Effectiveness of aftercare program for suicide ideators: Real-world evidence from National Suicide Surveillance System in Taiwan.

Aftercare programs' effectiveness for suicide ideators has seldom been reported. This study assessed rates and factors related to the recurrence of suicide-related episodes after the index suicidal ideation episode, index cases, and family members receiving aftercare. This is a secondary data analysis of 1787 suicidal ideation episodes from 1557 individuals reported to the National Suicide Surveillance System in New Taipei City, Taiwan, from January 2012 to June 2013 and followed up until September 2013. Among 1787 index suicidal ideations, 19.1% had recurrences of suicide-related episodes, including suicidal ideation (11.9%), attempt (6.7%), and death (0.5%) within 2 years after index ideation. These recurrences were significantly reduced after the index cases received aftercare twice, three, and four or higher. Family members receiving aftercare twice or more were associated with reduced suicidality in the index cases. Receiving aftercare among index cases was associated with being a woman, suicide due to occupation/finance, and reporting from suicide hotlines. Receiving aftercare among family members was associated with the index cases aged ≤ 19 years old, suicide reasons related to school, occupation/finance, and reporting from schools and hospitals. Aftercare programs for suicide ideators and family members of adolescent suicide ideators (aged ≤ 19 years old) decreased subsequent episodes of suicidal behavior.

Clinical Characteristics of Pesticide Self-Harm as Associated with Suicide Attempt Repetition Status.

PURPOSE: Previous suicide behavior predicts future suicide risk. Studies of suicide repetition are important for suicide prevention. This study examined the clinical characteristics and psychiatric comorbidities of pesticide self-harm as associated with suicide attempt repetition status. PATIENTS AND METHODS: This retrospective, observational study included patients admitted to a medical center in northern Taiwan between 2000 and 2015 following suicide attempts by pesticide. Diagnoses were made by a consultation-liaison psychiatry team based on the DSM IV-TR criteria. Independent samples t-test was used to analyze the quantitative variables and Pearson's Chi-squared test with a Bonferroni adjustment for categorical variables. Univariate binary logistic regression analysis was conducted to determine the predictors for repeated suicide attempt and multivariate binary logistic regression analysis to identify significant associated factors. RESULTS: Among 151 patients, organophosphate pesticides were the most used (80.8%). The average age was 52.9±17.2 years. Most patients were married males from rural areas, with depressive disorder most often diagnosed (40.4%). Nearly one-third of them were suicide repeaters (n=43, 28.5%); these patients were less likely to be married (53.5%, p=0.001), had previously used psychiatric services (72.1%, p<0.001) and chose complex suicide (46.5%, p=0.014) more often compared to nonrepeaters. No significant differences were found between repeaters and nonrepeaters regarding psychiatric comorbidities. Multivariate logistic regression analysis revealed that marital status (odds ratio: 2.916, 95% confidence interval: 1.234-6.891, p=0.015) and previous psychiatric services usage (odds ratio: 6.897, 95% confidence interval: 3.012-15.625, p<0.001) were significant risk factors associated with suicide repetition. CONCLUSION: Pesticide suicide repeaters were characterized by less likely to be married and more likely to use psychiatric services before suicide attempts. These features help ensuring that the needs of people who have made a suicide attempt are addressed, and it reduces the likelihood of repetition.

Perceptions, clinical characteristics, and other factors associated with prolonged and high daily dose of benzodiazepine use among patients with anxiety or depressive disorders.

