were generally similar among young-old and old-old adults. But poor function in physical activities of daily living predicted increase suicide risk only at younger ages. In addition to common risk factors, age-specific factors should also be noted in suicide prevention. CLINICAL TRIAL REGISTRATION According to the ICMJE, purely observational studies (those in which the assignment of the medical intervention is not at the discretion of the investigator) will not require registration. Our study was not registered because this is a case-control study. But all procedures of the study were carried out in accordance with the latest version of the Declaration of Helsinki. The study were approved by the Institutional Review Boards of the Central South University, Shandong University, and Guangxi Medical University.
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Affiliation(s)
- Jiali Wang
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhenyu Ma
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Cunxian Jia
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | | | - Liang Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
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Chattun MR, Amdanee N, Zhang X, Yao Z. Suicidality in the geriatric population. Asian J Psychiatr 2022; 75:103213. [PMID: 35917739 DOI: 10.1016/j.ajp.2022.103213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/01/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
Suicide in older adults is a major global concern in both public and mental health. With an ageing population on the rise, a surge in suicidal deaths is predicted in the coming years. The objectives of this paper are to review the risk factors, protective factors, assessment rating scales and current prevention strategies in the geriatric population. The identification of modifiable risk factors and strengthening of protective factors as well as staging according to suicidal ideation, behaviors and/or attempt(s) are necessary to devise appropriate personalized interventions in vulnerable older adults. A history or current psychiatric illness particularly depression, physical illnesses, previous suicide attempt, substance abuse, loneliness, marital status, financial stress, a family history of psychiatric illnesses or suicide in 1st degree relatives and low social support most commonly increase suicidal susceptibility in older adults. Conversely, factors that increase resilience in older adults include a good physical health and cognitive function, religiousness, good quality of life and life satisfaction, ability to perform activities of daily living, marital status, having friends and social connectedness. While the risk factors associated with suicide in the geriatric population are complex and multidimensional in nature, the current preventive strategies have provided no substantial decline in suicidal risk. Therefore, a combination of strategies applied via a multilevel prevention program at a primary, mental healthcare, societal and community level could mitigate suicidal risk. Further research and better preventive measures are warranted to diminish suicidal risk in older adults.
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Affiliation(s)
- Mohammad Ridwan Chattun
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Nousayhah Amdanee
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Zhijian Yao
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Medical School of Nanjing University, Nanjing Brain Hospital, 22 Hankou Road, Nanjing 210093, China.
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Christl J, Schröder N, Mennicken R, Jänner M, Supprian T. Inpatient Suicides in Late Life: A Retrospective Analysis of a Hospital Group with Nine Psychiatric Clinics. Arch Suicide Res 2022; 26:1436-1446. [PMID: 34006203 DOI: 10.1080/13811118.2021.1922107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Inpatient suicides are rare incidents; however, the impacts of such events on associated families and hospital staff are severe. Therefore, preventive strategies need to focus on risk factors. Clinical management in a hospital setting must integrate the home environment and social life of patients. Nevertheless, home leaves require careful preparation. METHODS Suicides were reported systematically from all psychiatric departments of the Landschaftsverband Rheinland (an assembly of municipalities) using a structured form during two periods (1995-2004, 2005-2014). From these reports we extracted data on suicide methods and sociodemographic and clinical variables. Only patients 65 years and older were included. RESULTS From a total of 551 reports on suicides in the period of 1995-2014, 103 patients 65 years and older (60 women, 43 men) died by suicide. In contrast to the general trend in Germany during this period, no decline in overall suicide rates was found. Most patients were treated because of depression (73.8%); schizophrenic psychosis was diagnosed in 11.7%; and dementia was only diagnosed in 1.9%. The most frequent suicide method was hanging (40%). All suicides within the hospital were hangings. The majority of suicides occurred outside the hospital during approved home leaves. Only 7% of suicides occurred when patients left the hospital without permission. Almost half of the patients (n = 44) died by suicide during the first month of treatment. With longer duration of hospitalization, the risk of suicide decreased. There were no significant trends with regard to suicide methods between the two periods. CONCLUSIONS In the first weeks of hospitalizations the patients are most endangered to die by suicide. Therefore, home leaves need careful consideration.
