Short- and Long-term Effects of Case Management on Suicide Prevention among Individuals with Previous Suicide Attempts: a Survival Analysis

Predictors of future suicide attempts in individuals with high suicide risk admitted to an acute psychiatry suicide intervention unit in India. A survival analysis study

OBJECTIVE

Determination of suicide vulnerability remains challenging in mental illness. Variability in risk factors identified compound its poor predictability. Longitudinal studies, offering more reliable indices of risk, from developing countries are conspicuously limited. Furthermore, research advances allude to inherent vulnerability. This study, the first of its kind from India, consequently aimed to delineate factors influencing subsequent attempts in mental illness and acute suicidality.

METHOD

Baseline and follow-up information (up to five years) was obtained from medical records of individuals (n = 130) with acute suicidality [recent attempt (first attempt/ reattempt) and high-risk ideators]. Variables were compared between individuals with, and without subsequent suicide attempts. Time to attempt and factors influencing the same was determined using survival analysis, and Cox proportional hazard for estimating the likelihood of a subsequent suicide attempt.

RESULTS

Median duration of follow up of the sample (n = 130) was 23 months. The sample comprised of individuals with a recent attempt (first-time attempt), recent reattempt and recent high-risk ideators. Subsequent suicide attempts were noted in 30 (23.1 %) patients. Baseline sociodemographic and clinical variables, including suicidality, could not differentiate individuals with a subsequent suicide attempt. Survival analysis indicated that 65 % of subsequent attempts occurred within 9 months of discharge. Family history of suicide and the presence of impulsive-aggressive traits were associated with both, reduced survival time and overall increased risk of a subsequent suicide attempt.

CONCLUSION

This study delineates both, the time frame associated with greatest risk, as well as individuals most likely to reattempt suicide. It thereby offers insights into potential windows of opportunity to mitigate prospective suicide risk. Strategies such as enhanced after-care and integrating specific interventions to attenuate impulsive-aggressive behaviors could be a focus to prevent future attempts, thereby decreasing rates of suicide amongst those with mental illness. Furthermore, the findings of this study reaffirm the role of factors that independently confer vulnerability to suicide. Traversing noted regional variations, the findings importantly reinforce the distinct pathophysiological underpinnings of suicide in mental illness.

Hospital-Based Case Management for Suicide High-Risk Group Using Delphi Survey

OBJECTIVE

As of 2019, suicide is serious problem in Korea, with the highest suicide rate among OECD countries. To reduce suicide rates Emergency Department Based Post-Suicide Attempt Case Management carried out with government funding in South Korea, but it is insufficient to address the issue. Aim of this study is to prevent suicide attempts through continuous provision of mental health services even after discharge from acute care.

METHODS

We selected 15 mental health specialists who are multidisciplinary experts in Suicide Prevention. Two-round Delphi survey was conducted on them to reach an agreement for hospital-based case management.

RESULTS

The first Delphi survey consisted of 8 areas and 39 questions. Among them, 30 questions draw agreement above the reference value. The second Delphi survey, consisted of 37 questions, resulted in 32 above-standard questions.

CONCLUSION

Consensus was reached in most category of the Hospital Based Case Management for Suicide High-Risk Group. Core of the developed plan was to provide services to patients who visited the hospital, pursue the stability and universalization of services through a medical insurance fee system. In the future, hospital-based case management service will be implemented as a new model contributing to the reduction of suicide rates in Korea.

Spatial Movement Patterns and Local Co-Occurrence of Nutria Individuals in Association with Habitats Using Geo-Self-Organizing Map (Geo-SOM)

Nutrias (Myocastor coypus) were imported to South Korea for farming in 1985; individuals escaped captivity and established wild populations in natural ecosystems in the late 1990s. Numerous studies have focused on their monitoring and management; however, information on the continuous movement of individuals is not available. In this study, telemetry data from field conditions were used to identify the nearest-neighbor distances of individuals in association with environmental factors, including plant type, land cover, and biological parameters. The minimum nearest-neighbor distances for the different sexes were, overall, according to the minimum distances for the same sex. Local co-occurrences of individuals, either of the same or different sex, were seasonal. Tall grasslands, followed by herbaceous vegetation, were associated with the co-occurrence of different sexes. Conversely, floating-leaved hydrophytes, followed by xeric herbaceous vegetation, were correlated with the co-occurrence of the same sex. Local female-male co-occurrences were negatively associated with male-male co-occurrences but not with female-female co-occurrences, suggesting male dominance in group formations. Movement and co-occurrence information extracted using Geo-self-organizing maps furthers our understanding of population dispersal and helps formulate management strategies for nutria populations.

