Travel Distance to Hospital Is Associated With Self-Harm Hospital Presentation But Not Suicide.

Background: Travel distance to hospital emergency departments (EDs) may be a more influential factor in the spatial variation in hospital-presenting self-harm than for suicide deaths. Aims: We investigated the associations of travel distance to the nearest ED with self-harm hospital presentations and suicides in a large city in Taiwan. Method: Data for self-harm and suicide were extracted from Taiwan's National Suicide Surveillance System (2012-2016). Results: Adjusted analyses using Bayesian hierarchical models showed that a longer travel distance to the nearest hospital ED was associated with lower self-harm hospital presentation rates but not suicide rates. Limitations: This is an ecological study; the area-level associations could not be directly implied at the individual level. Conclusion: Living in remote neighborhoods could be a barrier to seeking medical help after self-harm, and this has implications for suicide, surveillance, prevention and intervention strategies.

Factors mediating pre-existing autism diagnosis and later suicidal thoughts and behaviors: A follow-up cohort study.

LAY ABSTRACT: Autistic people are more likely to experience suicidal thoughts and behaviors. The underlying relationships between potential risk factors and suicidal thoughts and behaviors in autistic individuals remain unclear. To understand this, we investigated whether specific factors in childhood/youth explain the effects of pre-existing autism spectrum disorder (ASD) diagnoses on later suicidal thoughts and behaviors in adolescence/adulthood. We assessed internalizing and externalizing problems, bullying experiences, and executive functions (including cognitive flexibility, sustained attention, and spatial working memory) at an average baseline age of 13.4 years and suicidal thoughts and behaviors at an average follow-up age of 19.2 years among 129 autistic and 121 typically developing (TD) individuals. During the follow-up period in adolescence/adulthood, autistic individuals were more likely to report suicidal thoughts than TD individuals. Being bullied partially accounted for the relationship between a pre-existing ASD diagnosis and later-reported higher suicidal thoughts. Contrary to our hypothesis, higher (instead of lower) cognitive flexibility in some autistic young people appeared to partially explain their higher rates of suicidal thoughts compared with typically developing young people. The findings imply that school bullying prevention and tailored intervention programs for autistic people, especially those with higher cognitive flexibility, are warranted to reduce their risks of experiencing suicidal thoughts.

New COVID-19 challenges and response strategies adopted by a national suicide prevention hotline: A qualitative study.

Crisis helplines provide important support for vulnerable individuals during the COVID-19 pandemic, which may also impact the helplines. We explored the challenges that the pandemic brought to Taiwan's national suicide prevention hotline and the hotline's responses. We interviewed 14 hotline workers and conducted data analysis using the framework method. The pandemic posed two new challenges to the hotline: potential service interruption and the adjustment of perceived role among hotline workers. The hotline's well-formulated response plan helped it sustain its services during the pandemic, although the workers also experienced stress and frustration resulted from role ambiguity. Our data highlighted the hotline workers' need for accurate COVID-19 information, relevant training, and timely support.

Psychiatrist density and risk of suicide: a multilevel case-control study based on a national sample in Taiwan.

AIM: No previous studies, to our knowledge, have investigated the association between psychiatrist density and suicide, accounting for individual- and area-level characteristics. METHODS: We investigated all suicide cases in 2007-2017 identified from the national cause-of-death data files, with each suicide case matched to 10 controls by age and sex and each suicide case/control assigned to one of the 355 townships across Taiwan. Our primary outcome was the odds ratio (OR) of suicide and its 95% confidence interval (CI) estimated via multilevel models, which included both individual- and area-level characteristics. Townships with no psychiatrists were compared with the quartiles of townships with psychiatrists (density per 100,000 population): quartile 1 (Q1) (0.01-3.02); quartile 2 (Q2) (3.02-7.20); quartile 3 (Q3) (7.20-13.82); and quartile 4 (Q4) (>13.82). RESULTS: A total of 40,930 suicide cases and 409,300 age- and sex-matched controls were included. We found that increased psychiatrist density was associated with decreased suicide risk (Q1: adjusted OR [aOR], 0.95 [95% CI, 0.90-1.01]; Q2: aOR, 0.90 [95% CI, 0.85-0.96]; Q3: aOR, 0.89 [95% CI, 0.83-0.94]; Q4: aOR, 0.89 [95% CI, 0.83-0.95]) after adjusting for individual-level characteristics (employment state, monthly income, physical comorbidities, and the diagnosis of psychiatric disorders) and area socioeconomic characteristics. CONCLUSIONS: The psychiatrist density-suicide association suggests an effect of increased availability of psychiatric services on preventing suicide. Suicide prevention strategies could usefully focus on enhancing local access to psychiatric services.

