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Machetanz L, Lau S, Habermeyer E, Kirchebner J. Suicidal Offenders and Non-Offenders with Schizophrenia Spectrum Disorders: A Retrospective Evaluation of Distinguishing Factors Using Machine Learning. Brain Sci 2023; 13:brainsci13010097. [PMID: 36672077 PMCID: PMC9856902 DOI: 10.3390/brainsci13010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
Patients with schizophrenia spectrum disorders (SSD) have an elevated risk of suicidality. The same has been found for people within the penitentiary system, suggesting a cumulative effect for offender patients suffering from SSD. While there appear to be overlapping characteristics, there is little research on factors distinguishing between offenders and non-offenders with SSD regarding suicidality. Our study therefore aimed at evaluating distinguishing such factors through the application of supervised machine learning (ML) algorithms on a dataset of 232 offenders and 167 non-offender patients with SSD and history of suicidality. With an AUC of 0.81, Naïve Bayes outperformed all other ML algorithms. The following factors emerged as most powerful in their interplay in distinguishing between offender and non-offender patients with a history of suicidality: Prior outpatient psychiatric treatment, regular intake of antipsychotic medication, global cognitive deficit, a prescription of antidepressants during the referenced hospitalisation and higher levels of anxiety and a lack of spontaneity and flow of conversation measured by an adapted positive and negative syndrome scale (PANSS). Interestingly, neither aggression nor overall psychopathology emerged as distinguishers between the two groups. The present findings contribute to a better understanding of suicidality in offender and non-offender patients with SSD and their differing characteristics.
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Hu LL, Wang Q, Wang YH, Gu LX, Yu TG. A Retrospective Analysis of Death Among Chinese Han Patients with Schizophrenia from Shandong. Risk Manag Healthc Policy 2022; 15:403-414. [PMID: 35300275 PMCID: PMC8923028 DOI: 10.2147/rmhp.s351523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/16/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the mortality rate and cause of death among Han Chinese schizophrenia patients and to explore the risk factors affecting survival. Methods We performed a retrospective analysis of death among patients with schizophrenia from Jan 1, 2012, to Dec 31, 2019, using the Severe Mental Disorders Information System of Shandong Province (henceforth referred to as the SMDI system) in Shandong, China. The cohort included 72,102 patients, and 11,766 patients died during follow-up. The data in this cohort study were derived from the SMDI system. We calculated the crude mortality rate and standardized mortality rate (SMR, standardized according to the sex and age composition of the population in Shandong Province) for patients with schizophrenia. Cox regression analysis was used to analyze the risk factors affecting patient survival, and the statistical index was the hazard ratio (HR). Results The mean age of the cohort patients was 47.21±14.05 years; 51.79% were males, and 48.21% were females. Among them, 68.98% (49,735) had only a primary education level, 85.36% (61,549) were farmers, 64.37% (46,413) were married, and 94.01% (67,775) received community management. A total of 16.32% of the cohort died. The SMR in patients with schizophrenia was 4.9, and it was higher for males than females (4.99 versus 4.82). Among the 6 registered causes of death, physical illness had the highest SMR (5.15), followed by other causes of death (4.86), mental illness-related complications (4.57), homicide (4.31), accidents (4.13), and suicide (3.87). Higher levels of education, employment (in-service status), marriage, and urban residence were protective factors for survival among patients with schizophrenia. Conclusion In China, the SMR of schizophrenia is relatively high, and physical diseases are the main cause of death. We suggest that a variety of measures should be taken early to treat somatic diseases and reduce SMR in patients with schizophrenia.