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Wiktorsson S, Strömsten L, Renberg ES, Runeson B, Waern M. Clinical Characteristics in Older, Middle-Aged and Young Adults Who Present With Suicide Attempts at Psychiatric Emergency Departments: A Multisite Study. Am J Geriatr Psychiatry 2022; 30:342-351. [PMID: 34470715 DOI: 10.1016/j.jagp.2021.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/08/2021] [Accepted: 08/01/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To study age group differences in clinical characteristics in older, middle-aged and younger adults with actual suicide attempts (SA). DESIGN Cross-sectional cohort study. SETTING 3 Swedish university hospitals. PARTICIPANTS 821 persons who presented with self-harm at psychiatric emergency departments participated. Those with non-suicidal self-injury according to the Columbia Suicide Severity Rating Scale (C-SSRS) were excluded, leaving a total of 683 with an actual SA (18-44 years, n = 423; 45-64 years, n = 164; 65+, n = 96). MEASUREMENTS Suicidal behavior was characterized with the C-SSRS and the Suicide Intent Scale (SIS); symptoms associated with suicide were rated with the Suicide Assessment Scale (SUAS). Diagnoses were set using the Mini-International Neuropsychiatric Interview. Patients self-rated their symptoms with the Karolinska Affective and Borderline Symptoms Scale (KABOSS). RESULTS Older adults scored higher than the younger group on SIS total score and on the subjective subscale, but no age group differences were detected for the objective subscale. Half of the 65+ group fulfilled criteria for major depression, compared to 3-quarters in both the middle-aged and young groups. Anxiety disorders, as well as alcohol and substance use disorders were also less prevalent in the 65+ group, while serious physical illness was more common. Older adults scored lower on all symptom scales; effect sizes were large. CONCLUSIONS While older adults with an SA showed higher suicide intent than young adults, they had lower scores on all ratings of psychiatric symptomatology. Low ratings might interfere with clinicians' assessments of the needs of older adults with intentional self-harm.
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Affiliation(s)
- Stefan Wiktorsson
- Institute of Neuroscience (SW, MW), Department of Psychiatry, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland (SW, MW), Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden.
| | - Lotta Strömsten
- Department of Clinical Sciences (LS, ESR), Umeå University, Sweden
| | | | - Bo Runeson
- Department of Clinical Neuroscience (BR), Centre for Psychiatry Research, Karolinska Institute, and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Margda Waern
- Institute of Neuroscience (SW, MW), Department of Psychiatry, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland (SW, MW), Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
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Lee J, Kim D, Lee WJ, Woo SH, Jeong S, Kim SH. Association of the COVID-19 Pandemic and Low-rescue Suicide Attempts in Patients Visiting the Emergency Department after Attempting Suicide. J Korean Med Sci 2021; 36:e243. [PMID: 34463065 PMCID: PMC8405404 DOI: 10.3346/jkms.2021.36.e243] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/17/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic may increase the total number of suicide attempts and the proportion of low-rescue attempts. We investigated the factors affecting low-rescue suicide attempts using the risk-rescue rating scale (RRRS) among patients who visited the emergency department (ED) after attempting suicide before or during the COVID-19 pandemic. METHODS We retrospectively investigated suicide attempts made by patients who visited our ED from March 2019 to September 2020. Patients were classified into two groups based on whether they attempted suicide before or during the COVID-19 pandemic. Data on demographic variables, psychiatric factors, suicide risk factors and rescue factors were collected and compared. RESULTS A total of 518 patients were included in the study, 275 (53.1%) of whom attempted suicide during the COVID-19 pandemic. The proportion of patients who made low-rescue suicide attempts differed before and during the COVID-19 pandemic (37.1% vs. 28.8%) (P = 0.046). However, the proportions of patients who made high-risk suicide attempts and high-lethality suicide attempts did not significantly differ between the two periods. The independent risk factors for low-rescue suicide attempts were age and the COVID-19 pandemic (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00-1.03; P = 0.006) (OR, 1.52; 95% CI, 1.03-2.25; P = 0.034). CONCLUSION The COVID-19 pandemic was associated with low-rescue suicide attempts in patients visiting the ED after attempting suicide. Thus, we need to consider the implementation of measures to prevent low-rescue suicide attempts during similar infectious disease crises.
