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Namgung E, Ha E, Yoon S, Song Y, Lee H, Kang HJ, Han JS, Kim JM, Lee W, Lyoo IK, Kim SJ. Identifying unique subgroups in suicide risks among psychiatric outpatients. Compr Psychiatry 2024; 131:152463. [PMID: 38394926 DOI: 10.1016/j.comppsych.2024.152463] [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: 09/05/2023] [Revised: 01/27/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The presence of psychiatric disorders is widely recognized as one of the primary risk factors for suicide. A significant proportion of individuals receiving outpatient psychiatric treatment exhibit varying degrees of suicidal behaviors, which may range from mild suicidal ideations to overt suicide attempts. This study aims to elucidate the transdiagnostic symptom dimensions and associated suicidal features among psychiatric outpatients. METHODS The study enrolled patients who attended the psychiatry outpatient clinic at a tertiary hospital in South Korea (n = 1, 849, age range = 18-81; 61% women). A data-driven classification methodology was employed, incorporating a broad spectrum of clinical symptoms, to delineate distinctive subgroups among psychiatric outpatients exhibiting suicidality (n = 1189). A reference group of patients without suicidality (n = 660) was included for comparative purposes to ascertain cluster-specific sociodemographic, suicide-related, and psychiatric characteristics. RESULTS Psychiatric outpatients with suicidality (n = 1189) were subdivided into three distinctive clusters: the low-suicide risk cluster (Cluster 1), the high-suicide risk externalizing cluster (Cluster 2), and the high-suicide risk internalizing cluster (Cluster 3). Relative to the reference group (n = 660), each cluster exhibited distinct attributes pertaining to suicide-related characteristics and clinical symptoms, covering domains such as anxiety, externalizing and internalizing behaviors, and feelings of hopelessness. Cluster 1, identified as the low-suicide risk group, exhibited less frequent suicidal ideation, planning, and multiple attempts. In the high-suicide risk groups, Cluster 2 displayed pronounced externalizing symptoms, whereas Cluster 3 was primarily defined by internalizing and hopelessness symptoms. Bipolar disorders were most common in Cluster 2, while depressive disorders were predominant in Cluster 3. DISCUSSION Our findings suggest the possibility of differentiating psychiatric outpatients into distinct, clinically relevant subgroups predicated on their suicide risk. This research potentially paves the way for personalizing interventions and preventive strategies that address cluster-specific characteristics, thereby mitigating suicide-related mortality among psychiatric outpatients.
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Affiliation(s)
- Eun Namgung
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea
| | - Eunji Ha
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Sujung Yoon
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Yumi Song
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Hyangwon Lee
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Jung-Soo Han
- Department of Biological Sciences, Konkuk University, Seoul, South Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Wonhye Lee
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, South Korea
| | - In Kyoon Lyoo
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea; Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea.
| | - Seog Ju Kim
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, South Korea.
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Cowans C, Love A, Tangiisuran B, Jacob SA. Uncovering the Hidden Burden of Pharmaceutical Poisoning in High-Income and Low-Middle-Income Countries: A Scoping Review. PHARMACY 2023; 11:184. [PMID: 38133459 PMCID: PMC10747954 DOI: 10.3390/pharmacy11060184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/28/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Pharmaceutical poisoning is a significant global public health concern, causing approximately 190,000 deaths annually. This scoping review aims to comprehensively map the available literature on pharmaceutical poisoning and compare patterns between high-income countries (HICs) and low-middle-income countries (LMICs). A systematic search was performed across the following databases: Embase, PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and CINAHL. Studies included were from 1 January 2011 to 31 December 2020, in English, with full text available. Seventy-nine articles were included in the study; 21 were from LMICs and 58 were from HICs. Toxic exposure was largely intentional (77%) in LMICs and accidental (68%) in HICs. Drugs acting on the nervous system were responsible for 95% of toxicities worldwide with analgesics accounting for the largest subtherapeutic group in both LMICs (40%) and HICs (58%). Notable statistics were that HICs accounted for 99% of opioid overdoses, and LMICs accounted for 19% of anti-epileptic-induced toxicities. Overall, the medical outcomes due to poisonings were generally worse in LMICs. The review provides possible interventions to target specific geographic locations, based on the trends identified, to reduce the burden worldwide. Many gaps within the literature were recognised, calling for more robust analytical research.
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Affiliation(s)
- Claire Cowans
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Glasgow G4 0RE, UK; (C.C.); (A.L.)
| | - Anya Love
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Glasgow G4 0RE, UK; (C.C.); (A.L.)
| | - Balamurugan Tangiisuran
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Penang, Malaysia;
| | - Sabrina Anne Jacob
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Glasgow G4 0RE, UK; (C.C.); (A.L.)