Human Poisoning with Chlorpyrifos and Cypermethrin Pesticide Mixture: Assessment of Clinical Outcome of Cases Admitted in a Tertiary Care Hospital in Taiwan.

Background and Purpose: There is an overall paucity of data regarding the human toxicity of chlorpyrifos and cypermethrin pesticide mixture. Both organophosphate and pyrethroid insecticides are metabolized by carboxylesterases. Thus, its pesticide combination, organophosphates may boost the toxicity of pyrethroids via inhibited its detoxification by carboxylesterases. This study examined the clinical course, laboratory tests, and outcomes of patients with chlorpyrifos, cypermethrin or their pesticide mixture poisoning, and to determine what association, if any, might exist between these findings. Patients and Methods: Between 2000 and 2021, 121 patients poisoned with chlorpyrifos, cypermethrin, or their pesticide mixture were treated at Chang Gung Memorial Hospital. Patients were categorized as chlorpyrifos (n=82), cypermethrin (n=27) or chlorpyrifos and cypermethrin (n=12) groups. Demographic, clinical, laboratory and mortality data were collected for analysis. Results: The patients experienced a broad range of clinical symptoms, including aspiration pneumonia (44.6%), salivation (42.5%), acute respiratory failure (41.3%), acute kidney injury (13.9%), seizures (7.5%), hypotension (2.6%), etc. Leukocytosis (12,700±6600 /uL) and elevated serum C-reactive protein level (36.8±50.4 mg/L) were common. The acute respiratory failure rate was 41.3%, comprising 48.8% in chlorpyrifos, 11.1% in cypermethrin as well as 58.3% in chlorpyrifos and cypermethrin poisoning. Patients with chlorpyrifos and cypermethrin pesticide mixture poisoning suffered higher rates of acute respiratory failure (P=0.001) and salivation (P=0.001), but lower Glasgow Coma Scale score (P=0.011) and serum cholinesterase level (P<0.001) than other groups. A total of 17 (14.0%) patients expired. The mortality rate was 14.0%, including 17.1% in chlorpyrifos, 3.7% in cypermethrin as well as 16.7% in chlorpyrifos and cypermethrin poisoning. No significant differences in mortality rate were noted (P=0.214). Conclusion: Chlorpyrifos pesticide accounted for the major toxicity of the pesticide mixture. While the data show a higher rate of respiratory failure in the chlorpyrifos and cypermethrin pesticide mixture group than others, other measures of toxicity such as mortality and length of stay were not increased.

A Modified Suture Technique to Improve Scar Appearance in Wounds Under High Tension.

ABSTRACT: The purpose of this study was to introduce a modified suture technique and to compare its effects on skin scar formation with 2 traditional suture methods: simple interrupted suture (SIS) and vertical mattress suture (VMS). Three groups of healthy adult female Sprague-Dawley rats were selected (6 replicates in each group), and the full-thickness skin of 5 cm × 0.2 cm was cut off on the back of the rats after anesthesia. The wounds were then sutured using 1 of the 3 methods for each group: SIS, VMS, and a newly introduced modified vertical mattress suture (M-VMS) technique with the needle reinsertion at the exit point. A traction device was installed on the back of the rats to achieve high tension wounds. The tensile distance was increased by 1 mm every day for 20 days. After 20 days of healing, the hematoxylin-eosin staining method was used for observation of scar morphology. The collagen production rate was measured by Masson staining, and the type I collagen and type III collagen were detected by the immunofluorescence method. Immunohistochemical staining was used to detect the expression of myofibroblast marker α-smooth muscle actin, and real-time quantitative polymerase chain reaction and Western blot techniques were used to detect the expressions of transforming growth factors TGFß1, TGFß2, and TGFß3 to understand the mechanisms of scar formation. Results showed that the quantity and density of collagen fibers were both lower in the M-VMS group than in the other 2 groups. Immunofluorescence results showed that type I collagen was significantly lower, whereas type III collagen was significantly higher in the M-VMS group than in the other 2 groups. The expressions of α-smooth muscle actin and TGFß1 both were lower in the M-VMS group than in the other 2 groups. The expression of TGFß2 and TGFß3 had no obvious difference among the 3 groups. For wounds under high tension, compared with SIS and VMS methods, the M-VMS technique we proposed can reduce scar formation due to the reduction of collagen formation, myofibroblast expression, and TGFß1 expression.

