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Smith T, Magness C, Arango A, Finkelstein S, Kahsay E, Czyz E, Hong V, Kettley J, Smith PK, Ewell Foster C. Worsening Symptoms of Anxiety, Depression, and Sleep Problems in Caregivers Following Youth's Suicide-Related Emergency Department Visit. Arch Suicide Res 2024; 28:418-427. [PMID: 36691847 DOI: 10.1080/13811118.2023.2166439] [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] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Although families assume considerable responsibility in caring for their child after a suicidal crisis, little is known about caregiver well-being following a suicide-related pediatric Emergency Department (ED) visit. This study aimed to (1) describe the course of caregiver distress symptoms (e.g., anxiety, depression, and negative affect) and sleep problems following their child's suicide-related ED visit and to (2) identify factors (e.g., parents' mental health history, youth suicide risk chronicity, and perception of feeling supported by the mental health system) hypothesized to be related to caregiver distress symptoms and sleep problems at follow-up using a diathesis-stress model framework. METHOD Participants included 118 caregiver/youth (ages 11-17) dyads presenting to a psychiatric ED due to youths' suicide-related concerns. Caregivers and youth were assessed during index ED visit and 2-weeks following discharge. RESULTS Caregivers' anxiety and depressive symptoms and sleep problems increased significantly from the time of the ED visit to 2-week follow-up. There was no significant change in caregiver negative affect. Caregivers with their own history of mental illness and those whose children had a previous ED visit due to a psychiatric concern, suggestive of chronic suicide risk, reported higher anxiety and depressive symptoms at follow-up. CONCLUSION In the 2 weeks following an ED visit for their child's suicidal crisis, caregivers reported significant increases in anxiety and depressive symptoms and sleep problems. Findings highlight the need to consider the mental health of caregivers whose children are at elevated risk for suicide.HighlightsCaregivers report increases in distress symptoms following youth's suicidal crisis.Caregiver mental health history and youth suicide chronicity impacted distress.Caregiver mental health should be considered when planning youth interventions.
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Gibson M, Moreau N, Balzamo E, Crompton D. Peer Intervention following Suicide-Related Emergency Department Presentation: Evaluation of the PAUSE Pilot Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3763. [PMID: 36834458 PMCID: PMC9960257 DOI: 10.3390/ijerph20043763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
The risk for future suicidal behaviours is elevated following suicide attempts, particularly for those with complex needs or those who are disconnected from healthcare systems. The PAUSE program was designed to address this gap using peer workers to provide continuity and coordination of care following suicide-related emergency presentations. This study aimed to evaluate the pilot program's effect on suicidal ideation and hope, and to explore the acceptability and participants' experiences. A mixed-methods design was employed with pre- and post-evaluation questionnaires, including the GHQ-28-SS (general health questionnaire suicide scale), AHS (adult hope scale), and K10 (Kessler psychological distress scale). Participant engagement rates and semi-structured interviews were used to explore program acceptability. In total, 142 people were engaged with the PAUSE pilot between 24 August 2017 and 11 January 2020. There were no significant gender differences in engagement. The suicidal ideation scores decreased, and the hope scores increased after participation in PAUSE. A thematic analysis revealed that participants identified that the key program mechanisms were holistic and responsive support, ongoing social connectedness, and having peer workers who understood their experiences and treated them like people rather than clients. The small number of participants and lack of a control group limited the result generalizability. The findings suggest that PAUSE was an effective and acceptable model for supporting people following suicide-related hospitalisations in this pilot sample.
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Affiliation(s)
- Mandy Gibson
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD 4122, Australia
| | - Nick Moreau
- Brook Red Mental Health Charity Ltd., Brisbane, QLD 4122, Australia
| | | | - David Crompton
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD 4122, Australia
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Sullivan SR, Myhre K, Mitchell EL, Monahan M, Khazanov G, Spears AP, Gromatsky M, Walsh S, Goodman A, Jager-Hyman S, Green KL, Brown GK, Stanley B, Goodman M. Suicide and Telehealth Treatments: A PRISMA Scoping Review. Arch Suicide Res 2022; 26:1794-1814. [PMID: 35137677 DOI: 10.1080/13811118.2022.2028207] [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: 11/02/2022]
Abstract
BACKGROUND This PRISMA scoping review explored worldwide research on the delivery of suicide-specific interventions through an exclusive telehealth modality. Research over telehealth modalities with suicidal individuals highlights the importance of facilitating participants' access to treatments despite location and circumstances (e.g., rural, expenses related to appointments, etc.). AIM The review sought evidence of outcomes of trials or projects in which both the patient and therapist attended sessions conjointly and openly discussed suicide over a telehealth modality (e.g., phone, zoom). METHOD To explore this topic the authors searched for research trials and quality improvement projects using Ovid Medline, Ovid Embase, Ovid PsycINFO, EBSCO Social Services Abstracts, and Web of Science on 3/3/2021. RESULTS Nine different articles were included that each spanned distinct treatments, with eight being research studies and one being a quality improvement project. LIMITATIONS Publications featuring ongoing or upcoming research in which complete study results were not available did not meet inclusion criteria for this review. CONCLUSION Several important research gaps were identified. While this approach has been largely understudied, exclusive telehealth delivery of suicide-specific interventions has great potential for the prevention of suicidality, especially in the era of COVID-19 and beyond.