BACKGROUND: Benzodiazepines (BZDs) have been widely used to treat anxiety; however, the risk of adverse health effects caused by their long-term use is high. This study examined the factors associated with the duration and higher daily dose of BZDs use among a population with anxiety or depressive disorders. METHODS: A cross-sectional study design was used. Patients from a psychiatric outpatient department who had been prescribed BZDs were recruited. Data were collected from 250 patients. RESULTS: Nearly 94% of patients were long-term BZDs users. The mean duration of BZDs use was 5.5 years; and mean defined daily dose (DDD) of BZDs use, converted to diazepam milligram equivalent (DDD), was 1.53 DME-DDD. Patients who knew more about alternative treatments were less prone to use BZD longer. Patients aged 65 years or older and those with difficulty falling asleep were more prone to use BZDs longer. Patients who were currently taking BZDs at higher daily dose were those who felt more depressed, prescribed second generation antipsychotics, suffered from disrupted sleep, less aware of alternative treatments, had comorbid chronic physical illness, and were current smokers. LIMITATIONS: The cross-sectional study design limited its ability to confirm causal relationships. CONCLUSIONS: Long-term and excessive daily dose of BZDs use in patients with depressive or anxiety disorders needs to be noted. Providing information or program of non-pharmacological treatment in reducing anxiety and improving specific sleep disturbance is suggested. Elderly, suffering from depressive mood, had comorbid chronic physical illness need to be targeted for further intervention.

Psychiatric comorbidities in patients with intentional methanol intoxication.

BACKGROUND: Intentional methanol intoxication (IMI) is an emerging public health issue in Asian countries, but few data are available in the literature on underlying psychiatric comorbidities in these suicide attempters. PATIENTS AND METHODS: We conducted a retrospective chart review on patients with methanol intoxication (MI) treated at Chang-Gung Memorial Hospital, Linkou, Taiwan during 2000-2016. Of the 56 cases of documented MI, 16 were IMI. Baseline demographic, clinical, laboratory, psychiatric diagnoses, and mortality data were collected and analyzed. RESULTS: Patient group with IMI had more females (62.5% vs 7.5%, P=0.000), less alcohol consumption (33.3% vs 92.5%, P=0.000), and less smoking (40.0% vs 79.5%, P=0.009), but higher past psychiatric disease (73.3% vs 10.0%, P=0.000) and past suicide attempts (81.1% vs 2.5%, P=0.000) than patient group with unintentional MI (UMI). Pesticides (50.0%) comprised the most common source used for suicide, followed by industrial methanol (37.5%). There was no significant difference in mortality rates between these two group (25.0% vs 22.5%, P=0.548). Twelve (75.0%) survivors of IMI were referred to a psychiatric consultation-liaison team, and depressive disorder (58.3%) and adjustment disorder (25.0%) were common. CONCLUSION: There is a female predominance and a high prevalence of psychiatric comorbidities, namely depression and adjustment disorder in patients with IMI. Besides, alcohol consumption is a prevalent but not adequately treated condition in UMI group.

The effects of the empowerment education program in older adults with total hip replacement surgery.

AIMS: To measure the effectiveness of an education empowerment program on primary (self-efficacy and self-care competence) and secondary outcomes (Activities of Daily Life, mobility, depressive mood and quality of life) for older adults with total hip replacement surgery. BACKGROUND: Degenerative arthritis is a common and serious chronic illness that impacts the quality of life of older adults. As joints continue to degenerate and the hip damaged by arthritis, activities of daily life will be difficult to perform due to severe hip pain and joint stiffness. Therefore, hip replacement surgery should be considered and effective nursing care should be provided to improve the recovery of older adults. DESIGN: A prospective randomized control trial. METHODS: A trial was conducted from September 2013 - May 2014 in two hospitals in northern Taiwan. 108 participants were random assigned to either the education empowerment group or in the comparison group. The researchers collected baseline data at admission and outcomes on the day of discharge, one month after and three months after the discharge. RESULTS: After the interventions, the education empowerment group participants demonstrated significantly higher self-care competence and self-efficacy and lower depressive inclinations compared with those in the comparison group. Participants in both groups significantly improved on activities of daily life, mobility and quality of life over the course of the interventions. CONCLUSION: This education empowerment intervention was very effective in enhancing participants' outcomes. Moreover, involving both older adults and their caregivers for the participation this program is recommended for a greater impact.

Evaluation of a combined cognitive-behavioural and exercise intervention to manage fear of falling among elderly residents in nursing homes.