Intentions to Help People at Risk of Suicide and Associated Factors: A National Telephone Survey in Taiwan.

OBJECTIVE: Many people at risk of suicide do not actively seek help. Suicide prevention efforts need to involve the general public to provide appropriate support to those in need. It is important to investigate the intention to help those at risk of suicide and the factors associated with helping intentions in the general population. We aimed to assess the intention to help people at risk and associated factors using a national representative sample. METHOD: We conducted a national telephone survey of 1,087 Taiwanese adults and collected data regarding participants' socio-demographic characteristics, mental health status, helping intentions, misconceptions about suicide, and attitudes toward suicide and suicide prevention. RESULTS: The prevalence of high intentions to help people at risk of suicide was 56.5%. Helping intentions did not differ by sex, educational level, employment status, marital status, or mental health status. Those with high helping intentions were younger, less likely to have misconceptions about suicide or agree that suicide is a personal choice, and more likely to believe that suicide is preventable and support suicide prevention measures. CONCLUSIONS: Suicide prevention education programs aimed to enhance helping intentions may usefully target debunking misconceptions about suicide and cultivating positive attitudes toward suicide prevention.

The prevalence of high intentions to help people at risk of suicide was 56.5%.Individuals with high intentions to help were less likely to hold misconceptions about suicide.Individuals with high intentions to help were less likely to believe that suicide is a personal choice.

The use of premixed drugs in commodity packets in the population: prevalence and correlates revealed by the 2018 National Survey of Substance Use in Taiwan.

BACKGROUND: Administering premixed drugs in commodity packets was first reported in Asia in 2015, but there continues to be a dearth of related population-based data. This study aimed at examining (1) the prevalence of drug packet use in the population and (2) the sociodemographic profiles, particularly gender distribution, of drug packet users. METHODS: Data were derived from a survey of 18,626 Taiwanese civilians, aged 12-64 years, using stratified, multi-stage, random sampling in 2018. Participants anonymously completed a computer-assisted self-interview on tablet computers which covered the use and problematic use of illicit drugs/inhalants, prescription drugs and other psychoactive substances, among others. RESULTS: Approximately 1.46% of respondents had a lifetime use of illicit drugs, with drugs in commodity packets (0.18%) being ranked the fifth-most commonly used illicit drugs, higher than nitrous oxide (0.14%) and heroin (0.09%). Ten formats of drug packets were endorsed by users. Approximately 81.6% of persons with drug packet use had a lifetime use of other illicit drugs. The correlates of the use of drugs in commodity packets were similar to those of the exclusive use of other drugs except that there was a lack of gender differences in the use of drugs in commodity packets but not in the exclusive use of other drugs. CONCLUSION: Drugs in commodity packets have become a common way of administering illicit drugs in the population in Taiwan, and there were no gender differences among users. Our findings have implications for more efficient drug testing and culturally appropriate intervention for drug packet use.

Acceptability of a Chinese version of volitional help sheet to prevent self-harm repetition: qualitative study.

BACKGROUND: Individuals who self-harm have increased suicide rates. Brief interventions are associated with reduced repeated suicide attempts. However, very few previous studies investigated the acceptability of brief interventions before implementing new trials. AIMS: We aimed to explore the perceptions of individuals who self-harm toward a brief intervention, the Chinese version of the volitional help sheet (VHS-C), which encourages people to link a critical situation with an appropriate response. METHOD: Fourteen participants who presented to hospitals with self-harm were interviewed about their perspectives regarding the acceptability of the paper- and web-based VHS-C. Data were analysed with the framework method. RESULTS: The participants could understand the intended goal of the VHS-C by reading the written instructions, but indicated that having verbal instructions would also help. They shared the reasons why they felt the VHS-C was helpful (e.g. relatable contents, useful coping strategies and appropriate instructions that made them feel understood) or unhelpful (e.g., being not specific enough, not useful during the crisis and triggering negative emotional responses). Some indicated that the VHS-C might not be applicable to people experiencing ongoing distress in emergency departments. Most participants preferred the web-based to the paper-based VHS-C, and suggested that the format and frequency of follow-up reminders could leave the patient to decide. CONCLUSIONS: The contents of the VHS-C were acceptable for people who presented to hospitals with self-harm. The VHS-C may be more helpful before individuals encounter suicidal thoughts than when they have an ongoing crisis.

