Associations between lifetime mental disorders and suicidal behaviors: findings from the Taiwan psychiatry morbidity survey.

BACKGROUND: East Asia has high suicide rates but low prevalence of mental disorders. We examined the associations between prior lifetime mental disorders (mood disorders, anxiety disorders, substance use disorders, and impulse control disorders) and subsequent suicidal behaviors (suicidal ideation and attempts in the general population and suicide plans, planned attempts, and unplanned attempts in suicidal ideators) in Taiwan. METHODS: This survey applied the World Mental Health Survey Composite International Diagnostic Interview to a population representative sample of noninstitutionalized adults between 2003 and 2005. Odds ratios (ORs) obtained using discrete-time survival analysis were used to estimate population attributable fractions (PAFs) of suicidal behaviors due to lifetime mental disorders. RESULTS: Lifetime mental illness was a significant risk factor for subsequent suicidal behaviors (except unplanned attempts among ideators) despite the relatively low prevalence of mental disorders in people with suicidality (16.1%-35.0%). Each diagnosis increased the odds of suicidal ideation. In terms of acting on suicidal ideation, mood disorders were most strongly associated with having plans (OR = 10.0; 95% confidence interval, CI 4.3-21.1), whereas substance use disorders most strongly with either planned (OR = 27.3; 95% CI 6.3-118.5) or unplanned attempts (OR = 14.5; 95% CI 1.7-121.5). PAFs of all mental disorders on suicidality lay between 20 and 30% (except 11% of unplanned attempts among ideators). Mood, anxiety, and substance use disorders had higher PAFs than impulse control disorders. CONCLUSIONS: In addition to mood disorders, considering anxiety and substance use disorders is essential in devising population-based suicide prevention strategies.

Prevalence and correlates of suicidal behaviors in the Taiwan Psychiatric Morbidity Survey.

BACKGROUND/PURPOSE: Suicide is a huge global health burden. High suicide rates with a low prevalence of major depressive disorder were reported in East Asia. This study aimed to investigate the prevalence of suicidal behaviors in relation to the demographic characteristics and major depressive disorder in Taiwan. METHODS: This study was based on the Taiwan Psychiatric Morbidity Survey, conducted between 2003 and 2005, a survey of common psychiatric disorders in a nationally representative sample of non-institutionalized civilians aged 18 or above. Demographic data, major depressive disorder, and suicidal behaviors were ascertained by a face-to-face interview using the paper version of the World Mental Health Survey Composite International Diagnostic Interview. RESULTS: According to the total sample of 10,135 participants, the lifetime prevalence of suicidal ideation, plans and attempts was 7.52% (S.E = 0.46%), 1.31% (S.E. = 0.16%) and 1.29% (S.E. = 0.16%), respectively. Among suicide ideators, the conditional probability of making a suicide plan was 17.39% (S.E. = 1.92%), and a suicide attempt 17.16% (S.E. = 2.15%). Age ≤ 40, female sex, and major depressive disorder were related to a higher risk of suicidal behaviors in the general population; the former two were associated with further developing suicide attempts and the latter one developing plans among ideators. CONCLUSION: Despite low prevalence, major depressive disorder remained a significant risk factor for suicidal behaviors in Taiwan.

Suicide deaths among patients with end-stage renal disease receiving dialysis: A population-based retrospective cohort study of 64,000 patients in Taiwan.

BACKGROUND: Patients with end-stage renal disease (ESRD) who receive dialysis may experience increased distress and risk of suicide. METHODS: This population-based retrospective cohort study linked Taiwan's national register of ESRD patients on dialysis and the cause-of-death mortality data file. A separate multiple-cause-of-death data file was used to investigate the detailed suicide methods used. Standardized mortality ratios (SMRs) were calculated for the overall patient group and by sex, age, year of initiating dialysis, method of suicide, and time since initiation of dialysis. RESULTS: Among 63,854 ESRD patients on dialysis, 133 died by suicide in Taiwan in 2006-2012; the suicide rate was 76.3 per 100,000 patient-years. The SMR for suicide was 2.38 (95% confidence interval [CI] 1.99-2.82) in this patient group. Suicide risk was highest in the first year of dialysis (SMR = 3.15, 95% CI 2.39-4.08). The risk of suicide by cutting was nearly 20 times (SMR = 19.91, 95% CI 12.88-29.39) that of the general population. Detailed information on death certificates indicated that three quarters of patients who killed themselves by cutting cut vascular accesses used for hemodialysis. LIMITATIONS: Information on risk factors such as socioeconomic position and mental disorders was unavailable. CONCLUSION: In a country where the national health insurance program covers most expenses associated with dialysis treatment, the suicide risk in ESRD patients on dialysis still increased nearly 140%. Adequate support for ESRD patients initiating dialysis and the assessment of risk of cutting vascular access as a potential means of suicide could be important strategies for suicide prevention.

