Sex-specific incidences and risk profiles of suicide mortality in people with alcohol dependence in Taiwan

BACKGROUND AND AIMS

Alcohol-related mental health burden and suicidality impose heavy burdens on global public health. This study measured the sex-specific incidence and risk profiles of suicide mortality in individuals with alcohol dependence in a non-western context.

DESIGN

In this prospective cohort study, individuals with alcohol dependence who were enrollees in Taiwan's National Health Insurance Research database were followed-up over an almost 15-year period. Their data were linked to the national mortality registration database.

SETTING

Taiwan.

PARTICIPANTS

In total, 278 345 patients with alcohol dependence were enrolled and followed-up from 1 January 2001 to 31 December 2016.

MEASUREMENTS

We calculated the incidence and standardized mortality ratio (SMR) of suicide in the cohort and stratified the suicide methods by sex. Sex-specific risk profiles (based on demographic characteristics and physical and psychiatric comorbidities) were generated through Cox proportional hazards regression.

FINDINGS

The suicide rates of men and women were 173.5 and 158.9 per 100 000 person-years, respectively (P = 0.097). The SMR of suicide mortality was more than two times higher in women than in men (6.6 versus 15.0). Women and men adopted different suicide methods. A multivariable Cox proportional hazards regression with a time-varying model revealed that depressive disorder was a common risk factor for suicide in both men and women [adjusted hazard ratio (aHR) = 3.03, 95% confidence interval (CI) = 2.77-3.31 versus aHR = 5.46, 95% CI = 4.65-6.40]. For men, receiving a diagnosis of alcohol dependence between the ages of 25 and 44 years, being unemployed and having schizophrenia, drug-induced mental disorder or sleep disorder were risk factors for suicide.

CONCLUSION

In Taiwan, the incidence of suicide in patients with alcohol dependence is substantially higher than that of the general population. The standardized mortality ratio of suicide in women with alcohol dependence is more than twice that of men with alcohol dependence.

Sex and gender differences in the development of empathy

The topic of typical sex and gender difference in empathy is examined in both a developmental and neuroscientific perspective. Empathy is construed as a multi-layered phenomenon with various degrees of complexity unfolding in ontogeny. The different components of empathy (i.e., affective, cognitive, and prosocial motivation) will be discussed as they interact and are expressed behaviorally. Significant sex/gender differences in empathy are discussed in relation to putative bottom-up or top-down processes underlying empathetic responses. The early onset and the pervasive presence of such sex/gender differences throughout the lifespan are further discussed in light of social and neurobiological modeling factors, including early socialization, brain's structural/functional variances, as well as genetics and hormonal factors.

[Health and work in a gender perspective.]

OBJECTIVES

A literature review was performed to highlight which work-related diseases express sex/gender differences in health outcomes and focus the main limits of studies in this field.

METHODS

The research, carried out on PubMed by specific search string, identified 4828 articles (1997-2017 period) of which 381 are eligible for review (4-22%, depending on the disease).

RESULTS

Among them, 68% reported sex/gender differences in health outcomes, which in most cases appear to be due to different exposure and/or work segregation rather than to biological differences. However, few studies place this assessment among the research goals and results are almost never discussed and hypothesis are seldom formulated about any observed differences.

CONCLUSIONS

It seems necessary to use research methodologies and study design that can detect and explain the described complexity and useful in defining appropriate preventive strategies.