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Affiliation(s)
- Juneyoung Lee
- Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Daehee Kim
- Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woon Jeong Lee
- Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seon Hee Woo
- Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Sikyoung Jeong
- Department of Emergency Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong Hee Kim
- Department of Counseling Psychology, Graduate School of Theology, Seoul Theological University, Bucheon, Korea
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Kim SI, Han DH, Hwang JH, Oh JH, Shin MH, Kim SM. Cost-Effectiveness of a Multi-Disciplinary Emergency Consultation System for Suicide Attempts by Drug Overdose in Young People and Adult Populations. Front Public Health 2021; 9:592770. [PMID: 33718316 PMCID: PMC7952303 DOI: 10.3389/fpubh.2021.592770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 01/29/2021] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to compare the characteristics of suicide attempts by drug overdose between young people and adults, and evaluate the cost-effectiveness of a multi-disciplinary emergency consultation system (MECS) for suicide attempters with drug overdose. It was verified by comparing and analyzing data from June 1, 2017 to May 31, 2018 (before the MECS was implemented; pre-MECS), and from June 1, 2018 to May 31, 2019 (after the MECS was implemented; post-MECS). The data were retrospectively reviewed for a total of 251 such patients with suicide attempts by drug overdose who visited the emergency room of a university hospital in Seoul during the period. The young people group were shown to be more likely to use painkillers and less likely to use psychoactive drugs for a suicide attempt (p < 0.01), had more unplanned attempts than planned ones (p < 0.01), and had lower levels of intentionality for suicide (p = 0.04) and of suicide lethality (p = 0.02), compared to the adult group. We defined suicide attempts as being "serious" when there was both high intentionality and lethality. On this basis, the young people group had less serious suicide attempts, compared to the adult group (p = 0.02). Young people in the post-MECS group had lower intensive care unit (ICU) costs (p = 0.01) and lower costs in the 6-months after the suicide attempt (p = 0.02) compared to those in the pre-MECS group. Young people, both with serious (p < 0.01) and non-serious attempts (p < 0.01) in the post-MECS group had lower ICU costs compared to those in the pre-MECS group. Adults with non-serious attempts in the post-MECS group had lower ICU costs (p < 0.01) compared to those in the pre-MECS group. Therefore, it can be concluded that fast and precise cooperation from the multidisciplinary departments for patients who attempted suicide by drug overdose reduced unnecessary ICU treatment and costs, especially in young attempters and those with lower levels of intentionality and lethality.
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Affiliation(s)
- Sol I Kim
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Jin Ho Hwang
- Department of Nephrology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Je Hyeok Oh
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Myung Hee Shin
- Department of Safety, Leadership and Coaching, The Graduate School of Psychological Service, Chung-Ang University, Seoul, South Korea
| | - Sun Mi Kim
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, South Korea
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Factors Influencing Suicidal Ideation and Attempts among Older Korean Adults: Focusing on Age Discrimination and Neglect. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041852. [PMID: 33672881 PMCID: PMC7917585 DOI: 10.3390/ijerph18041852] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Abstract
This study was conducted to identify factors influencing the development of suicidal ideation and the transition from suicidal ideation to attempts by focusing on experiences of age discrimination and neglect among older Korean adults. This study analyzed data from 10,042 older adults from the 2017 National Survey of Older Koreans using national representative samples. Multiple logistic analyses were used to identify factors influencing the development of suicidal ideation and transition from suicidal ideation to attempts. While younger age, higher educational attainment, living alone, number of chronic diseases, depressive symptoms, social isolation, social support, experience of neglect, and age discrimination influenced the development of suicidal ideation, all of these did not influence the transition from ideation to attempts. Factors influencing this transition included male gender, less educational attainment, and experience of age discrimination. Thus, social efforts to reduce age discrimination are necessary to prevent suicide attempts among Korean older adults.
