Perceptions towards charcoal-burning suicide and the surge of this lethal method in Taiwan.

OBJECTIVE: Whether sociocultural perceptions of charcoal-burning suicide have influenced its rapid increase in prevalence is unclear. We aimed to explore perceptions of Taiwan's general population regarding charcoal-burning suicide, their personal belief in life after death, and related feelings of thoughts associated with those who attempt charcoal-burning suicide. METHODS: An online web-based survey, focussing on sociocultural attitudes towards death, as well as perceptions towards charcoal-burning suicide, and those who attempt charcoal-burning suicide, was conducted from 14 January to 14 June 2016. RESULTS: In total, 1343 adults completed the online survey (mean age of 33.46; 66.6% women). Notably, 90.3% of participants considered charcoal burning to be an easily accessible suicide method. Multivariable analyses revealed that among the examined factors, the perceived 'painlessness' of charcoal-burning suicide was associated with an over seven-fold increased risk of choosing charcoal-burning suicide (OR = 7.394; p < 0.001; 95% CI: 2.614-20.912). CONCLUSION: As reflected in this study, charcoal-burning suicide is perceived as easily accessible and painless. The perceived 'painlessness' may be the factor that distinguishes the choice of charcoal-burning suicide from that of other suicide methods. Future efforts to target these perceptions regarding charcoal-burning suicide may be warranted in both media reporting and suicide prevention programmes.

Comparison of treatment effectiveness and medical costs for different long-acting injectable antipsychotics in patients with schizophrenia in Taiwan: A nationwide population-based cohort study.

OBJECTIVE: To assess the comparative effectiveness and medical costs of five long-acting injectable (LAI) antipsychotics, flupentixol, fluphenazine, haloperidol, risperidone, and clopentixol/zuclopentixol, in patients with schizophrenia. METHOD: We conducted a retrospective cohort study of patients with schizophrenia using data from Taiwan's National Health Insurance Research Database. Patients aged 15years or older who began treatment with LAI antipsychotics between June 1, 2004 and December 31, 2008 were enrolled and followed for 1year. We evaluated the medical costs and treatment effectiveness, which was assessed using the rates of treatment discontinuation, psychiatric hospitalization, and emergency department visits. Risperidone was used as a reference group. RESULTS: Compared to risperidone, flupentixol was associated with higher hazard ratios of treatment discontinuation and psychiatric hospitalization, fluphenazine was associated with higher hazard ratios of treatment discontinuation, and haloperidol was associated with higher rates of psychiatric hospitalization and emergence department visits. However, fluphenazine, flupentixol, and haloperidol were associated with lower medical costs compared to risperidone. Clopentixol/zuclopentixol was inferior to risperidone in treatment effectiveness and medical cost. CONCLUSIONS: Our findings suggest that patients taking the LAI risperidone may be more effective in some but not all outcome measures; however, risperidone was also associated with higher medical costs in the Taiwanese healthcare setting.

Utilization of traditional Chinese medicine in patients treated for depression: a population-based study in Taiwan.

OBJECTIVES: Traditional Chinese medicine (TCM) has been used to treat depression-like symptoms in Taiwan. We aim to examine factors associated with utilization of TCM in patients with depression and to test whether the use of TCM would impact the use of psychiatric services with a subsequent impact on healthcare costs. METHODS: Adult patients (n = 216,557) who received antidepressant treatment for depression in 2003 was identified in the National Health Insurance Research Database in Taiwan. A Two-Part model was conducted. A multivariate logistic regression was employed to explore factors associated with the use of TCM, with a particular focus on baseline comorbidities, painful physical symptoms (PPS), and frequency of psychiatric service contacts over the ensuing 12-month study period. Multivariate generalized linear modeling was then applied to examine factors associated with healthcare costs for TCM users. RESULTS: More than 40% of individuals prescribed with antidepressant treatments for depression used TCM services. Younger age, female gender, the presence of certain comorbid mental/physical illnesses or PPS, as well as having fewer psychiatric service contacts were found to be associated with the use of TCM services. These factors also affected TCM costs for users; the TCM costs equaled to 30% of costs of psychiatric out-patient services for TCM users. CONCLUSIONS: The current study suggested a set of significant factors which could influence use and cost of TCM services for patients with depression. Utilization of TCM services could have a substantial impact on use of psychiatric services and healthcare costs for patients with depression.

Cognitive-behavioral therapy for sleep disturbance decreases inflammatory cytokines and oxidative stress in hemodialysis patients.