The MATES Case Management Model: Presenting Problems and Referral Pathways for a Novel Peer-Led Approach to Addressing Suicide in the Construction Industry

MATES in Construction (MATES) is a multimodal, peer-led, workplace suicide prevention and early intervention program developed to reduce the risk of suicide among construction industry workers through active facilitation of appropriate support. The MATES case management model provides an example of a nonclinical service for meeting the needs of individuals in the construction industry who, while at elevated risk of mental health problems and suicidality, are traditionally less likely to seek help. The aim of this research was to conduct an evaluation of the MATES case management database to quantify service demand, and to examine the demographic, occupational profile, presenting issues, referral pathways, and perceived benefit of case management among individuals who used this service. The research reports on routinely collected data from the Queensland MATES case management database, which contains records on 3759 individuals collected over the period 2010–2018, and findings from a small and opportunistic exit survey undertaken with 14 clients in 2019. Overall, findings suggest that the demand for case management through MATES has increased significantly and that clients felt that their needs and concerns were appropriately addressed. The most common presenting issues were relationship, work, and family problems, suicide, and mental health concerns. Findings confirm that causes of distress extend beyond the realm of mental disorder and span a range of psychosocial issues. Significantly, it offers an approach that may divert individuals in crisis away from presenting to over-run emergency departments, and towards services that are more equipped to meet their individual needs.

The Characteristics of Elderly Individuals Who Attempted Suicide by Poisoning: a Nationwide Cross-sectional Study in Korea

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.

Distribution and Management of Nutria (Myocastor coypus) Populations in South Korea

In 2014, the South Korean government initiated the “Nutria Eradication Project” to actively manage and control populations of nutria, an invasive alien species that threatens national biodiversity. In the present study, we examined domestic nutria habitats in 2014 to 2018 and analyzed spatial shifts in habitat distribution to develop management policies and eradication strategies for the South Korean Ministry of Environment. A total of 27,487 nutria individuals were captured over five years upon the initiation of the eradication project. We found that the number of habitat tracks decreased from 1510 in 19 administrative districts in 2014 to 176 in 14 districts in 2018. We examined the distribution of nutria habitat tracks and found a northwestward shift at an average angle of 313.9° and 46,656.9 m. This distribution shift prompted improvements in control policies focused on nutria capture to suppress rodent movement and shifting distributions. We redefined the spatial scope of our control regions accordingly and established isolated environments in each region to prevent further spread. Additionally, resource management was focused in areas showing habitat expansion. Overall, we observed an estimated 54% decrease in nutria habitat tracks from 2016 to 2017. Our results have since been enacted in government policies and provide a basis for establishing flexible strategies for effectively controlling nutria habitats and populations. In 2017, the South Korean government allocated additional funds for research and for the development of further control strategies working toward the project’s goals.

The effects of case management program completion on suicide risk among suicide attempters: A 5-year observational study

BACKGROUND

A prior suicide attempt is known to be the most important risk factor for suicide. Case management programs provide psychosocial support and rehabilitation for suicide attempters. This study aimed to determine whether case management completion is associated with good clinical outcomes for suicide attempters visiting the emergency department (ED).

METHODS

A cross-sectional observational study was conducted using risk assessment records for suicide attempters visiting the ED from October 2013 to December 2017. We created two groups according to completion of the case management program. The primary outcome was a decrease in suicide risk. The secondary and tertiary outcomes were untreated stressors and lack of a support system. We calculated the adjusted odds ratio (AOR) of the case management completion for study outcomes adjusting for potential confounders.

RESULTS

Among 439 eligible suicide attempters, only 277 (63.1%) participants completed the case management program. Participants who completed the case management program were more likely to have decreased suicide risk (65.3% vs. 46.9%, AOR: 2.13 (1.42-3.20)) and less untreated stressors (49.8% vs. 61.1%, AOR: 0.64 (0.43-0.96)). However, there was no significant difference in lack of a support system (35.4% vs. 45.7%, AOR: 0.68 (0.45-1.03)).

CONCLUSION

Completion of a case management program was associated with reduction of suicide risk. Multicomponent strategies to increase compliance with a case management program are needed to prevent suicide reattempt and reduce the health burden of suicide.