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Affiliation(s)
- Li-li Hu
- Department of Public Health, Shandong Mental Health Center, Jinan, People’s Republic of China
| | - Qing Wang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- Institute for Medical Dataology, Shandong University, Jinan, People’s Republic of China
| | - Yan-hu Wang
- Department of Public Health, Shandong Mental Health Center, Jinan, People’s Republic of China
| | - Ling-xi Gu
- Department of Public Health, Shandong Mental Health Center, Jinan, People’s Republic of China
| | - Tian-gui Yu
- Department of Public Health, Shandong Mental Health Center, Jinan, People’s Republic of China
- Correspondence: Tian-gui Yu, Department of Public Health, Shandong Mental Health Center, Jinan, People’s Republic of China, Tel +86-531-86336798, Email
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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: 20] [Impact Index Per Article: 6.7] [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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Hassan A, De Luca V, Dai N, Asmundo A, Di Nunno N, Monda M, Villano I. Effectiveness of Antipsychotics in Reducing Suicidal Ideation: Possible Physiologic Mechanisms. Healthcare (Basel) 2021; 9:healthcare9040389. [PMID: 33915767 PMCID: PMC8066782 DOI: 10.3390/healthcare9040389] [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: 11/30/2020] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of this study is to evaluate whether any specific antipsychotic regimen or dosage is effective in managing suicidal ideation in schizophrenia. Four comparisons were conducted between: (1) clozapine and other antipsychotics; (2) long-acting injectable and oral antipsychotics; (3) atypical and typical antipsychotics; (4) antipsychotics augmented with antidepressants and antipsychotic treatment without antidepressant augmentation. Methods: We recruited 103 participants diagnosed with schizophrenia spectrum disorders. Participants were followed for at least six months. The Beck Scale for Suicidal Ideation (BSS) was used to assess the severity of suicidal ideation at each visit. We performed a multiple linear regression model controlling for BSS score at study entry and other confounding variables to predict the change in the BSS scores between two visits. Results: Overall, there were 28 subjects treated with clozapine (27.2%), and 21 subjects with depot antipsychotics (20.4%). In our sample, 30 subjects experienced some suicidal ideation at study entry. When considering the entire sample, there was a statistically significant decrease in suicidal ideation severity in the follow-up visit compared to the study entry visit (p = 0.043). Conclusions: To conclude, our preliminary analysis implies that antipsychotics are effective in controlling suicidal ideation in schizophrenia patients, but no difference was found among alternative antipsychotics’ classes or dosages.
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Affiliation(s)
- Ahmed Hassan
- Group for Suicide Studies, CAMH, Department of Psychiatry, University of Toronto, Toronto, ON M5T1R8, Canada; (A.H.); (N.D.)
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5T1R8, Canada
| | - Vincenzo De Luca
- Group for Suicide Studies, CAMH, Department of Psychiatry, University of Toronto, Toronto, ON M5T1R8, Canada; (A.H.); (N.D.)
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5T1R8, Canada
- Correspondence: ; Tel.: +1-416-535-8501 (ext. 34421); Fax: +1-416-979-4666
| | - Nasia Dai
- Group for Suicide Studies, CAMH, Department of Psychiatry, University of Toronto, Toronto, ON M5T1R8, Canada; (A.H.); (N.D.)
| | - Alessio Asmundo
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, Section of Legal Medicine, University of Messina, 98122 Messina, Italy;
| | - Nunzio Di Nunno
- Department of History, Society and Studies on Humanity, University of Salento, 73100 Lecce, Italy;
| | - Marcellino Monda
- Department of Experimental Medicine, Universita’ della Campania ‘Luigi Vanvitelli’, Via Santa Maria a Costantinopoli 16, I-80138 Naples, Italy; (M.M.); (I.V.)
| | - Ines Villano
- Department of Experimental Medicine, Universita’ della Campania ‘Luigi Vanvitelli’, Via Santa Maria a Costantinopoli 16, I-80138 Naples, Italy; (M.M.); (I.V.)
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Shafti SS, Memarie A, Rezaie M, Rahimi B. Clinical Profile of Mortality among Chronic Schizophrenic Patients: A Local Pilot Survey in Iran. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082216666200706000540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Many scholars believe that mental disorders may increase the risk of mortality
among psychiatric patients in comparison with ordinary people. Unfortunately, since there is
no systematic psychiatric case register system in Iran, a precise study of the rate of mortality of
psychiatric patients in Iran is not easy.
Objective:
The objective of the current study included estimation of the rate of mortality and clinical
profile of the died patients in a group of non-western aged schizophrenic patients.
Methods:
Senior section of Razi psychiatric hospital was selected as the specific field of investigation,
and all elderly schizophrenic patients (≥65 years old), who had been hospitalized there, were
nominated as the accessible sample and estimated with respect to the objectives of the present assessment.
For survey, all deaths in the said district, which had occurred throughout the last sixty
months (April of 2014-August 2019), had been listed by the supervisor of the mortality committee
of the hospital. The clinical diagnosis was based on ‘Diagnostic and Statistical Manual of Mental
Disorders’, 5th edition, criteria.
