A stress survey in anesthesia personnel in Thailand.

OBJECTIVE: To find out stressful events related to anesthesia and psychological responses in anesthesia personnel. MATERIAL AND METHOD: Three hundred fifty three nurses and 286 doctors from all over the country who currently working in operating theatres participated in this study. Research tools comprised of interactive online anesthesia-related and psychological stress tests. Data were analyzed as mean and standard deviations. Comparisons of all associated factors between groups were performed by the Kolmogorov-Smirnov Two-Sample test and t-test independent. Correlations between groups were determined by Spearman's rho and Pearson's. Statistical significance was defined as p-value less than 0.05 with a 95% confidence interval. RESULTS: Nurses expressed greater worries with impairment of cognitive and immune functions, particularly on night shifts. They had intense responsibility, compounded by lack of experiences and knowledge. Doctors were under stress during the day. This depended on their ages, experiences, morbidity rumors, working hours, and day off after operation, which manifested themselves as disturbances of the autonomic nervous system and emotions. CONCLUSION: Nurse anesthetists expressed their worries, particularly on night shifts. Their psychological distresses were observed as impairment of cognitive and immune functions. Doctors were under professional stress during the day, which came across as disturbances of the autonomic nervous systems and emotions.

Evidence-based nursing-sensitive indicators for patients hospitalized with depression in Thailand.

The aim of this study was to develop and validate nursing-sensitive indicators for patients hospitalized with depression in Thailand. The initial draft, consisting of 12 categories with 37 subcategories, was then evaluated by experts in the US and Thailand. Hospital records were then utilized to evaluate the feasibility and efficacy of the indicators. The finalized instrument consisted of 11 categories with 43 items with a validity of .98 and internal consistency of .88. This is the first set of indicators developed to evaluate nursing-sensitivity for patients hospitalized with a diagnosis of depression in Thailand. Having nursing indicators for depressed patients provides nurses with concrete tools to evaluate their work with depressed patients, allowing these staff to assess their work in a very specific, methodical, and consistent manner. When problems are discovered, both the staff and administration can work to address these issues through training, procedural changes, and departmental shifts.

Factors related to suicide attempts among individuals with major depressive disorder.

BACKGROUND: Major depressive disorder (MDD) is the leading cause of suicidal behaviors. Risk related to suicide attempts among individuals with MDD remains uninvestigated in upper northern Thailand, where the completed suicide rate is the highest in the nation. OBJECTIVE: To examine risk related to suicide attempts among individuals with MDD. METHODS: Individuals diagnosed with MDD using the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10), codes F32.x and F33.x, seeking care at Suanprung Psychiatric Hospital between October 2006 and May 2009 were eligible. All individuals with MDD admitted due to suicide attempts were defined as cases (n = 186), and four controls per case were selected from those who did not attempt suicide on the same day or within a week of case selection (n = 914). Their medical charts were reviewed for sociodemographic and clinical factors influencing suicide attempts using multivariable logistic regression analysis. RESULTS: Factors related to suicide attempts were stressful life events (adjusted odds ratio [OR], 2.32; 95% confidence interval [CI]: 1.27-4.24), alcohol use (adjusted OR, 2.08; 95% CI: 1.29-3.34), intermittent or poor psychiatric medications adherence (adjusted OR, 2.25; 95% CI: 1.44-3.51), up to two previous suicide attempts (adjusted OR, 3.64; 95% CI: 2.32-5.71), more than two previous suicide attempts (adjusted OR, 11.47; 95% CI: 5.73-22.95), and prescribed antipsychotics (adjusted OR, 3.84; 95% CI: 2.48-5.95). Risk factors that were inversely related to suicide attempts were increasing years of MDD treatment; one to five years (adjusted OR, 0.22; 95% CI: 0.11-0.44), over five years (adjusted OR, 0.44; 95% CI: 0.23-0.86), and antidepressant prescribed (norepinephrine [NE] and/or serotonin reuptake inhibitors [SRIs], adjusted OR, 0.28; 95% CI: 0.10-0.78). The final model explained 85.8% probability of suicide attempts. CONCLUSION: Seven key factors suggested from this study may facilitate clinicians to identify individuals with MDD at risk of suicide attempt and provide them close monitoring, timely assessment, and intensive treatments.

A risk-scoring scheme for suicide attempts among patients with bipolar disorder in a Thai patient cohort.