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor, Malaysia
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Lo CH, Liao CH, Tan ST, Su YJ. Differences of chronological seasonality in drug overdose. J Int Med Res 2023; 51:3000605231192779. [PMID: 37632450 PMCID: PMC10926412 DOI: 10.1177/03000605231192779] [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: 03/11/2023] [Accepted: 07/20/2023] [Indexed: 08/28/2023] Open
Abstract
OBJECTIVE To investigate the association between seasonality and intentional drug overdose (IDO), a commonly seen method of self-harm in daily emergency medicine practice. METHODS Cases of IDO were retrospectively selected using the International Classification of Diseases (ICD)-10 coding system (codes T36-T50), in patients who attended the Emergency Department of MacKay Memorial Hospital between January 2018 and August 2019. Data regarding age, sex, arrival time, marital status, vital signs, comorbidities, psychiatric history, social conflicts, substance of overdose, and length of hospital stay by season, were analysed using Student's t-test and χ2-test. RESULTS Of all included cases (n = 196), IDO occurred most frequently in spring (32.1%), particularly in male patients (28/49 male cases). First-time IDO occurred most frequently in spring (51/133 first-time cases) and most spring cases were first-time IDO (51/63 spring cases). Repeat IDO occurred most frequently in autumn (20/63 repeat cases). Female conflict with father and/or boyfriend, and personality disorder in patients who overdosed, showed seasonality with a spring peak. Hospital admission rate was highest in winter (10/45 winter cases [22.2%]). CONCLUSION Episodes of IDO exhibited seasonality, with a spring peak, particularly for male patients, female patients in conflict with father and/or boyfriend, and those with personality disorder. Clinicians should pay close attention to the abovementioned patient groups.
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Affiliation(s)
- Chih-Hung Lo
- Emergency Department, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chen-Hao Liao
- Department of Emergency Medicine, Tamshui Branch, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Sheng-Teck Tan
- Emergency Department, Mackay Memorial Hospital, Taipei, Taiwan
- Toxicology Division, Emergency Department, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yu-Jang Su
- Emergency Department, Mackay Memorial Hospital, Taipei, Taiwan
- Toxicology Division, Emergency Department, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Department of Nursing, MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
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Lee GE, Kim JW, Lee KR, Hong DY, Park SO, Kim SY, Baek KJ, Jeon HJ. Vulnerable individuals and changes in suicidal behaviour during the COVID-19 pandemic in Korea. BJPsych Open 2022; 8:e166. [PMID: 36073010 PMCID: PMC9464507 DOI: 10.1192/bjo.2022.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic poses a major threat to mental health and is associated with an increased risk of suicide. An understanding of suicidal behaviours during the pandemic is necessary for establishing policies to prevent suicides in such social conditions. AIMS We aimed to investigate vulnerable individuals and the characteristics of changes in suicidal behaviour during the COVID-19 pandemic. METHOD We retrospectively reviewed the medical records of patients with suicide attempts who visited the emergency department from February 2019 to January 2021. We analysed the demographic and clinical characteristics, risk factors and rescue factors of patients, and compared the findings between the pre-pandemic and pandemic periods. RESULTS In total, 519 patients were included. During the pre-pandemic and pandemic periods, 303 and 270 patients visited the emergency department after a suicide attempt, respectively. The proportion of suicide attempts by women (60.1% v. 69.3%, P = 0.035) and patients with a previous psychiatric illness (63.4% v. 72.9%, P = 0.006) increased during the COVID-19 pandemic. In addition, patients' rescue scores during the pandemic were lower than those during the pre-pandemic period (12 (interquartile range: 11-13) v. 13 (interquartile range: 12-14), P < 0.001). CONCLUSIONS Women and people with previous psychiatric illnesses were more vulnerable to suicide attempts during the COVID-19 pandemic. Suicide prevention policies, such as continuous monitoring and staying in touch with vulnerable individuals, are necessary to cope with suicide risk.