Results:
Among 840 chronic elderly schizophrenic patients, 69 deaths were registered by the mortality
committee of the hospital. As evident by the results, the annual rate of mortality among elderly
schizophrenic patients in the present assessment was around 0.015 (0.15 per 1,000 individuals per
year) and 0.017 (0.17 per 1,000 individuals per year) among male and female aged patients, respectively,
which was significantly lower than the native crude death rate. While the average age of the
expired female patients was significantly longer than male cases, the life expectancy of both male
and female patients was significantly shorter than the life expectancy of native people. Besides,
while among the present sample of old schizophrenics cardiac disease was the main leading cause of
death, other causes, like violence, suicide, road traffic accidents, falls, fires, drug use, tuberculosis,
drowning, epilepsy, and Parkinson’s disease were not liable at all.
Conclusion:
While the rate of mortality among aged schizophrenics was significantly lower than the
native crude death rate, the age of the expired female patients was significantly longer than the male
cases and the life expectancy of both male and female patients was significantly shorter than the life
expectancy of native people. Cardiac disorder was the leading cause of death among the present
sample of aged schizophrenics.
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Affiliation(s)
- Saeed Shoja Shafti
- Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences (USWR), Razi Psychiatric Hospital, Tehran, Iran
| | - Alireza Memarie
- Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences (USWR), Razi Psychiatric Hospital, Tehran, Iran
| | - Masomeh Rezaie
- Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences (USWR), Razi Psychiatric Hospital, Tehran, Iran
| | - Behjat Rahimi
- Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences (USWR), Razi Psychiatric Hospital, Tehran, Iran
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Ran MS, Xiao Y, Fazel S, Lee Y, Luo W, Hu SH, Yang X, Liu B, Brink M, Chan SKW, Chen EYH, Chan CLW. Mortality and suicide in schizophrenia: 21-year follow-up in rural China. BJPsych Open 2020; 6:e121. [PMID: 33054894 PMCID: PMC7576648 DOI: 10.1192/bjo.2020.106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Little is known about the trend and predictors of 21-year mortality and suicide patterns in persons with schizophrenia. AIMS To explore the trend and predictors of 21-year mortality and suicide in persons with schizophrenia in rural China. METHOD This longitudinal follow-up study included 510 persons with schizophrenia who were identified in a mental health survey of individuals (≥15 years old) in 1994 in six townships of Xinjin County, Chengdu, China, and followed up in three waves until 2015. Kaplan-Meier survival analysis and Cox hazard regressions were conducted. RESULTS Of the 510 participants, 196 died (38.4% mortality) between 1994 and 2015; 13.8% of the deaths (n = 27) were due to suicide. Life expectancy was lower for men than for women (50.6 v. 58.5 years). Males consistently showed higher rates of mortality and suicide than females. Older participants had higher mortality (hazard ratio HR = 1.03, 95% CI 1.01-1.05) but lower suicide rates (HR = 0.95, 95% CI 0.93-0.98) than their younger counterparts. Poor family attitudes were associated with all-cause mortality and death due to other causes; no previous hospital admission and a history of suicide attempts independently predicted death by suicide. CONCLUSIONS Our findings suggest there is a high mortality and suicide rate in persons with schizophrenia in rural China, with different predictive factors for mortality and suicide. It is important to develop culture-specific, demographically tailored and community-based mental healthcare and to strengthen family intervention to improve the long-term outcome of persons with schizophrenia.