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12
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Choi JW, Lee KS, Han E. Suicide risk within 1 year of dementia diagnosis in older adults: a nationwide retrospective cohort study. J Psychiatry Neurosci 2021; 46:E119-E127. [PMID: 33119492 PMCID: PMC7955848 DOI: 10.1503/jpn.190219] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Although severe dementia could protect against suicide death by decreasing a person's capacity to implement a suicide plan, patients with early dementia may have better cognition, giving them more sustained insight into their disease and better enabling them to carry out a suicide plan. This study investigated suicide risk in older adults within 1 year of receiving a diagnosis of dementia. METHODS This study used National Health Insurance Service Senior Cohort data and included 36 541 older adults with newly diagnosed dementia (a Mini-Mental State Examination score ≤ 26 and a Clinical Dementia Rating score ≥ 1 or a Global Deterioration Scale score ≥ 3), including Alzheimer disease, vascular dementia and other/unspecified dementia, from 2004 to 2012. We selected older adults without dementia through 1:1 propensity-score matching using sex, age, comorbidities and index year, with follow-up throughout 2013. We estimated adjusted hazard ratios (AHRs) of suicide deaths within 1 year after diagnosis using a time-dependent Cox proportional hazards model. RESULTS We verified 46 suicide deaths during the first year after a dementia diagnosis. Older adults with dementia had an increased risk of suicide death compared to those without dementia (AHR 2.57; 95% confidence interval [CI] 1.49-4.44). Older adults with Alzheimer disease (AHR 2.50; 95% CI 1.41-4.44) or other/unspecified dementia (AHR 4.32; 95% CI 2.04-9.15) had an increased risk of suicide death compared to those without dementia. Patients with dementia but without other mental disorders (AHR 1.96; 95% CI 1.02-3.77) and patients with dementia and other mental disorders (AHR 3.22; 95% CI 1.78-5.83) had an increased risk of suicide death compared to patients without dementia. Patients with dementia and schizophrenia (AHR 8.73; 95% CI 2.57-29.71), mood disorders (AHR 2.84; 95% CI 1.23-6.53) or anxiety or somatoform disorders (AHR 3.53; 95% CI 1.73-7.21), respectively, had an increased risk of suicide death compared to patients with those conditions but without dementia. LIMITATIONS This study examined only elderly patients in South Korea, a population with a substantially higher suicide rate than the global population. Caution must be exercised when generalizing the results to populations with dissimilar backgrounds. CONCLUSION Patients with dementia had an increased risk of suicide death within 1 year after diagnosis compared to those without dementia.
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Affiliation(s)
- Jae Woo Choi
- From the College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea (Choi, Han); and the Department of Psychiatry, CHA University College of Medicine, Bundang CHA Hospital, Gyeonggi-do, South Korea (Lee)
| | - Kang Soo Lee
- From the College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea (Choi, Han); and the Department of Psychiatry, CHA University College of Medicine, Bundang CHA Hospital, Gyeonggi-do, South Korea (Lee)
| | - Euna Han
- From the College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea (Choi, Han); and the Department of Psychiatry, CHA University College of Medicine, Bundang CHA Hospital, Gyeonggi-do, South Korea (Lee)
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Choi JW, Han E. Risk of new-onset depressive disorders after hearing impairment in adults: A nationwide retrospective cohort study. Psychiatry Res 2021; 295:113351. [PMID: 32807534 DOI: 10.1016/j.psychres.2020.113351] [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: 10/29/2019] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 11/25/2022]
Abstract
Previous studies reported that hearing impairment has been associated with depressive disorders, but little is known about the risk of newly diagnosed depression after hearing impairment diagnosed by a physician and registered with the government. We evaluated the risk of new-onset depressive disorders following hearing impairment in adults. We used data from the Korean National Health Insurance Service-National Sample Cohort and included adults with hearing impairment, and a comparison group without hearing impairment, selected by a 1:3 propensity score matching between 2004 and 2012. The dependent variable was a depressive disorder diagnosis. The hazard ratio of risk of depression was estimated using a Cox proportional hazard model. In the sample of 14,212 adults, 15.0% of people with hearing impairment (n = 3,553) experienced a depressive disorder following their hearing impairment. Those who had not experienced depression previously were more likely to develop a new-onset depressive disorder following hearing impairment than the comparison group. Male, female, old adults (60-74 years) and very-old adults (≥ 75 years) with hearing impairment were associated with an increased risk for a new-onset depressive disorders than their matched counterparts. These findings suggest a need for psychological support along with hearing rehabilitation, especially for older adults.
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Affiliation(s)
- Jae Woo Choi
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea.