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Affiliation(s)
- Gi Eun Lee
- Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Medical Center, Republic of Korea
| | - Jong Won Kim
- Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Medical Center, Republic of Korea
| | - Kyeong Ryong Lee
- Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Medical Center, Republic of Korea
| | - Dae Young Hong
- Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Medical Center, Republic of Korea
| | - Sang O Park
- Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Medical Center, Republic of Korea
| | - Sin Young Kim
- Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Medical Center, Republic of Korea
| | - Kwang Je Baek
- Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Medical Center, Republic of Korea
| | - Hong Jun Jeon
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Republic of Korea
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Carrasco-Barrios MT, Huertas P, Martín P, Martín C, Castillejos MC, Petkari E, Moreno-Küstner B. Determinants of Suicidality in the European General Population: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4115. [PMID: 32526975 PMCID: PMC7312422 DOI: 10.3390/ijerph17114115] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022]
Abstract
Close to one million people commit suicide each year, with suicidal attempts being the main risk factor for suicide. The aim of this systematic review and meta-analysis is to achieve a greater understanding of suicidality in the general population of Europe by studying associated factors and their statistical significance with suicidality, as well as the effect of the temporal moment in which suicidality is observed in a relationship. A search strategy was carried out in electronic databases: Proquest's Psychology Database, Scopus, PsycINFO, Medline and Embase. Odds ratios (ORs), publication bias, influential studies on heterogeneity and analysis moderators were calculated. Twenty-six studies were included after meeting the inclusion criteria. Factors statistically associated with suicidality are female gender, age over 65 years, unemployment, low social support, adulthood adversity, childhood adversity, family history of mental disorder, any affective disorder, major depression, anxiety/stress/somatoform disorders, tobacco and substance use, any mental disorder and body mass index. As a limitation, a high heterogeneity between studies was found. Factors associated with suicidality in the general population are relevant for understanding the suicidal phenomenon.
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Affiliation(s)
- María Teresa Carrasco-Barrios
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, 29010 Malaga, Spain; (M.T.C.-B.); (P.M.); (M.C.C.); (B.M.-K.)
| | - Paloma Huertas
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, 29010 Malaga, Spain; (M.T.C.-B.); (P.M.); (M.C.C.); (B.M.-K.)
| | - Paloma Martín
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, 29010 Malaga, Spain; (M.T.C.-B.); (P.M.); (M.C.C.); (B.M.-K.)
| | - Carlos Martín
- Primary Care Center of Marquesado, Área Nordeste de Granada, 18512 Granada, Spain;
| | - Mª Carmen Castillejos
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, 29010 Malaga, Spain; (M.T.C.-B.); (P.M.); (M.C.C.); (B.M.-K.)
| | - Eleni Petkari
- Social and Behavioural Sciences, European University Cyprus 6th Diogenous st., Nicosia 2063, Cyprus;
| | - Berta Moreno-Küstner
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, 29010 Malaga, Spain; (M.T.C.-B.); (P.M.); (M.C.C.); (B.M.-K.)
- Biomedical Research Institute of Malaga (IBIMA), 29010 Málaga, Spain
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Yasuda M, Kobayashi T. Suicide attempts by drug overdose at Jichi Medical University Hospital emergency centre: A study of patient characteristics and quantity of drug overdose. Asian J Psychiatr 2019; 41:34-37. [PMID: 30318306 DOI: 10.1016/j.ajp.2018.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Patients attempted suicide by psychotropic drug overdose and require medical care have increased, becoming a serious problem in Japan. This study investigated the characteristics of patients who attempted suicide by overdose and required emergency care, with a focus on quantity of drugs taken. METHODS We conducted a clinical survey of 98 patients examined at the emergency centre of the psychiatric department of Jichi Medical University Hospital and hospitalized for attempted suicide by drug overdose from January 1, 2012 to December 31, 2014. Data were collected by chart review and subjected to statistical analysis. RESULTS Diagnoses were mainly mood disorder and neurosis in both genders. Also, 23.5% of the cases had multiple hospitalizations at the centre, and past overdose was significantly higher in these patients. The average total number of pills/sachets ingested was 84.4 ± 95.5, but no significant difference was noted in dosage according to psychiatric clinic visit history (P = 0.63). Of these patients, 45.1% returned to their previous hospital, and 12.2% were hospitalized in the psychiatric ward. CONCLUSION These results are consistent with reports in the literature. Psychiatric outpatient history does not seem to be a risk factor for attempted suicide by ingesting higher drug doses.
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Affiliation(s)
- Manabu Yasuda
- Department of Psychiatry, Jichi Medical University, Tochigi, Japan.