BACKGROUND: In Thailand, risk factors associated with suicide attempts in bipolar disorder (BD) are rarely investigated, nor has a specific risk-scoring scheme to assist in the identification of BD patients at risk for attempting suicide been proposed. OBJECTIVE: To develop a simple risk-scoring scheme to identify patients with BD who may be at risk for attempting suicide. METHODS: Medical files of 489 patients diagnosed with BD at Suanprung Psychiatric Hospital between October 2006 and May 2009 were reviewed. Cases included BD patients hospitalized due to attempted suicide (n = 58), and seven controls were selected (per suicide case) among BD in- and out-patients who did not attempt suicide, with patients being visited the same day or within 1 week of case study (n = 431). Broad sociodemographic and clinical factors were gathered and analyzed using multivariate logistic regression, to obtain a set of risk factors. Scores for each indicator were weighted, assigned, and summed to create a total risk score, which was divided into low, moderate, and high-risk suicide attempt groups. RESULTS: Six statistically significant indicators associated with suicide attempts were included in the risk-scoring scheme: depression, psychotic symptom(s), number of previous suicide attempts, stressful life event(s), medication adherence, and BD treatment years. A total risk score (possible range -1.5 to 11.5) explained an 88.6% probability of suicide attempts based on the receiver operating characteristic (ROC) analysis. Likelihood ratios of suicide attempts with low risk scores (below 2.5), moderate risk scores (2.5-8.0), and high risk scores (above 8.0) were 0.11 (95% CI 0.04-0.32), 1.72 (95% CI 1.41-2.10), and 19.0 (95% CI 6.17-58.16), respectively. CONCLUSION: The proposed risk-scoring scheme is BD-specific, comprising six key indicators for simple, routine assessment and classification of patients to three risk groups. Further validation is required before adopting this scheme in other clinical settings.

Incidence and risk factors of suicide reattempts within 1 year after psychiatric hospital discharge in mood disorder patients.

BACKGROUND: The incidence and risk factors of suicide reattempts within 1 year after psychiatric hospital discharge in mood disorder patients remain uninvestigated in Thailand. OBJECTIVE: To determine incidence and risk factors of suicide reattempts within 1 year after psychiatric hospital discharge in mood disorder patients. METHODS: A retrospective cohort study was conducted by reviewing medical charts at Suanprung Psychiatric Hospital, Chiang Mai, Thailand. Mood disorder patients, diagnosed with the International Statistical Classification of Diseases and Related Health Problems 10th Revision codes F31.x, F32.x, and F33.x, who were admitted owing to suicide attempts between October 2006 and May 2009 were eligible. The influence of sociodemographic and clinical risk factors on suicide reattempts was investigated using Cox's proportional-hazards regression analysis. RESULTS: Of 235 eligible mood disorder patients, 36 (15.3%) reattempted suicide (median 109.5 days, range 1-322), seven (3.0%) completed suicide (median 90 days, range 5-185), and 192 (84.2%) neither reattempted nor completed suicide during follow-up. Of all nonfatal suicide reattempts, 14 patients (38.9%) did so within 90 days. Among suicide completers, one (14.3%) did so 5 days after discharge, and four (57.1%) did so within 90 days. The following three risk factors explained 73.3% of the probability of suicide reattempts: over two previous suicide attempts before the index admission (adjusted hazard ratio [HR] 2.48; 95% confidence interval [CI] 1.07-5.76), being concomitantly prescribed typical and atypical antipsychotics (adjusted HR 4.79; 95% CI 1.39-16.52) and antidepressants, and taking a selective serotonin reuptake inhibitor alone (adjusted HR 5.08; 95% CI 1.14-22.75) or concomitantly with norepinephrine and/or serotonin reuptake inhibitors (adjusted HR 6.18; 95% CI 1.13-33.65). CONCLUSION: Approximately 40% of suicide reattempts in mood disorder patients occurred within 90 days after psychiatric hospital discharge. For mood disorders and when there have been over two previous suicide attempts, prescribed antipsychotics or antidepressants may help predict suicide reattempts.

Long-term outcomes in methamphetamine psychosis patients after first hospitalisation.

INTRODUCTION AND AIMS: As a consequence of the methamphetamine epidemic in Thailand, the occurrence of methamphetamine psychosis (MAP) dramatically increased. This study aimed to examine the long-term outcomes of MAP patients following their first presentation to a psychiatric hospital. DESIGN AND METHODS: Methamphetamine psychosis patients who were first hospitalised in Suan Prung psychiatric hospital Thailand in 2000-2001 were identified through a review of the hospital database. Eligible participants were scheduled for visits by trained field researchers in 2007. For those giving consent, a structured face-to-face interview was conducted. Outcomes were collected from both medical records and interviews. RESULTS: A total of 1116 participants were included in the study. Ninety-two (8.2%) participants had died from suicide, accident or AIDS. Due to relocation, only 449 (40.2%) individuals were interviewed. Most of the participants were male (90.6%) with a mean age of 33.3 years (SD = 8.0). The medical records showed that 263 had revisited the hospital in the interim. Of those, 39.2% were re-hospitalised and 38% were given a diagnosis of schizophrenia due to persistent psychosis. The outreach interview found that more than half (55.7%) had experienced psychosis relapse. Mini International Neuropsychiatric Interview revealed the following current conditions: psychotic disorders (15.8%), alcohol use disorders (52.1%) and suicidality (22.3%). Participants who did not have a diagnosis of current methamphetamine abuse could be divided into those with a single episode psychosis (52.6%) and those with chronic course of psychosis (38.8%). DISCUSSION AND CONCLUSIONS: Individuals with MAP are likely to have poor outcomes, in terms of premature death, several relapses of psychotic symptoms, chronic psychotic manifestation, and very rates of alcohol use disorder and suicidality. Therefore, those individuals with MAP require long-term monitoring and psychiatric care.