Revisiting the hidden wound: Impact of the COVID-19 pandemic on domestic violence and divorce in Taiwan (2020-2021).

BACKGROUND: Data from some countries showed a worrisome increase in domestic violence but a paradoxical decrease in divorce during the early months of the COVID-19 pandemic. We investigated the impact of the pandemic on domestic violence and divorce in Taiwan in 2020-2021. METHOD: Data for reported domestic violence and divorce by month and county/city (2017-2021) were from Taiwan government's registries. We used random-effects negative binomial regression to estimate the rate ratios (RRs) and their 95% confidence intervals (CIs) between the observed numbers of domestic violence cases and divorces in 2020-2021 and the expected numbers based on prepandemic trends (2017-2019). We calculated RRs for the two outbreak periods (First: January-May 2020; Second: May-July 2021) and the two postoutbreak periods (First: June 2020-April 2021; Second: August-December 2021) and each month in 2020-2021. RESULTS: The number of overall domestic violence cases was greater than expected during the first COVID-19 outbreak-a 3% increase (95% CI [0.3%-6%])-and the two postoutbreak periods-a 9% increase ([6%-12%]) and a 12% increase ([8%-16%]), respectively. Intimate partner violence was the main contributor to the increases. The number of divorces was lower than expected throughout the pandemic (a 5%-24% decrease). CONCLUSION: Reported domestic violence cases were higher than expected during the pandemic, particularly during the postoutbreak periods when the outbreak control measures were relaxed and people's movement resumed. Tailored prevention and intervention measures may be needed to address the increased vulnerability to domestic violence and restricted access to support during the outbreaks. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Surveillance of pesticide poisoning in an East and a West Malaysian hospital: characteristics of pesticide poisoning and the early impact of a national Paraquat ban.

BACKGROUND: Previous studies have shown that pesticide bans were associated with reduced fatal pesticide self-poisoning cases in high, and low-and-middle-income countries. We aimed to investigate the characteristics of pesticide poisoning patients admitted to two Malaysian hospitals and the early impact of the national paraquat ban implemented on 1st January 2020 in a culturally heterogenous South-East-Asian upper-middle-income setting. METHODS: Data were collected from an East (Bintulu) and a West (Ipoh) Malaysian hospital medical records in 2015-2021 and 2018-2021, respectively. Logistic regression analyses were conducted to investigate the association of aspects such as socio-demographic and clinical characteristics, paraquat ban with the types of pesticides involved (paraquat versus non-paraquat versus unknown) ,and the outcomes (fatal versus non-fatal). RESULTS: From the study sample of 212 pesticide poisoning patients aged 15 years or above, the majority were self-poisoning cases (75.5%) with a disproportionate over-representation of Indian ethnic minority (44.8%). Most pesticide poisoning cases had socio-environmental stressors (62.30%). The commonest stressors were domestic interpersonal conflicts (61.36%). 42.15% of pesticide poisoning survivors had a psychiatric diagnosis. Paraquat poisoning accounted for 31.6% of all patients and 66.7% of fatalities. Case fatality was positively associated with male gender, current suicidal intent, and paraquat poisoning. After the paraquat ban, the proportion of pesticide poisoning cases using paraquat decreased from 35.8 to 24.0%, and the overall case-fatality dropped slightly from 21.2 to 17.3%. CONCLUSIONS: Socio-environmental stressors in specific domestic interpersonal conflicts, seemed more prominent in pesticide poisoning compared to psychiatric diagnosis. Paraquat accounted for the majority of pesticide-associated deaths occurring in hospitals in the study areas. There was preliminary evidence that the 2020 paraquat ban led to a fall in case fatality from pesticide poisoning.

Association of Body Mass Index and Cardiometabolic Factors With Elderly Suicide: A Cohort Study of 101,518 Older Taiwanese.

