Increased suicide risk of psychiatric patients following the recent utilization of health care services: results from a nationwide cohort study in South Korea.

Purpose: This study aimed to examine whether and to what degree the suicide risk of psychiatric patients is associated with psychiatric and non-psychiatric health service utilization. Methods: We selected incident psychiatric patients, including schizophrenia, bipolar disorders, borderline personality disorder, depressive disorders, other affective disorders, and post-traumatic stress disorder patients, in 2007-2010 and followed them up until 2017 based on the data linkage between the Korean National Health Insurance and National Death Registry. We analyzed the time-dependent association between suicide and four types of health service (psychiatric vs. non-psychiatric and outpatient vs. inpatient) utilization using a time-dependent Cox regression. Results: The suicide risk of psychiatric patients was significantly increased with recent psychiatric and non-psychiatric admission and psychiatric outpatient visits. The adjusted suicide hazard ratios for recent outpatient visits were similar to or even higher than those for recent psychiatric admission. The adjusted suicide hazard ratios of schizophrenia patients for psychiatric admission, psychiatric outpatient visits, and non-psychiatric admission within the recent 6 months were 2.34 (95% confidence interval [CI]: 2.12-2.58, p < 0.001), 2.96 (95% CI: 2.65-3.30, p < 0.001), and 1.55 (95% CI: 1.39-1.74, p < 0.001), respectively. Suicide risk was not associated with recent non-psychiatric outpatient visits in patients, except for the depressive disorders group showing a negative association. Conclusion: Our results highlight the priority of suicide prevention for psychiatric patients in the clinical setting. Additionally, our results warrant the precaution against increased suicide risk of psychiatric patients after psychiatric and non-psychiatric discharge.

Age, Period, and Cohort Effects on Suicide Mortality in South Korea, 1992⁻2015.

Although the effects of age, period, and cohort (APC) on suicide are important, previous work in this area may have been invalid because of an identification problem. We analyzed these effects under three different scenarios to identify vulnerable groups and thus overcame the identification problem. We extracted the annual numbers of suicides from the National Death Register of Korea (1992⁻2015) and estimated the APC effects. The annual average suicide rates in 1992⁻2015 were 31.5 and 14.7 per 100,000 males and females, respectively. The APC effects on suicide were similar in both sexes. The age effect was clearly higher in older subjects, in contrast to the minimal changes apparent during earlier adulthood. The birth cohort effect showed an inverted U shape; a higher cohort effect was evident in females born in the early 1980s when period drift was larger than 3.7%/year. Period effect increased sharply during the early 1990s and 2000s. We found that elderly and young females may be at a particularly high risk of suicide in Korea.

Risk factors for feelings of sadness and suicide attempts among cancer survivors in South Korea: findings from nationwide cross-sectional study (KNHANES IV-VI).

INTRODUCTION: As the number of cancer survivors is rapidly increasing with the increased incidence of the disease and improved survival of patients, the prevalence of, and risk factors for, mental health problems and suicidality among cancer survivors should be examined. METHODS AND ANALYSIS: Using data obtained from the Korean National Health and Nutrition Examination Survey (2007-2013), we examined 1285 and 33 772 participants who had been and never been diagnosed with cancer, respectively. We investigated the risks of feelings of sadness and suicide attempts among cancer survivors and general population and examined differences in the risks of cancer survivors among subgroups according to cancer-related characteristics. RESULTS: The median age of survivors at the time of the survey and at diagnosis was 63 and 54 years, respectively. After adjusting for sex, level of education, household income, occupation, marital status, cancer type, current status of treatment, age at diagnosis and years since diagnosis, the risk of suicide attempts was significantly higher in participants diagnosed with cancer before 45 years of age compared with those diagnosed at 45-64 years (adjusted OR=3.81, 95% CI 1.07 to 13.60, P=0.039), and the higher risk of suicide attempts with borderline significance was found in those for whom more than 10 years had passed since diagnosis compared with those for whom the diagnosis was made only 2-10 years ago (adjusted OR=3.38, 95% CI 0.98 to 11.70, P=0.055). However, feelings of sadness were not significantly associated with any cancer-related characteristic. CONCLUSION: Our results reveal an increased risk of suicide attempts among cancer survivors diagnosed early in life and in those for whom more than 10 years has passed since the diagnosis, suggesting the need for intensive monitoring and support for mental health problems and suicidal risks in this population.

Effects of Discipline-based Career Course on Nursing Students' Career Search Self-efficacy, Career Preparation Behavior, and Perceptions of Career Barriers.

PURPOSE: The purpose of this study was to investigate the effectiveness of a discipline-based career course on perceptions of career barriers, career search self-efficacy, and career preparation behavior of nursing students. Differences in career search self-efficacy and career preparation behavior by the students' levels of career barriers were also examined. METHODS: The study used a modified one-group, pretest-posttest design. The convenience sample consisted of 154 undergraduate nursing students in a university. The discipline-based career course consisted of eight sessions, and was implemented for 2 hours per session over 8 weeks. The data were collected from May to June in 2012 and 2013 using the following instruments: the Korean Career Indecision Inventory, the Career Search Efficacy Scale, and the Career Preparation Behavior Scale. Descriptive statistics, paired t test, and analysis of covariance were used to analyze the data. RESULTS: Upon the completion of the discipline-based career course, students' perceptions of career barriers decreased and career search self-efficacy and career preparation behavior increased. Career search self-efficacy and career preparation behavior increased in students with both low and high levels of career barriers. The difference between the low and high groups was significant for career search self-efficacy but not for career preparation behavior. CONCLUSIONS: The discipline-based career course was effective in decreasing perceptions of career barriers and increasing career search self-efficacy and career preparation behavior among nursing students.

The Prefrontal Cortex Activity and Psychological Effects of Viewing Forest Landscapes in Autumn Season.

Recently reported research indicate that forest environments have physiological and psychological relaxing effects compared to urban environments. However, some researchers claim that the stress of the subjects from being watched by others during measurements can affect the measurement result in urban experiments conducted in the center of a street. The present study was conducted to determine whether forest environments have physiological and psychological relaxing effects, using comparison of viewing a forest area with viewing an urban area from the roof of an urban building without being watched by others. Near-infrared spectroscopy (NIRS) measurement was performed on subjects while they viewed scenery for 15 min at each experimental site (urban and forest areas). Subjective assessments were performed after the NIRS measurement was complete. Total hemoglobin and oxyhemoglobin concentrations were significantly lower in the forest area than in the urban area. For semantic differential in subjective assessments, feelings of "comfortable", "natural", and "soothed" were significantly higher in the forest area than in the urban area, and for profile of mood states, negative emotions were significantly lower in the forest area than in the urban area. The results of physiological and psychological measurements show that viewing the forest enabled effective relaxation.

A blended learning program on undergraduate nursing students' learning of electrocardiography.

This study sought to evaluate the feasibility of applying the blended learning program that combines the advantages of face-to-face(FTF) learning and e-learning. The blended learning program was developed by the authors and implemented for 4 weeks. 56 senior nursing students were recruited at a university in Korea. Significant improvement was noted in learning achievement. No significant differences were noted between FTF and web-based learning in learning motivation. Learning satisfaction and students' experience in taking this course revealed some positive effects of blended learning. The use of blended learning program for undergraduate nursing students will provide an effective learning model.