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Affiliation(s)
- Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, China
| | - Yunyu Xiao
- School of Social Work, Indiana University-Bloomington and IUPUI, Indianapolis, USA
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, UK
| | - Yeonjin Lee
- Department of Social Work and Social Administration, University of Hong Kong, China
| | - Wei Luo
- Xinjin Second People's Hospital, Chengdu, China
| | | | - Xin Yang
- Guangyuan Mental Health Center, China
| | - Bo Liu
- Jingzhou Mental Health Center, China
| | - Maria Brink
- Department of Psychiatry, University of Rochester Medical Center, New York, USA
| | | | | | - Cecilia Lai-Wan Chan
- Department of Social Work and Social Administration, University of Hong Kong, China
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Pungor K, Bozikas VP, Emsley R, Llorca PM, Gopal S, Mathews M, Wooller A, Bergmans P. Stable patients with schizophrenia switched to paliperidone palmitate 3-monthly formulation in a naturalistic setting: impact of patient age and disease duration on outcomes. Ther Adv Psychopharmacol 2020; 10:2045125320981500. [PMID: 35186258 PMCID: PMC8851108 DOI: 10.1177/2045125320981500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/13/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Paliperidone palmitate 3-monthly (PP3M) is a second-generation, long-acting injectable antipsychotic formulation indicated for the maintenance treatment of adults with schizophrenia first stabilized with paliperidone palmitate 1-monthly (PP1M). This exploratory post hoc subgroup analysis of the 52-week, phase 3b REMISSIO study analysed outcomes according to patient age and disease duration in a naturalistic clinical setting. METHODS Outcomes of patients with schizophrenia were analysed according to age [<35 years (n = 123) versus ⩾35 years (n = 182)] and disease duration [⩽3 years (n = 72) versus >3 years (n = 233)]. The primary efficacy outcome was the proportion of patients achieving symptomatic remission according to the Andreasen criteria. Adverse events were monitored throughout the study. RESULTS At endpoint (last observation carried forward), 60.7% (95% CI: 51.4%, 69.4%) of younger patients and 54.1% of older patients (95% CI: 46.6%, 61.6%) achieved symptomatic remission. The proportions for patients with disease duration ⩽3 years and >3 years were similar: 57.8% (45.4%, 69.4%) versus 56.5% (49.8%, 62.9%). Functional remission was reached by 45.4% (36.2%, 54.8%) of patients aged <35 years and 36% (28.9%, 43.6%) of patients aged ⩾35 years with a similar pattern when analysed by disease duration. PP3M had a favourable safety profile and was generally well tolerated in both age groups. CONCLUSION Patients with schizophrenia, previously stabilized on PP1M, may benefit from PP3M treatment with some additional potential improvements if started early in the disease course. CLINICAL TRIALSGOV NCT02713282.
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Affiliation(s)
- Katalin Pungor
- Janssen, EMEA Medical Affairs, Johnson & Johnson Platz 1, Neuss, 41470, Germany
| | - Vasilis P Bozikas
- Second Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Robin Emsley
- Stellenbosch University, Cape Town, South Africa
| | | | - Srihari Gopal
- Department of Neuroscience, Janssen Research and Development, LLC, NJ, USA
| | - Maju Mathews
- Department of Neuroscience, Janssen Research and Development, LLC, NJ, USA
| | | | - Paul Bergmans
- Janssen Cilag, Biostatistics, Breda, The Netherlands
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Chen HL, Xiao Y, Liu YJ, Zhang TM, Luo W, Zeng Y, Hu SH, Yang HJ, Yang X, Liu B, Xu MJ, Chan CLW, Conwell Y, Ran MS. Treatment Status of Elderly Patients With Severe Mental Disorders in Rural China. J Geriatr Psychiatry Neurol 2019; 32:291-297. [PMID: 31480980 DOI: 10.1177/0891988719862622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was performed to compare the treatment status between older (≥65 years) and younger adults (18-64 years) with severe mental illness (SMI) and explore factors associated with treatment status in rural China. Persons with SMI were identified in one mental health survey in 2015 in 6 townships of Xinjin County, Chengdu, China. Logistic regressions were conducted to explore factors associated with treatment status. Older adults with SMI, especially major depressive disorder, reported significantly lower rates of treatment than younger group. Older age, longer duration of illness, and poor mental status were risk factors for never-treated status in these patients. Never-treated status (46.3%) and poor treatment status in these older patients are serious issues. Different treatment statuses in these patients had various influencing factors. It is crucial to develop culture-specific, community-based mental health services to improve early identification, diagnosis, treatment, and recovery of older adults with SMI in rural China.