BACKGROUND: Older people have the highest suicide rate across age groups in most countries. The prevalence of cardiometabolic risk factors also increases with age. We investigated the association between body mass index (BMI), cardiometabolic risk factors, and suicide in a large cohort of older people in Taiwan. METHODS: We conducted a cohort study using data from an elderly health examination program in Taipei City, Taiwan (2005-2010), linked to the national cause-of-death data files. We used competing risk Cox regression models to investigate the associations of BMI (kg/m2) and cardiometabolic factors with suicide after adjusting for sex, age, socioeconomic variables, chronic diseases, psychological distress, and cognitive function. RESULTS: Among 101,518 individuals aged ≥ 65 years, 92 died by suicide during an average follow-up of 3.9 years. Underweight (BMI<18.5) was associated with increased suicide risk (adjusted hazard ratio [aHR]=2.33, 95% confidence interval [CI] 1.20-4.52) (reference: normal weight). Low diastolic blood pressure was associated with increased suicide risk - aHR was 0.51 (95% CI 0.29-0.91) and 0.55 (95% CI 0.31-0.99) for the third and fourth quartiles of diastolic blood pressure (reference: the lowest quartile), respectively. Older people with a higher waist circumference (aHR per 1-standard-deviation increase=0.60 [95% CI 0.37-0.98]) and a higher number of metabolic syndrome criteria (aHR per 1-criterion increase=0.65 [95% 0.46-0.92]) had lower suicide risk. Systolic blood pressure, pulse rate, fasting blood glucose, and lipid profiles were not associated with suicide risk. CONCLUSIONS: Underweight, low diastolic blood pressure, and low waist circumference may be markers of increased suicide risk in older people.

Space-time self-harm and suicide clusters in two cities in Taiwan.

AIMS: Suicidal acts may cluster in time and space and lead to community concerns about further imitative suicidal episodes. Although suicide clusters have been researched in previous studies, less is known about the clustering of non-fatal suicidal behaviour (self-harm). Furthermore, most previous studies used crude temporal and spatial information, e.g., numbers aggregated by month and residence area, for cluster detection analysis. This study aimed to (i) identify space-time clusters of self-harm and suicide using daily incidence data and exact address and (ii) investigate the characteristics of cluster-related suicidal acts. METHODS: Data on emergency department presentations for self-harm and suicide deaths in Taipei City and New Taipei City, Taiwan, were used in this study. In all-age and age-specific analyses, self-harm and suicide clusters were identified using space-time permutation scan statistics. A cut-off of 0.10 for the p value was used to identify possible clusters. Logistic regression was used to investigate the characteristics associated with cluster-related episodes. RESULTS: A total of 5,291 self-harm episodes and 1,406 suicides in Taipei City (2004-2006) and 20,531 self-harm episodes and 2,329 suicides in New Taipei City (2012-2016) were included in the analysis. In the two cities, two self-harm clusters (n [number of self-harm episodes or suicide deaths in the cluster] = 4 and 8 in Taipei City), four suicide clusters (n = 3 in Taipei City and n = 4, 11 and 4 in New Taipei City) and two self-harm and suicide combined clusters (n = 4 in Taipei City and n = 8 in New Taipei City) were identified. Space-time clusters of self-harm, suicide, and self-harm and suicide combined accounted for 0.05%, 0.59%, and 0.08% of the respective groups of suicidal acts. Cluster-related episodes of self-harm and suicide were more likely to be male (adjusted odds ratio [aOR] = 2.22, 95% confidence interval [CI] 1.26, 3.89) and young people aged 10-29 years (aOR = 2.72, 95% CI 1.43, 5.21) than their cluster-unrelated counterparts. CONCLUSIONS: Space-time clusters of self-harm, suicide, and self-harm and suicide combined accounted for a relatively small proportion of suicidal acts and were associated with some sex/age characteristics. Focusing on suicide deaths alone may underestimate the size of some clusters and/or lead to some clusters being overlooked. Future research could consider combining self-harm and suicide data and use social connection information to investigate possible clusters of suicidal acts.

Human Poisoning with Methomyl and Cypermethrin Pesticide Mixture.