Incorporation of Mobile Application (App) Measures Into the Diagnosis of Smartphone Addiction.

OBJECTIVE: Global smartphone expansion has brought about unprecedented addictive behaviors. The current diagnosis of smartphone addiction is based solely on information from clinical interview. This study aimed to incorporate application (app)-recorded data into psychiatric criteria for the diagnosis of smartphone addiction and to examine the predictive ability of the app-recorded data for the diagnosis of smartphone addiction. METHODS: Smartphone use data of 79 college students were recorded by a newly developed app for 1 month between December 1, 2013, and May 31, 2014. For each participant, psychiatrists made a diagnosis for smartphone addiction based on 2 approaches: (1) only diagnostic interview (standard diagnosis) and (2) both diagnostic interview and app-recorded data (app-incorporated diagnosis). The app-incorporated diagnosis was further used to build app-incorporated diagnostic criteria. In addition, the app-recorded data were pooled as a score to predict smartphone addiction diagnosis. RESULTS: When app-incorporated diagnosis was used as a gold standard for 12 candidate criteria, 7 criteria showed significant accuracy (area under receiver operating characteristic curve [AUC] > 0.7) and were constructed as app-incorporated diagnostic criteria, which demonstrated remarkable accuracy (92.4%) for app-incorporated diagnosis. In addition, both frequency and duration of daily smartphone use significantly predicted app-incorporated diagnosis (AUC = 0.70 for frequency; AUC = 0.72 for duration). The combination of duration, frequency, and frequency trend for 1 month can accurately predict smartphone addiction diagnosis (AUC = 0.79 for app-incorporated diagnosis; AUC = 0.71 for standard diagnosis). CONCLUSIONS: The app-incorporated diagnosis, combining both psychiatric interview and app-recorded data, demonstrated substantial accuracy for smartphone addiction diagnosis. In addition, the app-recorded data performed as an accurate screening tool for app-incorporated diagnosis.

Impact of universal health coverage on suicide risk in newly diagnosed cancer patients: Population-based cohort study from 1985 to 2007 in Taiwan.

BACKGROUND: National Health Insurance (NHI), launched in 1995 in Taiwan, lightens patient's financial burdens but its effect on the suicide risk in cancer patients is unclear. We aimed to investigate the impacts of the NHI on the suicide in newly diagnosed cancer patients. METHODS: We identified patients with newly diagnosed cancer from the nationwide Taiwan Cancer Registration from 1985 to 2007, and ascertained suicide deaths from the national database of registered deaths between 1985 and 2009. Standardized mortality ratio (SMR) of suicide risk among patients with cancer was calculated, and the suicide risk ratios were examined by gender, age group, and prognosis. RESULTS: For the 916 337 registered cancer patients with 4 300 953 person-years, 2 543 died by suicide, with a suicide rate of 59.1 per 100 000 person-years. Compared to the general population, cancer patients had an SMR of 2.47 for suicide, with a higher figure for males (2.73), age 45 to 64 (2.89), and cancer of poor prognosis (3.19). The suicide risk was highest in the first 2 years after the initial diagnosis. Comparing the cohorts of the period before (1985 to 1992) and after (1996 to 2007) the launch of NHI, we saw a reduction in the SMR within the first 2 years after cancer diagnosis (20%), with more prominent reduction for females (29%), age under 45 (69%), and cancer of good prognosis (33%). CONCLUSIONS: A universal health coverage relieving both physical and psychological distress may account for the post-NHI reduction of immediate suicide risk in patients of newly diagnosed cancer.

Proposed Diagnostic Criteria for Smartphone Addiction.

BACKGROUND: Global smartphone penetration has led to unprecedented addictive behaviors. The aims of this study are to develop diagnostic criteria of smartphone addiction and to examine the discriminative ability and the validity of the diagnostic criteria. METHODS: We developed twelve candidate criteria for characteristic symptoms of smartphone addiction and four criteria for functional impairment caused by excessive smartphone use. The participants consisted of 281 college students. Each participant was systematically assessed for smartphone-using behaviors by psychiatrist's structured diagnostic interview. The sensitivity, specificity, and diagnostic accuracy of the candidate symptom criteria were analyzed with reference to the psychiatrists' clinical global impression. The optimal model selection with its cutoff point of the diagnostic criteria differentiating the smartphone addicted subjects from non-addicted subjects was then determined by the best diagnostic accuracy. RESULTS: Six symptom criteria model with optimal cutoff point were determined based on the maximal diagnostic accuracy. The proposed smartphone addiction diagnostic criteria consisted of (1) six symptom criteria, (2) four functional impairment criteria and (3) exclusion criteria. Setting three symptom criteria as the cutoff point resulted in the highest diagnostic accuracy (84.3%), while the sensitivity and specificity were 79.4% and 87.5%, respectively. We suggested determining the functional impairment by two or more of the four domains considering the high accessibility and penetration of smartphone use. CONCLUSION: The diagnostic criteria of smartphone addiction demonstrated the core symptoms "impaired control" paralleled with substance related and addictive disorders. The functional impairment involved multiple domains provide a strict standard for clinical assessment.