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Affiliation(s)
- Hong-Lin Chen
- 1 Department of Social Work, Fudan University, Shanghai, China
| | - Yunyu Xiao
- 2 Silver School of Social Work, New York University, New York, NY, USA
| | - Yu-Jun Liu
- 3 Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Tian-Ming Zhang
- 3 Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Wei Luo
- 4 Xinjin Second People's Hospital, Xinjin, Chengdu, China
| | - Ya Zeng
- 4 Xinjin Second People's Hospital, Xinjin, Chengdu, China
| | - Shi-Hui Hu
- 5 Chengdu Mental Health Center, Chengdu, China
| | | | - Xin Yang
- 6 Guangyuan Mental Health Center, Guangyuan, China
| | - Bo Liu
- 7 Jingzhou Mental Health Center, Jingzhou, Hubei, China
| | - Mei-Jun Xu
- 7 Jingzhou Mental Health Center, Jingzhou, Hubei, China
| | - Cecilia Lai-Wan Chan
- 3 Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Yeates Conwell
- 8 Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Mao-Sheng Ran
- 3 Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
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Hassan AN, Stuart EA, De Luca V. Childhood maltreatment increases the risk of suicide attempt in schizophrenia. Schizophr Res 2016; 176:572-577. [PMID: 27236409 DOI: 10.1016/j.schres.2016.05.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/12/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In this study, we evaluated the effect of several types of childhood trauma on lifetime suicide attempt in patients with schizophrenia spectrum disorders. METHODS We interviewed 361 participants with schizophrenia. Childhood trauma was collected using the Childhood Trauma Questionnaire (CTQ). Suicidal attempts were confirmed using subjective and objective validated scales. We applied an observational study design using propensity scores to match individuals with history of childhood trauma to those without past history of trauma. We used logistic regression models to estimate the effect of each type of childhood maltreatment on suicidal attempts controlling for demographics and known suicidal risk factors. RESULTS In our sample, 39.1% of the subjects had lifetime suicide attempt. After matching the two groups and controlling for demographics and clinical confounders, total trauma score and the majority of childhood maltreatment subtypes predicted suicide attempt (odds ratios ranged from 1.74 to 2.49 with p-values ranging from 0.001 to 0.02). Physical neglect was not significantly associated with suicide attempt in our sample (p=0.94). CONCLUSION Childhood maltreatment is confirmed to be a strong independent risk factor for suicidal attempts in schizophrenia. The risk is probably aggravated by the development of depressive symptoms and feeling of hopelessness in the adult life. Early screening and modified psychosocial treatment are recommended for psychotic individuals with trauma history.
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Affiliation(s)
- Ahmed N Hassan
- Group for Suicide Studies, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Vincenzo De Luca
- Group for Suicide Studies, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Canada.
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10
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Chan KY, Zhao FF, Meng S, Demaio AR, Reed C, Theodoratou E, Campbell H, Wang W, Rudan I. Prevalence of schizophrenia in China between 1990 and 2010. J Glob Health 2016; 5:010410. [PMID: 26649171 PMCID: PMC4663755 DOI: 10.7189/jogh.05.010410] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Dramatic development and changes in lifestyle in many low and middle-income countries (LMIC) over the past three decades may have affected mental health of their populations. Being the largest country and having the most striking record of development, industrialization and urbanization, China provides an important opportunity for studying the nature and magnitude of possible effects. METHODS We reviewed CNKI, WanFang and PubMed databases for epidemiological studies of schizophrenia in mainland China published between 1990 and 2010. We identified 42 studies that reported schizophrenia prevalence using internationally recognized diagnostic criteria, with breakdown by rural and urban residency. The analysis involved a total of 2 284 957 persons, with 10 506 diagnosed with schizophrenia. Bayesian methods were used to estimate the probability of case of schizophrenia ("prevalence") by type of residency in different years. FINDINGS In urban China, lifetime prevalence was 0.39% (0.37-0.41%) in 1990, 0.57% (0.55-0.59%) in 2000 and 0.83% (0.75-0.91%) in 2010. In rural areas, the corresponding rates were 0.37% (0.34-0.40%), 0.43% (0.42-0.44%) and 0.50% (0.47-0.53%). In 1990 there were 3.09 (2.87-3.32) million people in China affected with schizophrenia during their lifetime. The number of cases rose to 7.16 (6.57-7.75) million in 2010, a 132% increase, while the total population increased by 18%. The contribution of cases from urban areas to the overall burden increased from 27% in 1990 to 62% in 2010. CONCLUSIONS The prevalence of schizophrenia in China has more than doubled between 1990 and 2010, with rates being particularly high in the most developed areas of modern China. This has broad implications, as the ongoing development in LMIC countries may be increasing the global prevalence of schizophrenia.