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14
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Sultanoğlu H, Erdem Sultanoğlu T. Evaluation of elderly patients in adult suicide cases admitted to the emergency department. J Forensic Leg Med 2020; 77:102103. [PMID: 33341021 DOI: 10.1016/j.jflm.2020.102103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/09/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
The proportion of elderly people in the general population has been increasing in our country. The suicide rate increases by a person's age, and old age appears as one of the life periods with a high suicide incidence. We aimed at investigating the causes and risk factors of suicide attempts and to analyze the sociodemographic and clinical features of the elderly individuals presenting to the emergency department after suicide attempt. Cross-sectional retrospective study was performed.1403 patients were enrolled. The patients were categorized into two age groups of 18-64 years and 65 years or older. The male gender had a greater proportion in both groups. The young group contained more subjects having an educational level of primary school while the illiterate ones in the older group had a greater suicide tendency. The married subjects had a greater suicide tendency in the younger group while widowed/divorced subjects had a greater suicide tendency in the older group. Subjects without any comorbidity or medication use had a greater suicide tendency in the younger group whereas those who had comorbidities or medication use greater suicide tendency. Mood disorders were the most common psychiatric disorder in both groups. Medication intake was the most common method of suicide in both groups; suicide attempts were more common in summer and between 16:00-24:00. Domestic problems as the cause of suicide were more common in the younger group, while communication problems were more common in the older group. Male gender, divorced/widowed, low education and sociocultural level, presence of depression, communication problems have been identified as risk factors for older group.
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Affiliation(s)
- Hasan Sultanoğlu
- Department of Emergency Medicine, School of Medicine, Düzce University, Düzce, Turkey.
| | - Tuba Erdem Sultanoğlu
- Department of Physical Medicine and Rehabilitation, School of Medicine, Düzce University, Düzce, Turkey.
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15
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Song SJ, Park GJ, Lee JH, Kim SC, Kim H, Lee SW. The Characteristics of Elderly Individuals Who Attempted Suicide by Poisoning: a Nationwide Cross-sectional Study in Korea. J Korean Med Sci 2020; 35:e286. [PMID: 32893518 PMCID: PMC7476799 DOI: 10.3346/jkms.2020.35.e286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Suicide among the elderly is a public health concern, as life expectancy is increasing rapidly and suicide rates increase with age. In Korea, self-poisoning is the most common method of attempted suicide. This study aimed to evaluate the characteristics of attempted suicide by self-poisoning among the elderly and to identify risk factors related to the suicide attempts. METHODS A cross-sectional observational study was conducted using the Emergency Department-based Injury In-depth Surveillance database in Korea. We included all adult patients visiting the emergency department (ED) who attempted suicide by poisoning between January 2011 and December 2017 and stratified according to age: the elderly (≥ 65 years old) and the younger group. Characteristics and risk factors for attempted suicide by poisoning among the elderly were evaluated using stepwise regression analysis. RESULTS Among 25,904 adult patients, 5,164 (19.9%) were classified as elderly. The elderly were more likely to be admitted to hospital and intensive care units, the average ED length of stay was longer, and total mortality was higher than that of the younger group. Male sex, low socioeconomic status, poor physical health, pesticide use, lower alcohol consumption, and fewer prior suicide attempts were found to be risk factors for suicide among the elderly. CONCLUSION Self-poisoning among the elderly is associated with poorer clinical outcomes than in younger adult patients. Suicide among the elderly is a potentially preventable public health problem, and with proper identification of the associated risk factors, appropriate multidisciplinary intervention strategies can be implemented.
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Affiliation(s)
- Sun Jin Song
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Gwan Jin Park
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea.