Risk factors of suicide mortality among multiple attempters: A national registry study in Taiwan.

BACKGROUND/PURPOSE: Little is known about the risk factors of suicide mortality among multiple attempters. This study aims to investigate the predictors of suicidal mortality in a prospective cohort of attempters in Taiwan, focusing on the time interval and suicide method change between the last two nonfatal attempts. METHODS: The representative data retrieved from the National Suicide Surveillance System (NSSS) was linked with National Mortality Database to identify the causes of death in multiple attempters during 2006-2008. Cox-proportional hazard models were applied to calculate the hazard ratios for the predictors of suicide. RESULTS: Among the 55,560 attempters, 6485 (11.7%) had survived attempts ranging from one to 11 times; 861 (1.5%) eventually died by suicide. Multiple attempters were characterized by female (OR = 1.56, p < 0.0001), nonrecipient of national aftercare service (OR = 1.62, p < 0.0001), and current contact with mental health services (OR = 3.17, p < 0.0001). Most multiple attempters who survived from hanging (68.1%) and gas poisoning (61.9%) chose the same method in the following fatal episode. Predictors of suicidal death were identified as male, older age (≥ 45 years), shorter interval and not maintaining methods of low lethality in the last two nonfatal attempts. Receipt of nationwide aftercare was associated with lower risk of suicide but the effect was insignificant. CONCLUSION: The time interval of the last two nonfatal attempts and alteration in the lethality of suicide method were significant factors for completed suicide. Risk assessment involving these two factors may be necessary for multiple attempters in different clinical settings. Effective strategies for suicide prevention emphasizing this high risk population should be developed in the future.

Time distortion associated with smartphone addiction: Identifying smartphone addiction via a mobile application (App).

BACKGROUND: Global smartphone penetration has brought about unprecedented addictive behaviors. AIMS: We report a proposed diagnostic criteria and the designing of a mobile application (App) to identify smartphone addiction. METHOD: We used a novel empirical mode decomposition (EMD) to delineate the trend in smartphone use over one month. RESULTS: The daily use count and the trend of this frequency are associated with smartphone addiction. We quantify excessive use by daily use duration and frequency, as well as the relationship between the tolerance symptoms and the trend for the median duration of a use epoch. The psychiatrists' assisted self-reporting use time is significant lower than and the recorded total smartphone use time via the App and the degree of underestimation was positively correlated with actual smartphone use. CONCLUSIONS: Our study suggests the identification of smartphone addiction by diagnostic interview and via the App-generated parameters with EMD analysis.

Encephalopathy associated with autoimmune thyroid disease (Hashimoto's thyroiditis) presenting as depression: a case report.

Encephalopathy associated with autoimmune thyroid disease (EAATD) is a rare condition associated with Hashimoto's thyroiditis or Graves' disease. It is often underdiagnosed because of the various clinical presentations and lack of widely accepted diagnostic criteria. We report a 46-year-old man who presented with an acute depressive episode and was proven to have encephalopathy associated with Hashimoto's thyroiditis. The exclusive psychiatric manifestations of this case called our attention to the fact that an improved awareness of EAATD in patients with a history of thyroid disease can lead to a timely diagnosis and excellent disease prognosis.

Iron deficiency anemia - a rare etiology of sinus thrombosis in adults.

PURPOSE: Cerebral venous thrombosis (CVT) has a wide spectrum of symptoms and is therefore difficult to diagnose. CVT has been reported to be associated with various etiologies. There are, however, very few reported cases of CVT associated with iron deficiency anemia (IDA), especially in adults. CASE REPORT: We reported the case of a female patient with seizure and hemorrhagic infarction due to sagittal sinus thrombosis. She had severe hypochromic microcytic anemia due to iron deficiency, and had a good prognosis after iron supplementation and oral anticoagulation therapy. CONCLUSION: The present case indicates that iron deficiency is a risk factor for CVT.