Sleep disturbance is common in dialysis patients and is associated with the development of enhanced inflammatory responses. Cognitive-behavioral therapy is effective for sleep disturbance and reduces inflammation experienced by peritoneal dialysis patients; however, this has not been studied in hemodialysis patients. To determine whether alleviation of sleep disturbance in hemodialysis patients also leads to less inflammation, we conducted a randomized controlled interventional study of 72 sleep-disturbed hemodialysis patients. Within this patient cohort, 37 received tri-weekly cognitive-behavioral therapy lasting 6 weeks and the remaining 35, who received sleep hygiene education, served as controls. The adjusted post-trial primary outcome scores of the Pittsburgh Sleep Quality Index, the Fatigue Severity Scale, the Beck Depression Inventory, and the Beck Anxiety Inventory were all significantly improved from baseline by therapy compared with the control group. The post-trial secondary outcomes of high-sensitive C-reactive protein, IL-18, and oxidized low-density lipoprotein levels significantly declined with cognitive-behavioral therapy in comparison with the control group. Thus, our results suggest that cognitive-behavioral therapy is effective for correcting disorganized sleep patterns, and for reducing inflammation and oxidative stress in hemodialysis patients.

Standardized mortality ratio of inpatient suicide in a general hospital.

Inpatient suicide rates are seldom reported using age-standardized methods. This study aimed to estimate the standardized suicide rate in a general hospital. A total of 27 suicidal patients were identified by the adverse event reports during hospitalization from 1995 to 2004. Standardized suicide mortality ratios (SMR) were examined using the Poisson regression model. The SMR of inpatient suicide was 8.25 (95% CI = 5.67-12.06). Hospital suicide rates were considerably higher than the corresponding general population rates for all age groups and were particularly high in age categories of 25-29, 30-34, 40-44, and 55-59 years after controlling for sex and calendar year. Hospitalized patients had an eight times higher risk of suicide mortality than that of the general population. While the elderly are at increased risk for suicide in the general population, young- and middle-aged patients are the age group at risk for suicide mortality during hospitalization.

Inpatient suicide in a general hospital.

OBJECTIVES: This study aimed to compare the characteristics of psychiatric and nonpsychiatric suicidal inpatients in one general hospital and examine the predictors of completed suicide in the patients with suicidal acts during hospitalization. METHODS: One hundred ten study subjects were identified by the adverse event reports of suicidal acts during hospitalization from 1995 to 2004. Demographic data and clinical information were collected by chart reviews. RESULTS: Psychiatric inpatients with suicidal acts were mainly younger females with psychiatric diagnoses and previous suicide attempts. Nonpsychiatric suicidal inpatients had less suicide communication, performed suicidal acts more rapidly after admission and used more violent suicidal methods than the psychiatric inpatients did. Suicidal acts performed outside the hospital, use of violent suicidal methods and male gender increased the risk of suicide mortality in our suicidal inpatients. CONCLUSION: This study suggests that suicide prevention efforts need to be tailored in psychiatric and nonpsychiatric wards according to differing patient risk characteristics in these patient cohorts.

Predictors of treatment response and length of stay for inpatients with major depression.

BACKGROUND/PURPOSE: Depressive illness is highly recurrent, frequently chronic and associated with a high level of functional disability. Studies have shown that depression combined with anxiety is the most common reason for admission worldwide. This study aimed to examine the variables associated with treatment response or length of stay (LOS) among a group of inpatients with major depression. METHODS: The attending psychiatrist rated severity of depression (using the Hamilton Rating Scale for Depression, HAM-D) of the patients (n = 67), and the patients were asked to complete several self-rating scales (including the Beck Depression Inventory, BDI) on admission. Three days before discharge, these assessments were repeated. Logistic regression models were used to examine the variables of remission status (defined by the HAM-D or the BDI) and LOS (dichotomized by a median of 25 days), respectively. RESULTS: The remission rates of depression at discharge defined by the HAM-D (

Intermediate-term outcome of psychiatric inpatients with major depression.

BACKGROUND/PURPOSE: A wide range of recovery rates has been reported during the 1st year of follow-up inpatients with depression, and there is a lack of consensus regarding which clinical and psychosocial variables are associated with prognosis. This study investigated the outcome of inpatients with a major depressive episode at 10-22 months (mean +/- SD = 14.0 +/- 3.4 months) of follow-up and the associated psychosocial and clinical variables. METHODS: The demographic and clinical characteristics of 67 inpatients with a DSM-IV major depressive episode were assessed at admission, discharge and 1 year after the initial assessment. A logistic regression model was used to examine the predictive factors of depressive status at follow-up. RESULTS: At the 1-year follow-up, 12 patients could not be located, one refused further interview and one had committed suicide 1 month after discharge. Eighty percent of patients had follow-up examinations. Out of 67 patients, 31 (47%) underwent a DSM-IV diagnosis (29 with major depression and two with minor depression) and 22 (33%) recovered. Low socioeconomic status (p = 0.05), long duration of illness before admission (p = 0.03) and number of previous hospitalizations (p = 0.04) were predictive factors for a depressive morbidity at 10-22 months. CONCLUSION: At follow-up, almost half of the discharged depressive patients were still depressed. Screening for predictive factors of chronic depressive morbidity facilitates better outcome by considering the heterogeneity of psychopathology that can lead to failure in the treatment plan.