Prevalence of Suicide Crisis Syndrome and Its Associated Psychosocial Characteristics, Psychopathology and Suicidality: A Nationwide Population-Based Survey during COVID-19 Pandemic in Taiwan

Jia-In Lee ； Chia-Yi Wu ； Ming-Been Lee ； Chia-Ta Chan ； Chun-Ying Chen ； Megan L. Rogers ； Igor Galynker

《Journal of Suicidology》 Vol.18 No.1 (2023/03) Pp. 456-468

https://doi.org/10.30126/JoS.202303_18(1).0006

摘要

Background: Suicide Crisis Syndrome (SCS) is a pre-suicidal mental status characterized as affective disturbances, loss of cognitive control, hyper-arousal, social withdrawal and entrapment. A five-item Suicide Crisis Scale (SCS-5) derived from the revised Suicide Crisis Inventory (SCI-2) has been validated to identify SCS and recent week suicidal ideation (SI) in an online population survey in Taiwan. The study aimed further to investigate the prevalence of SCS assessed by the SCS-5 and its associated psychosocial characteristics, suicidality and psychopathology among the general population. Methods: Participants were recruited from a representative sample of the general population aged ≥15 years in Taiwan. A computer-assisted telephone interview was performed to select the respondents using telephone numbers with the stratified proportional randomization method. The SCS-5, the five-item Brief Symptom Rating Scale (BSRS-5) and suicidality assessment were used to investigate SCS, psychopathology and suicidal risks in different time spans. The chi-square tests and regression models were used to estimate the association between SCS and its associated factors. Cronbach's alpha and factor analysis were used to test the reliability and validity of the SCS-5. A receiver operating characteristic (ROC) curve was conducted to confirm the predictive utility of the SCS-5 on recent SI. Results: In total, 2,101 participants completed the survey questions, and the results of which were included in the analysis. The SCS-5 demonstrated good internal consistency (α= 0.84) and one-factor structure with a good model fit. The SCS-5 had strong positive correlations with all of the BSRS-5 items and suicidality variables. A regression analysis on the SCS-5 revealed that affective disturbance, loss of cognitive control and entrapment significantly explained 23.9% of the variance of one-week SI. A ROC curve indicated that the optimal cutoff (4/5) of the SCS-5 could significantly differentiate the one-week SI. The weighted prevalence of SCS in the general population was 3.77% without gender difference. In comparison with the non-SCS, the individuals with SCS were characterized as: younger age (<40 years); higher education (university); occupation of professionals and freelancers; higher prevalence of psychopathology; higher suicidality, including SI (lifetime, in past year and in past month and suicide attempt (lifetime and in recent year) and future intent to suicide. Conclusion: The SCS-5 performed satisfactorily to identify recent SI and future suicide intent among the general adult population in Taiwan. The SCS individuals were at higher risks of psychiatric morbidity and suicidality across different time points.

關鍵字

suicide ； suicide crisis syndrome ； five-item Suicide Crisis Scale (SCS-5) ； imminent suicide risk ； psychological distress ； five-item Brief Rating Scale (BSRS-5)