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Affiliation(s)
- Kit Yee Chan
- Centre for Population Health Sciences and Global Health Academy, University of Edinburgh Medical School, Scotland, UK ; World Health Organization's Collaborative Centre for Population Health Research and Training ; Nossal Institute for Global Health, University of Melbourne, Australia ; Joint first authors
| | - Fei-Fei Zhao
- Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China ; Joint first authors
| | - Shijiao Meng
- Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China ; Joint first authors
| | - Alessandro R Demaio
- Harvard Global Equity Initiative, Harvard Medical School, Boston, USA ; Copenhagen School of Global Health, University of Copenhagen, Denmark
| | - Craig Reed
- Centre for Population Health Sciences and Global Health Academy, University of Edinburgh Medical School, Scotland, UK ; World Health Organization's Collaborative Centre for Population Health Research and Training
| | - Evropi Theodoratou
- Centre for Population Health Sciences and Global Health Academy, University of Edinburgh Medical School, Scotland, UK ; World Health Organization's Collaborative Centre for Population Health Research and Training
| | - Harry Campbell
- Centre for Population Health Sciences and Global Health Academy, University of Edinburgh Medical School, Scotland, UK ; World Health Organization's Collaborative Centre for Population Health Research and Training
| | - Wei Wang
- Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China ; Joint senior authors
| | - Igor Rudan
- Centre for Population Health Sciences and Global Health Academy, University of Edinburgh Medical School, Scotland, UK ; World Health Organization's Collaborative Centre for Population Health Research and Training ; Joint senior authors
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11
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Zhang W, Li X, Lin Y, Zhang X, Qu Z, Wang X, Xu H, Jiao A, Guo M, Zhang Y, Li Y, Tian D. Pathways to psychiatric care in urban north China: a general hospital based study. Int J Ment Health Syst 2013; 7:22. [PMID: 24020825 PMCID: PMC3852166 DOI: 10.1186/1752-4458-7-22] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 09/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pathway studies highlight the help-seeking behaviors of patients with physical and mental illnesses. A number of studies in this field have been completed in various parts of the world. The purpose of this study is to explore the characteristics of the help-seeking pathways of patients with mental illness from urban north China at Mental Health Professional (MHP). METHODS The pathway diagrams, which accounted for more than five percent of patients, were documented for 441 subjects using the translated version of the World Health Organization (WHO) pathway encounter form. The patterns and durations of care-seeking were analyzed in different diagnostic groups. The χ2-test and the Mann-Whitney U test were employed, as needed. RESULTS Respondents visited the MHP through a variety of pathways. Approximately three-quarters of the patients took an indirect pathway (74.8% vs 25.2%, χ2 = 108.8, p < 0.0001), and on average, each patient consulted 3.4 caregivers. The vast majority of patients first visited local tertiary general hospitals (56.4% vs 4.1%, χ2 = 138.3, p < 0.0001) or local secondary general hospitals (24.8% vs 4.1%, χ2 = 40.96, p < 0.0001). However, only 9.6% of patients were diagnosed with mental disorders for the patients who first visited non-psychiatric hospitals. Of the patients who first contacted with psychiatry hospital, 55.6% received a professional diagnosis and finally reached the MHP because of the poor treatment or high-cost medical care. CONCLUSIONS The majority of patients seek other pathways than to go to MHP directly and this may be due to stigma, and/or lack of knowledge. The study gives emphasis on the importance of improving skills and knowledge that will facilitate the recognition of psychiatric disorders in the community health centers, the general hospitals system and by private practitioners. The pathway described by this study may be helpful while preparing mental health programs in the future.