| | - Ji Han Lee
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Sang Chul Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Hoon Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Suk Woo Lee
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea
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Choi JW, Park EC. Suicide risk after cancer diagnosis among older adults: A nationwide retrospective cohort study. J Geriatr Oncol 2020; 11:814-819. [DOI: 10.1016/j.jgo.2019.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/09/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
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17
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Choi JW, Lee SG, Kim TH, Han E. Poststroke suicide risk among older adults in South Korea: A retrospective longitudinal cohort study. Int J Geriatr Psychiatry 2020; 35:282-289. [PMID: 31859411 DOI: 10.1002/gps.5245] [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: 07/26/2019] [Accepted: 11/24/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The present study evaluated suicide risk within 1 year after discharge among older adults with stroke as a function of depression onset. METHOD We used the Korean National Health Insurance Service-Senior cohort data and included first discharged patients with a stroke as the principal diagnosis. The comparison group was selected by a 1:2 case-control propensity score matching for age, sex, Charlson comorbidity index, and diagnosis year between 2005 and 2012. Suicide deaths were measured by code for causes of death from Statistics Korea, and the main outcome was suicide death within 1 year following discharge. An adjusted hazard ratio (AHR) of suicidal risk was measured using a Cox proportional hazard model. RESULTS In the total sample of 128 286 older adults (aged 63-114 years), the higher suicidal risk was examined for stroke patients vs the comparison group (AHR = 1.4; 95% confidence interval [CI], 1.1-1.8). Stroke patients with depression had an increased suicide risk (AHR = 2.9; 95% CI, 1.8-4.8) but only for poststroke depression (AHR = 4.1; 95% CI, 1.8-9.5). Pre and poststroke depression suicidality (AHR = 4.8; 95% CI, 2.1-11.1) was also higher when compared to stroke patients without depression. CONCLUSIONS Poststroke patients are at increased suicidal risk during 1 year following discharge. Furthermore, patients who were diagnosed with depression after a stroke are more likely to commit suicide than stroke patients without depression. This suggests a necessity for early suicide preventive intervention for stroke patients while considering depressive symptomology.
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Affiliation(s)
- Jae Woo Choi
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
| | - Sang Gyu Lee
- Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Tae Hyun Kim
- Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
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Costanza A, Amerio A, Radomska M, Ambrosetti J, Di Marco S, Prelati M, Aguglia A, Serafini G, Amore M, Bondolfi G, Michaud L, Pompili M. Suicidality Assessment of the Elderly With Physical Illness in the Emergency Department. Front Psychiatry 2020; 11:558974. [PMID: 33024437 PMCID: PMC7516267 DOI: 10.3389/fpsyt.2020.558974] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland.,Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Andrea Amerio
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Mood Disorders Program, Tufts Medical Center, Boston, MA, United States
| | - Michalina Radomska
- Faculty of Psychology, University of Geneva (UNIGE), Geneva, Switzerland
| | - Julia Ambrosetti
- Emergency Psychiatric Unit, Department of Psychiatry and Emergency Department, Geneva University Hospitals, Geneva, Switzerland
| | - Sarah Di Marco
- Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Massimo Prelati
- Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Andrea Aguglia
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Guido Bondolfi
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland.,Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Michaud
- Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.,McGill Group for Suicide Studies, McGill University, Montreal, QC, Canada
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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19
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Kim DW, Cho SE, Kang JM, Woo SK, Kang SG, Yeon BK, Cho SJ. Risk Factors for Serious Suicide Attempts: Difference Between Older and Younger Attempters in the Emergency Department. Front Psychiatry 2020; 11:607811. [PMID: 33488429 PMCID: PMC7820120 DOI: 10.3389/fpsyt.2020.607811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/07/2020] [Indexed: 01/11/2023] Open
Abstract
Objective: Suicide attempts of the older adults are known to be more serious than that of the younger adults. Despite its major social impact in South Korea, the behavioral mechanism of serious suicide attempt (SSA) in old people remains to be elucidated. Thus, we investigated the risk factors for SSA in older and younger suicide attempters in the emergency department. Methods: Demographic data, clinical information, and the level of seriousness of suicide with Risk Rescue Rating Scale were compared between older (age ≥65) and younger (age <65) adults who visited the emergency department for a suicide attempt. Regression analyses were performed to identify the risk factors for SSA in these two groups. Results: Among 370 patients, 37 were older adults (10%; aged 74.41 ± 6.78), more likely to have another medical disease (p < 0.001), and a higher suicide completion rate (16.2 vs. 5.4%, p = 0.023). In the younger group, old age (B = 0.090, p < 0.001), male sex (B = -0.038, p = 0.019), and impression of schizophrenia (B = 0.074, p = 0.027) were associated with a higher risk-rescue ratio and interpersonal stress condition was associated with a lower risk-rescue ratio (B = -0.045, p = 0.006). In the older group, however, no variables were included significant in the regression model for the Risk Rescue Rating Scale. Conclusions: Demographic and clinical factors such as old age, male sex, interpersonal stress, and impression of schizophrenia were associated with lethality in the younger suicide attempters. However, no factors were associated with SSA in the older adult group. Different mechanisms may underly the lethality in old age suicide.