There is limited literature analyzing the outcome of human poisoning with methomyl and cypermethrin pesticide mixture. Between 2002 and 2018, a total of 63 patients intoxicated with methomyl, cypermethrin, or their pesticide mixture were treated at Chang Gung Memorial Hospital. The patients were categorized into three groups based on the type of pesticide, as methomyl (n = 10), cypermethrin (n = 31), or methomyl and cypermethrin (n = 22). Demographic, clinical, laboratory, and mortality data were obtained for analysis. The patients were aged 54.9 ± 18.9 years. Following ingestion, the patients experienced a wide range of clinical symptoms, including aspiration pneumonia (50.8%), acute respiratory failure (41.3%), acute kidney injury (33.3%), multiple organ failure (19.0%), emesis (19.0%), acute hepatitis (12.7%), diarrhea (7.9%), seizures (4.8%), lacrimation (4.8%), etc. After analysis, it was found that patients with methomyl and cypermethrin poisoning suffered higher incidences of acute respiratory failure (p < 0.001), aspiration pneumonia (p = 0.004), acute kidney injury (p = 0.011), and multiple organ failure (p < 0.001) than the other groups. Laboratory analyses revealed that patients with methomyl and cypermethrin poisoning had a higher creatinine level (p = 0.011), white blood cell count (p < 0.001), and neutrophil count (p = 0.019) than the other groups. A total of seven (11.1%) patients died. The average duration of hospitalization was 9.8 ± 10.0 days. In a multivariate logistic regression model, it was revealed that methomyl pesticide (p = 0.045) or methomyl and cypermethrin pesticide mixture (p = 0.013) were significant risk factors for acute respiratory failure. Nevertheless, no mortality risk factor could be identified. Therefore, the analytical results suggest that methomyl pesticide is the major contributor to the toxicity of methomyl and cypermethrin pesticide mixture poisoning. More research is needed.

Cause-specific mortality after discharge from inpatient psychiatric care in Taiwan: A national matched cohort study.

AIMS: We aimed to investigate the trajectories of absolute and relative risks of cause-specific mortality among patients discharged from inpatient psychiatric services. METHODS: We conducted a national matched cohort study (2002-2013) using data from the Taiwan National Health Insurance database linked to national cause-of-death data files. Patients discharged from inpatient psychiatric care without prior psychiatric hospitalizations were individually matched to 20 comparison individuals based on sex and age. The rates, rate differences, and relative risks (hazard ratios, HRs) of cause-specific mortality were calculated at six follow-up periods post-discharge. Cumulative mortality incidence was assessed at 5 years of follow-up. RESULTS: The mortality risks of all causes were increased among patients (n = 158 065) relative to comparison individuals (n = 3 161 300). Mortality rate differences were greater for natural causes, while relative risks (HRs) were higher for unnatural causes. Suicide was the leading cause of death within the first year of discharge, while circulatory and respiratory diseases were the leading causes of death from the second year. The mortality rates and HRs for all causes of death (except homicide) were highest during the first 3 months. The elevated risk of unnatural-cause mortality declined rapidly after discharge but remained high in the long term; in contrast, risk elevation for natural-cause mortality was more stable over time. Approximately one-eighth of patients (12.9%, 95% confidence interval 12.7-13.7%) died within 5 years of follow-up. CONCLUSIONS: Integrated physical and mental health care is needed to reduce excess mortality, particularly during the first 3 months post-discharge, among psychiatric patients.

Suicide Misconceptions and Attitudes Toward Suicide Prevention Measures in Taiwan.

Background: Debunking suicide misconceptions is an important suicide prevention measure. Few studies on suicide misconceptions and their correlates have been conducted in East Asia, where suicide is known to be more permissible. Aims: We investigated the prevalence and associated characteristics of suicide misconceptions in Taiwan. Whether holding suicide misconceptions was associated with reduced support for governmental suicide prevention measures was also assessed. Method: A dual-frame nationally representative telephone survey combining landlines and mobiles was conducted with 1,087 respondents. Logistic regression analyses were used to examine factors associated with suicide misconceptions. Results: Nearly 82% of the respondents held at least one type of suicide misconceptions. The most commonly held misconception was "Talking about suicide would encourage suicide" (49.5%), followed by "People who talk about suicide do not mean to do it" (47.3%) and "Most suicides happen suddenly without any warning" (46.5%). Suicide misconceptions were more common in younger people, divorced/widowed individuals, and those with lower educational attainment. Individuals with suicide misconceptions were less likely to support governmental investments in suicide prevention. Limitations: Causality could not be inferred from the cross-sectional study. Conclusions: Suicide misconceptions are prevalent in Taiwan. Debunking suicide misconceptions should be an integral part of national suicide prevention strategies.

Population-attributable risk of psychiatric disorders for suicide among adolescents and young adults in Taiwan.