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Rostami M, Rahmati-Najarkolaei F, Salesi M, Azad E. A Systematic Review of Suicide Prevention Interventions in Military Personnel. Arch Suicide Res 2022; 26:481-499. [PMID: 33403933 DOI: 10.1080/13811118.2020.1848669] [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: 10/22/2022]
Abstract
OBJECTIVE In response to the increasing rates of suicide in military personnel throughout the world, there is an increasing focus on the development and implement of interventions aimed at preventing suicide among this group. Therefore, the goal of the present systematic review was to examine the effectiveness of interventions focused on preventing suicidal ideation and behavior in military personnel. METHOD Search for articles was conducted in PsycINFO, PubMed, Web of Science, EMBASE, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), IranMedex, Scientific Information Database (SID), and MagIran. International databases were searched from June 2008 to May 2019, and Iranian databases were searched from their inception to May 2019. RCT and non-RCT studies focused on the effectiveness of preventive interventions for suicide in military personnel were included in the analysis. Narrative synthesis of results was the main strategy for data analysis. RESULTS According to the inclusion and exclusion criteria, 18 articles were selected. Interventions were divided into four categories according to their nature: interventions based on psychotherapy, interventions based on crisis management, interventions based on pharmacotherapy, and community-based interventions. In addition, most studies had moderate methodological quality. CONCLUSION Most of the preventive interventions were effective in reducing suicidal ideation and behavior in military personnel; however, in some cases, there were serious challenges in terms of effectiveness. Interventions based on cognitive-behavioral approaches constitute a significant portion of the interventions. Overall, RCTs and non-RCTs, especially community-based studies, need to use more rigorous examinations in order to gain research and clinical support. HIGHLIGHTSInterventions based on psychotherapy and community-based interventions were the most commonly used interventions, respectively.The majority of interventions based on psychotherapy came from cognitive-behavioral approaches.There are few evidence-based studies on prevention of suicide in military personnel.
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Liu H, Chen G, Li J, Hao C, Zhang B, Bai Y, Song L, Chen C, Xie H, Liu T, Caine ED, Hou F. Sequential multiple assignment randomised trial of a brief contact intervention for suicide risk management among discharged psychiatric patients: an implementation study protocol. BMJ Open 2021; 11:e054131. [PMID: 34836907 PMCID: PMC8628333 DOI: 10.1136/bmjopen-2021-054131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The postdischarge suicide risk among psychiatric patients is significantly higher than it is among patients with other diseases and general population. The brief contact interventions (BCIs) are recommended to decrease suicide risk in areas with limited mental health service resources like China. This study aims to develop a postdischarge suicide intervention strategy based on BCIs and evaluate its implementability under the implementation outcome framework. METHODS AND ANALYSIS This study will invite psychiatric patients and family members, clinical and community mental health service providers as the community team to develop a postdischarge suicide intervention strategy. The study will recruit 312 patients with psychotic symptoms and 312 patients with major depressive disorder discharged from Shenzhen Kangning Hospital (SKH) in a Sequential Multiple Assignment Randomised Trial. Participants will be initially randomised into two intervention groups to receive BCIs monthly and weekly, and they will be rerandomised into three intervention groups to receive BCIs monthly, biweekly and weekly at 3 months after discharge according to the change of their suicide risk. Follow-ups are scheduled at 1, 3, 6 and 12 months after discharge. With the intention-to-treat approach, generalised estimating equation and survival analysis will be applied. This study will also collect qualitative and quantitative information on implementation and service outcomes from the community team. ETHICS/DISSEMINATION This study has received ethical approval from the Ethics Committee Review Board of SKH. All participants will provide written informed consent prior to enrolment. The findings of the study will be disseminated through peer-reviewed scientific journals, conference presentations. A project report will be submitted to the National Natural Science Foundation of China as the concluding report of this funded project, and to the mental health authorities in the Shenzhen to refine and apply evidence-based and pragmatic interventions into health systems for postdischarge suicide prevention. TRIAL REGISTRATION NUMBER NCT04907669.