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Affiliation(s)
- Dong Wook Kim
- College of Medicine, Gachon University, Incheon, South Korea
| | - Seo Eun Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Jae Myeong Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Soo Kyun Woo
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Seung-Gul Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Byeong Kil Yeon
- Department of Psychiatry, Gyeonggi Provincial Medical Center Suwon Hospital, Suwon, South Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
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20
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Zhu RT, Ma Z, Jia C, Zhou L. Suicide Means Used by the Older Adults in Rural China: A Comparison Between Those Using Pesticides and Other Means. J Geriatr Psychiatry Neurol 2019; 32:319-326. [PMID: 31480983 DOI: 10.1177/0891988719862625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The most frequently used means of committing suicide was pesticide poisoning in rural China, yet little is known about the characteristics and risk factors for suicides committed with pesticides compared to those committed via other means in older adults. METHODS The participants were 242 older adults (aged 60 or older) who had committed suicide in the rural areas of 3 provinces (Shandong, Hunan, and Guangxi) in China. This study was conducted using the psychological autopsy (PA) method. RESULTS In univariate analyses, no statistically significant differences were found between those who committed suicide with pesticide or with other means in terms of demographic and clinical variables except age, prevalence of mental disorders, suicidal intent, number of recent life events, social support, hopelessness, impulsivity, and depressive symptoms (P > .05); age, history of suicide attempts, having pesticides available at home, the total number of life events, and the number of long-term life events were significantly different (P < .05) between the 2 groups. In multivariate logistic regression model, the factors associated with committing suicide with pesticides were the availability of pesticides at home (odds ratio [OR] = 3.48, 95% confidence interval [CI]: 1.99-6.08) and the number of long-term life events (OR = 0.87, 95% CI: 0.78-0.97). CONCLUSION The older adults who committed suicide by pesticides and those using other means are probably the same population. The main determinant of choosing pesticides as suicide means was likely the availability of pesticides at home. Suicide risk among older adults might be reduced by placing appropriate restrictions on access to pesticides.
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Affiliation(s)
- Rong-Ting Zhu
- 1 Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,2 Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Zhenyu Ma
- 3 School of Public Health, Guangxi Medical University, Nanning, China
| | - Cunxian Jia
- 4 School of Public Health, Shandong University, Jinan, China
| | - Liang Zhou
- 1 Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,2 Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
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Choi JW, Kim TH, Shin J, Han E. Poverty and suicide risk in older adults: A retrospective longitudinal cohort study. Int J Geriatr Psychiatry 2019; 34:1565-1571. [PMID: 31276241 DOI: 10.1002/gps.5166] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 06/29/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We aimed to identify the impact of poverty on suicide risk in older adults. METHOD The data used in this study was obtained from the National Health Insurance Service-Senior claims database from 2002 to 2013. A total of 558 147 individuals were followed for up to 12 years. Poverty was assessed from insurance premium levels, and causes of death were analysed by linking individuals' deaths to the data for causes of death from the National Statistics Office in South Korea. Cox proportional hazard models were used to analyse the associations between poverty and suicide deaths after adjustments for possible confounders. RESULTS Among 558 147 older adults (aged 60-119 years), the poverty group had an increased risk of suicide compared with the high-income group (adjusted hazard ratio [AHR], 1.34; 95% confidence interval [CI], 1.22-1.47), and poverty-group males had a significantly higher risk of suicide than males in the high-income group (AHR, 1.50; 95% CI, 1.33-1.68). Adults aged 60 to 74 years in the poverty group had a higher risk of suicide than those with a high income in the same age group (AHR, 1.41; 95% CI, 1.27-1.57). However, no statistically significant income gradient was found for females or adults aged 75 years or older. CONCLUSIONS Our findings revealed that poverty is a risk factor for death by suicide in older adults. Suicide prevention strategies for older adults should be specifically tailored by income level.
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Affiliation(s)
- Jae Woo Choi
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea.,Department of Health Administration, Dongseo University, Busan, South Korea
| | - Tae Hyun Kim
- Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Jaeyong Shin
- Department of Preventive Medicine and Public Health, Ajou University College of Medicine, Gyeonggi-Do, Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
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