BACKGROUND: Youth suicide rates have increased markedly in some countries. This study aimed to estimate the population-attributable risk of psychiatric disorders associated with suicide among Taiwanese youth aged 10-24 years. METHODS: Data were obtained from the National Death Registry and National Health Insurance (NHI) claims database between 2007 and 2019. Youth who died by suicide were included, and comparisons, 1:10 matched by age and sex, were randomly selected from the Registry for NHI beneficiaries. We used multivariable logistic regression to estimate suicide odds ratios for psychiatric disorders. The population-attributable fractions (PAF) were calculated for each psychiatric disorder. RESULTS: A total of 2345 youth suicide and 23 450 comparisons were included. Overall, 44.8% of suicides had a psychiatric disorder, while only 7.9% of the comparisons had a psychiatric disorder. The combined PAF for all psychiatric disorders was 55.9%. The top three psychiatric conditions of the largest PAFs were major depressive disorder, dysthymia, and sleep disorder. In the analysis stratified by sex, the combined PAF was 45.5% for males and 69.2% for females. The PAF among young adults aged 20-24 years (57.0%) was higher than among adolescents aged 10-19 years (48.0%). CONCLUSIONS: Our findings of high PAF from major depressive disorder, dysthymia, and sleep disorder to youth suicides suggest that youth suicide prevention that focuses on detecting and treating mental illness may usefully target these disorders.

Population-based prevalence of somatic symptom disorder and comorbid depression and anxiety in Taiwan.

OBJECTIVE: The nationwide prevalence of somatic symptom disorder (SSD) has not yet been investigated in Asia. SSD is often comorbid with depression and anxiety, and the effects of these conditions on medical utilization await clarification. We hence performed a study in Taiwan to explore these issues. METHODS: Using telephone-based sampling and interview, we obtained data for 3161 participants whose age, gender and living area were compatible with the Taiwan population. We gathered scores of the Patient Health Questionnaire-15 (PHQ-15), Health Anxiety Questionnaire (HAQ) and Patient Health Questionnaire-4 (PHQ-4). Individuals with a PHQ-15 score of at least 4 and a HAQ score of at least 17 were considered to have SSD. Descriptive statistics were used to clarify the prevalence and normative data of the questionnaires. We used multiple logistic regression analyses to investigate the relation between diagnoses and medical utilization. RESULTS: The prevalence of SSD was 5.00% and women had a higher SSD prevalence than men; participants aged 40-49 years had the highest SSD prevalence. In SSD patients, 33.58% had depression or anxiety. After correcting for demographics, SSD and anxiety (but not depression) were associated with a significantly high level of outpatient/emergency department attendance. Comorbid depression or anxiety did not significantly increase the medical utilization of SSD patients. CONCLUSION: The nationwide SSD prevalence in Taiwan is compatible with the description in the DSM-5. The comorbidity of SSD and depression/anxiety is common, but depression or anxiety does not significantly increase the SSD patients' medical utilization.

Societal factors and psychological distress indicators associated with the recent rise in youth suicide in Taiwan: A time trend analysis.

OBJECTIVE: We investigated recent trends in youth suicide and their associations with societal and psychological factors in Taiwan. METHODS: Suicide data (1971-2019) for 10-24 year olds were extracted from Taiwan's national cause-of-death data files. We investigated changes in trends in youth suicide rates, societal factors (gross domestic product per capita, Gini index, overall and youth unemployment rates, divorce rates in people aged 40-59 years [i.e. the age of most 15-24 year olds' parents] and Internet use rates) and psychological distress indicators (youth self-harm rates and the prevalence of worry-related insomnia, and suicide ideation, plan and attempt) using joinpoint regression and graphic examinations. The associations of these factors with youth suicide rates were examined using Prais-Winsten regression. RESULTS: Suicide rates in Taiwan's 10-24 year olds changed from a downward trend (2005-2014) to an upward trend in 2014 and increased 11.5% (95% confidence interval = [5.2%, 18.1%]) annually between 2014 and 2019. There was also an upturn in divorce rates among females aged 40-59 years in 2014 and self-harm rates among 15- to 24-year-old youth in 2013. The prevalence of self-reported insomnia and suicide ideation, plan and attempt in youth started to increase from 2013 to 2016. In the regression analysis, Internet use, female divorce rates and youth self-harm rates were positively associated with youth suicide rates. CONCLUSION: Suicide rates and the prevalence of suicidal behaviors began to increase in Taiwanese youth in the 2010s. These increases may be associated with concurrent rises in parental divorce rates, Internet use and poor sleep. Further research is needed to examine the mechanisms underlying recent increases in youth suicide risk.