OBJECTIVES: Although the fear of falling is common among elderly residents in long-term care facilities, interventions developed for fear of falling management is very rare. Of these limited interventions, most were exercise interventions with only limited testing. The cognitive-behavioural intervention can decrease the fear of falling; however no intervention of the kind was developed and assessed to decrease fear of falling among the elderly in long-term care facilities. The purpose of this study was to examine the effectiveness of cognitive-behavioural strategies either with or without exercise in reducing fear of falling among elderly residents in nursing homes. METHOD: A prospective randomized control trial was conducted in six nursing homes in northern Taiwan. Seventy-five elderly participants were randomly assigned to one of the three groups: the comparison group, the cognitive-behavioural strategies with or without exercise group. The fear of falling, falls, depressive inclination, mobility, and muscle strength of extremities were collected at the two-month and five-month follow-up sessions, in which the progress of the patients were assessed. RESULTS: The mixed model analysis revealed that elderly adults in the combination experimental group had significant improvements compared with the other two groups on fear of falling, depressive inclination, mobility, and muscle strength at five months. The incidences of falls, post intervention, in both experimental groups were significantly lower than those in the comparison group. CONCLUSIONS: The results suggest that the combination intervention helped elderly residents manage their fear of falling and falls, decrease their depressive inclination, and enhance their mobility and muscle strength.

Effectiveness of individualised intervention on older residents with constipation in nursing home: a randomised controlled trial.

AIMS AND OBJECTIVES: To develop and examine the effectiveness of individualised intervention to reduce constipation among older adults in nursing homes. BACKGROUND: In long-term care facilities, approximately 60-80% of the residents have symptoms of constipation. Constipation may lead to haemorrhoids, faecal impaction, ulcers, intestinal bleeding and can also lead to a decrease in quality of life. Although a high prevalence of constipation in older adults can be seen, there is a lack of empirical evidence for delivering interventions based on individual risk factors of constipation. Many factors cause constipation but the risk factors are different for each individual. DESIGN: A prospective, randomised control trial conducted in northern Taiwan. METHODS: Nursing home residents (n = 43) were randomly assigned to either the control group or the experimental group. The control group received no extra care from the researcher while the experimental group received an individualised intervention and an eight-week follow-up. Participants were assessed using the Bristol Stool Form Scale, the Patient Assessment of Constipation Symptoms, types and dosages of laxative, and bowel sound observations. Data were taken at baseline, four weeks as well as eight weeks after the intervention. RESULTS: The participants in the experimental group had a significantly higher increase in the frequency of defecation (group effect, p = 0·029) and in bowel sounds (interaction effect, p = 0·010) compared to those in the control group. However, the two groups did not differ significantly in symptoms and the severity of the constipation symptoms, Bristol Stool Form and use of laxatives. CONCLUSIONS: The results of this trial suggest that the individualised intervention may be appropriate for decreasing constipation among nursing home residents and encourage further study and confirmation. RELEVANCE TO CLINICAL PRACTICE: Using individualised intervention to enhance the self-care ability related to constipation among older adults is recommended.

Quality of life in Parkinson's disease patients: validation of the Short-Form Eight-item Parkinson's Disease Questionnaire (PDQ-8) in Taiwan.

PURPOSE: This study sought to evaluate the Chinese version of the eight-item Parkinson's Disease Questionnaire (PDQ-8), through standard psychometric techniques. METHODS: A cross-sectional study was conducted on 100 Parkinson's disease patients attending a Movement Disorders Unit. Neurologists' assessments were based on Hoehn and Yahr, Schwab and England and Unified Parkinson's Disease Rating Scales. Patients' self-evaluations included the Taiwanese Depression Questionnaire, the 39-item Parkinson's Disease Questionnaire (PDQ-39) and PDQ-8, pain, and Pittsburgh Sleep Quality Index. Analyses for internal consistency, inter-rater reliability, and construct validity were performed. RESULTS: There was no evidence of floor or ceiling effects. The alpha coefficient was 0.81. Correlation of social support and bodily discomfort with the PDQ-8 was modest (0.46 and 0.36, respectively). PDQ-8 convergent validity with the PDQ-39 was very high (r = 0.96), and known-groups validity proved satisfactory. CONCLUSIONS: The results of this study suggest the PDQ-8 is a valid and reliable disease-specific health-related quality-of-life instrument for Parkinson's disease in Taiwan when used independently of the PDQ-39.