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Affiliation(s)
- Huiming Liu
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Guanjie Chen
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Jinghua Li
- Sun Yat-sen Global Health Institute, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
| | - Chun Hao
- Sun Yat-sen Global Health Institute, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
| | - Bin Zhang
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Yuanhan Bai
- Department of Bipolar Disorders, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Liangchen Song
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Chang Chen
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Haiyan Xie
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Tiebang Liu
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Eric D Caine
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Fengsu Hou
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
- Sun Yat-sen Global Health Institute, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
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Ferracuti S, Barchielli B, Napoli C, Fineschi V, Mandarelli G. Evaluation of official procedures for suicide prevention in hospital from a forensic psychiatric and a risk management perspective. Int J Psychiatry Clin Pract 2020; 24:245-249. [PMID: 32362180 DOI: 10.1080/13651501.2020.1759647] [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: 10/24/2022]
Abstract
Background: Suicide is a severe public health problem, in 2008 the Italian ministerial recommendation n° 4 on the management of suicide defined key areas for the identification of suicidal risk in hospital wards. The guidelines are important in defining professional liability issues, in line with Law 24 of 8/3/2017 'Gelli-Bianco'. Our study aimed to investigate the appropriateness of the official documents on suicide prevention delivered by Italian hospitals and their compliance with the ministerial recommendation.Methods: The Italian hospitals' public procedures on suicide prevention issued between 2008 and 2019 (n = 33) were retrieved thorough web search and further evaluated according to their compliance with the 2008 Italian ministerial recommendations.Results: The guidelines documents were generally in line with the ministerial recommendation. However, we found a lack of implementation in the specific training of health professionals. Most guidelines provided no risk stratification, nor specific procedures for different risk degrees or diagnoses. More than half of the documents did not report standardised tools for the assessment of suicidal risk.Conclusions: The public procedures on suicide prevention in Italian hospitals present general indications, leaving room for interpretation. Public procedures should be implemented with greater attention to the elements of judgement in the assessment of suicidal risk.KEY POINTSProcedures for suicide prevention are of uttermost importance for psychiatrist working in hospital.Standards in suicide risk evaluations are needed.Comparison between procedures can improve risk assessment and evaluation.
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Affiliation(s)
- Stefano Ferracuti
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Christian Napoli
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedical Sciences, Sapienza University of Rome, Rome, Italy
| | - Gabriele Mandarelli
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari "Aldo Moro", Bari, Italy
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Obeid JS, Dahne J, Christensen S, Howard S, Crawford T, Frey LJ, Stecker T, Bunnell BE. Identifying and Predicting Intentional Self-Harm in Electronic Health Record Clinical Notes: Deep Learning Approach. JMIR Med Inform 2020; 8:e17784. [PMID: 32729840 PMCID: PMC7426805 DOI: 10.2196/17784] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/25/2020] [Accepted: 05/21/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Suicide is an important public health concern in the United States and around the world. There has been significant work examining machine learning approaches to identify and predict intentional self-harm and suicide using existing data sets. With recent advances in computing, deep learning applications in health care are gaining momentum. OBJECTIVE This study aimed to leverage the information in clinical notes using deep neural networks (DNNs) to (1) improve the identification of patients treated for intentional self-harm and (2) predict future self-harm events. METHODS We extracted clinical text notes from electronic health records (EHRs) of 835 patients with International Classification of Diseases (ICD) codes for intentional self-harm and 1670 matched controls who never had any intentional self-harm ICD codes. The data were divided into training and holdout test sets. We tested a number of algorithms on clinical notes associated with the intentional self-harm codes using the training set, including several traditional bag-of-words-based models and 2 DNN models: a convolutional neural network (CNN) and a long short-term memory model. We also evaluated the predictive performance of the DNNs on a subset of patients who had clinical notes 1 to 6 months before the first intentional self-harm event. Finally, we evaluated the impact of a pretrained model using Word2vec (W2V) on performance. RESULTS The area under the receiver operating characteristic curve (AUC) for the CNN on the phenotyping task, that is, the detection of intentional self-harm in clinical notes concurrent with the events was 0.999, with an F1 score of 0.985. In the predictive task, the CNN achieved the highest performance with an AUC of 0.882 and an F1 score of 0.769. Although pretraining with W2V shortened the DNN training time, it did not improve performance. CONCLUSIONS The strong performance on the first task, namely, phenotyping based on clinical notes, suggests that such models could be used effectively for surveillance of intentional self-harm in clinical text in an EHR. The modest performance on the predictive task notwithstanding, the results using DNN models on clinical text alone are competitive with other reports in the literature using risk factors from structured EHR data.