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Affiliation(s)
- Weijun Zhang
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Xuemei Li
- Clinics of Cadre, Department of Outpatient, General Hospital of the People's Liberation Army, Beijing 100853, China
| | - Yan Lin
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Xiulan Zhang
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Zhiyong Qu
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Xiaohua Wang
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Huiwen Xu
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Alvina Jiao
- Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ 08544-1013, USA
| | - Mengqi Guo
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Yurong Zhang
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Yafang Li
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Donghua Tian
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
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Ndetei DM, Pizzo M, Khasakhala LI, Mutiso VN, Ongecha FA, Kokonya DA. A cross-sectional study of co-occurring suicidal and psychotic symptoms in inpatients at mathari psychiatric hospital, nairobi, kenya. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2012; 11:110-4. [PMID: 19617943 DOI: 10.4088/pcc.08m00671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 07/17/2008] [Indexed: 10/20/2022]
Abstract
UNLABELLED To investigate the prevalence of suicidal symptoms and their co-occurrence with psychotic symptoms in patients at Mathari Hospital. METHOD A descriptive cross-sectional study was conducted in June 2004 on inpatients at Mathari Hospital, the national psychiatric teaching and referral hospital. Data on sociodemographic characteristics and clinical diagnoses of inpatients were extracted from their clinical notes. The Structured Clinical Interview for DSM-IV (SCID) Screening Module was used to elicit information on psychotic and suicidal symptoms. RESULTS A total of 691 patients were interviewed, of whom 308 (44.6%) had suicidal symptoms. There were significant positive correlations (p < .05) between psychotic and suicidal symptoms diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) suggesting co-existence of these 2 sets of disorders. CONCLUSIONS There is a high prevalence of suicidal symptoms in the patients admitted at Mathari Hospital with predominantly psychotic disorders. Although these prevalence rates are much lower than those reported elsewhere, especially for schizophrenia, they are still a cause for concern given that these suicidal symptoms were not being managed.
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Affiliation(s)
- David M Ndetei
- Department of Psychiatry, University of Nairobi , and the Africa Mental Health Foundation , Nairobi, Kenya.
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13
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Schizophrenia--a predictor of suicide during the second half of life? Schizophr Res 2012; 134:111-7. [PMID: 22018943 PMCID: PMC3266451 DOI: 10.1016/j.schres.2011.09.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 09/19/2011] [Accepted: 09/27/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Little is known about the suicide risk of older adults diagnosed with schizophrenia. The purpose of the study is to examine whether older adults diagnosed with schizophrenia have an elevated risk of dying by suicide, examine trends by age, and identify predictors of death by suicide. METHODS Individual-level register data on all older adults aged 50+ living in Denmark during 1990-2006 (N=2,899,411) were assessed using survival analysis. The impact of predictors was adjusted for a series of socio-demographic and health-related covariates. RESULTS In all, 248 suicides were identified among older adults diagnosed with schizophrenia. The suicide rate ratios of men and women aged 50-69years with a diagnosis of schizophrenia was 7.0 [95%CI: 5.8-8.4] and 13.7 [95%CI: 11.3-16.6], respectively, when compared to those with no diagnosis. With increasing age a lower rate ratio was found; for men and women aged 70+ it was 2.1 [95%CI: 1.1-3.9] and 3.4 [95%CI: 2.0-5.8], respectively. Adjusted analyses revealed an elevated risk of suicide for diagnoses of schizophrenia, greater number of hospitalizations, recent admission (for men), recent discharge, previous suicide attempt, recent suicide attempt, comorbidity of mood disorders, personality disorders, and substance abuse (for women). CONCLUSIONS We found an elevated mortality risk of suicide for both men and women aged 50years and over diagnosed with schizophrenia. Health care staff should be aware of elevated risk, particularly in older women diagnosed with schizophrenia, in relation to chronic disease courses, recent discharge, and suicide attempt.
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Abstract
Risk assessment is a core skill in psychiatry. Risk prediction for suicide in schizophrenia is known to be complex. We undertook a systematic review of all original studies concerning suicide in schizophrenia published since 2004. We found 51 data-containing studies (from 1281 studies screened) that met our inclusion criteria, and ranked these by standardized quality criteria. Estimates of rates of suicide and risk factors associated with later suicide were identified, and the risk factors were grouped according to type and strength of association with suicide. Consensus on the lifetime risk of suicide was a rate of approximately 5%. Risk factors with a strong association with later suicide included being young, male, and with a high level of education. Illness-related risk factors were important predictors, with number of prior suicide attempts, depressive symptoms, active hallucinations and delusions, and the presence of insight all having a strong evidential basis. A family history of suicide, and comorbid substance misuse were also positively associated with later suicide. The only consistent protective factor for suicide was delivery of and adherence to effective treatment. Prevention of suicide in schizophrenia will rely on identifying those individuals at risk, and treating comorbid depression and substance misuse, as well as providing best available treatment for psychotic symptoms.
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Affiliation(s)
| | - Mark Taylor
- Dr Taylor, Ballenden House, 28 Howden St, Edinburgh EH8 9HL, UK
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