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Choo CC, Burton AA. Smartphone Apps for Mindfulness Interventions for Suicidality in Asian Youths: Literature Review. JMIR Mhealth Uhealth 2018; 6:e139. [PMID: 29880468 PMCID: PMC6013712 DOI: 10.2196/mhealth.8304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/13/2017] [Accepted: 11/16/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The advent of mobile technology has ushered in an era in which smartphone apps can be used as interventions for suicidality. OBJECTIVE We aimed to review recent research that is relevant to smartphone apps that can be used for mindfulness interventions for suicidality in Asian youths. METHODS The inclusion criteria for this review were: papers published in peer-reviewed journals from 2007 to 2017 with usage of search terms (namely "smartphone application" and "mindfulness") and screened by an experienced Asian clinician to be of clinical utility for mindfulness interventions for suicidality with Asian youths. RESULTS The initial search of databases yielded 375 results. Fourteen full text papers that fit the inclusion criteria were assessed for eligibility and 10 papers were included in the current review. CONCLUSIONS This review highlighted the paucity of evidence-based and empirically validated research into effective smartphone apps that can be used for mindfulness interventions for suicidality with Asian youths.
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Affiliation(s)
| | - André Ad Burton
- School of Psychology, Curtin University, Western Australia, Australia
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Jeon GS, Choi K, Cho SI. Gender differences in exposure and vulnerability to psychosocial and behavioral factors of suicide attempt among Korean adolescents. Asia Pac Psychiatry 2017; 9. [PMID: 28127870 DOI: 10.1111/appy.12272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 11/21/2016] [Accepted: 12/08/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This study examined gender differences in suicide attempts and their association with exposure and vulnerability to psychosocial, behavioral, and structural factors among Korean adolescents. METHODS Data of 74 854 adolescents, taken from the 2010 Korea Youth Risk Behavior Survey, were used. Logistic regression analysis was used to assess the contribution of differential exposure to psychosocial, behavioral, and structural factors for gender differences of suicidal attempt. RESULTS Gender differences were observed in the degree of exposure to the various factors. Females were more likely to report psychosocial problems, whereas males were more likely to report experience of smoking and drinking alcohol and to engage in vigorous physical activity. Stress and unhappiness were significantly associated with suicide attempts in both males and females, and gender differences in these variables were nonsignificant. Depressive symptoms were associated with a higher risk of suicide attempts, and this relationship was significantly stronger for males. The effects of cigarette smoking and risky drinking were significantly stronger in females. DISCUSSION Greater exposure to perceived stress, feelings of unhappiness, depression, and higher vulnerability of smoking and heavy drinking accounted for higher suicide attempts of female adolescents. Higher exposure to health-related behaviors and greater vulnerability to depressive symptoms in male were also noted. In conclusion, differences in exposure and vulnerability to psychosocial and behavioral factors may partly explain gender differences in suicide attempts among Korean adolescents.
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Affiliation(s)
- Gyeong-Suk Jeon
- Department of Nursing, Division of Natural Science, Mokpo National University, Muan-gun, South Korea
| | - Kyungwon Choi
- Department of Nursing, Korea National University of Transportation, Cheongju, Chungbuk, South Korea
| | - Sung-Il Cho
- Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, South Korea
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Ho CSH, Ong YL, Tan GHJ, Yeo SN, Ho RCM. Profile differences between overdose and non-overdose suicide attempts in a multi-ethnic Asian society. BMC Psychiatry 2016; 16:379. [PMID: 27821108 PMCID: PMC5100276 DOI: 10.1186/s12888-016-1105-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 11/01/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study explores differences in characteristics of overdose (OD) and non-overdose (NOD) suicide attempts in Singapore. METHODS Four hundred eighty-five medical records of people who attempted suicide were extracted from a local general hospital patient database and classified into OD and NOD groups. Differences in socio-demographic factors, suicide characteristics and hospital admission types between both groups were examined. RESULTS Indians were more likely than the Chinese and Malays to employ OD method in their attempts. More suicide attempts in the OD group than NOD group were self-reported. The most likely place for suicide attempts for both groups was at home, though more NOD suicide attempts were in public areas as compared to the OD group. Analgesics were the most used substance in the OD group. Those who attempted suicide using OD had a higher number of psychiatric ward admissions than the NOD group. Risk and protective factors varied between both groups. CONCLUSION Differences in socio-demographics, suicide characteristics and admission characteristics between OD and NOD groups were observed. Recommendations for suicide prevention in the community are discussed. Further studies on the mediators and moderators of these trends and characteristics of suicide attempts are necessary to ensure maximal efficacy of prevention and management.
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Affiliation(s)
- Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Lower Kent Ridge Road, Singapore, 119 228, Singapore.
| | - Y L Ong
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Lower Kent Ridge Road, Singapore, 119 228, Singapore
| | - Gabriel H J Tan
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Lower Kent Ridge Road, Singapore, 119 228, Singapore
| | - S N Yeo
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Lower Kent Ridge Road, Singapore, 119 228, Singapore
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