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Affiliation(s)
- Jihad S Obeid
- Medical University of South Carolina, Charleston, SC, United States
| | - Jennifer Dahne
- Medical University of South Carolina, Charleston, SC, United States
| | - Sean Christensen
- Medical University of South Carolina, Charleston, SC, United States
| | - Samuel Howard
- Medical University of South Carolina, Charleston, SC, United States
| | - Tami Crawford
- Medical University of South Carolina, Charleston, SC, United States
| | - Lewis J Frey
- Medical University of South Carolina, Charleston, SC, United States
| | - Tracy Stecker
- Medical University of South Carolina, Charleston, SC, United States
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Tseng MCM, Chang CH, Liao SC, Yeh YC. Rates and trends of psychiatric inpatient and postdischarge suicides in Taiwan, 2002-2013: a national register-based study. Soc Psychiatry Psychiatr Epidemiol 2019; 54:591-598. [PMID: 30637434 DOI: 10.1007/s00127-019-01656-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE In contrast to the downsizing trend of psychiatric beds in the Western world, the psychiatric bed capacity in Taiwan has steadily increased in recent decades. This study aimed to assess the suicide rates and their variations over time among psychiatric inpatients and recently discharged patients. METHODS Data on psychiatric inpatients admitted from 2002 to 2013 were extracted from the psychiatric inpatient registry of the National Health Insurance and merged with information from the Cause of Death data by means of unique identified numbers. Suicides occurring during admission and within 90 days after discharge were defined as inpatient and postdischarge suicides, respectively. Calendar year was fitted as a continuous variable in multivariate Poisson regression models to evaluate these rates over time. The analyses were adjusted for sex, age, primary psychiatric diagnosis, and number of admissions in the preceding year. RESULTS The overall inpatient suicide rate was very low (81 per 100,000 person-years). It decreased significantly from 146 to 74 per 100,000 person-years over the study period. This fall was observed among both genders and across all psychiatric diagnoses. The postdischarge suicide rate was comparatively high (1108 per 100,000 person-years) and did not show statistically significant change over the study period. CONCLUSIONS Our results suggest that efforts to increase public awareness of mental disorders and efficient utilization of psychiatric inpatient care are essential for suicide prevention despite the comparatively high bed capacity. The discharge plans of inpatients should be bridged with population suicide prevention programs for continuity of care after discharge.
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Affiliation(s)
- Mei-Chih Meg Tseng
- Department of Psychiatry, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 22060, Taiwan, Republic of China. .,Department of Psychiatry, National Taiwan University College of Medicine, Taipei, 10051, Taiwan, Republic of China. .,Department of Nursing, Oriental Institute of Technology, New Taipei City, 22061, Taiwan, Republic of China.
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, 10055, Taiwan, Republic of China
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University College of Medicine, Taipei, 10051, Taiwan, Republic of China.,Department of Psychiatry, National Taiwan University Hospital, Taipei, 10002, Taiwan, Republic of China
| | - Yi-Chun Yeh
- Department of Medical Research, National Taiwan University Hospital, Taipei, 10055, Taiwan, Republic of China
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Liang Y, Yang M, Zhao G, Mao Y, Zhang L, Hu Z. Relationship between mortality in people with mental disorders and suicide mortality in China during 2000 to 2014: An observational study. Medicine (Baltimore) 2018; 97:e13359. [PMID: 30544403 PMCID: PMC6310536 DOI: 10.1097/md.0000000000013359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Suicide is one of the top 10 causes of death in many countries. Although there are many studies on mental disorders, few studies have examined mortality in suicide population and mentally ill population. This study examined the association between mortality and mental disorders using data on suicides and mental disorders in China. Data from China's Health and Family Planning Statistical Yearbook for 2000 to 2014 were used to analyze the relationship between mortality associated with suicide and mental disorders. The analyses found that mortality among people with mental disorders dropped from 5.42/10 million in 2000 to 2.68/10 million in 2014, decreased more among females than males, and differed between urban and rural areas; that suicide mortality dropped from 10.79/10 million in 2000 to 6.79/10 million in 2014; the decrease was greater in women than in men, with suicide being highest among male residents of cities; and no significant correlation was found between mortality among persons with mental disorders and suicide mortality. There was no correlation between suicide mortality and mental-disorder mortality during 2000 to 2014; however, overall mortality decreased more among females than males during this period.
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Affiliation(s)
- Yundan Liang
- Department of Pathology and Pathophysiology, Chengdu Medical College
| | - Mengchang Yang
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan
| | - Gaofeng Zhao
- Mental Health Hospital of Jining, Jining, Shandong
| | - Yuanyi Mao
- Department of Forensic Psychiatry, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Lushun Zhang
- Department of Pathology and Pathophysiology, Chengdu Medical College
| | - Zeqing Hu
- Department of Forensic Psychiatry, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China
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