Journal of Suicidology/自殺防治學
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社團法人台灣自殺防治學會,正常發行
選擇卷期
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Suicide prevention remains a critical challenge across the world under the COVID-19 pandemic. Although restrictions for the pandemic have been lifted since September 2022 in Taiwan, the pandemic has caused economic and social impact plus many hidden yet severe mental health consequences, including anxiety, depression, and suicide. This volume in the Journal of Suicidology (JoS), a rich source of topics related to suicide risk factors was included. The topics covered genes, cancer/medical illnesses, psychopathology, service utilization, media news report, mental health care under COVID-19, and suicide prevention strategies of campus and local government. Moreover, two articles about bereavement services among suicide survivors and hospital preventive interventions highlighted the important contexts of suicide prevention, while school preventive strategies bringing in more readers' attention to the teachers' perspectives on campus suicide prevention and the impact of an adolescent support group study. Most importantly, policymakers should play a pivotal role in putting into action the suicide preventive strategies.
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The IASP has announced that the main theme of World Suicide Prevention Day for the years 2021-2023 is ＂Creating Hope through Action＂. It is to remind everyone that they can signal to people experiencing suicidal thoughts that they can get help and support. Everybody can be a competent gatekeeper for suicide prevention (SP) after training. It is well recognized that the COVID-19 pandemic crisis has caused numerous mental health problems and heightened suicide risk worldwide. The associated risk factors included a wide range of physical, psychosocial, and economical issues such as the confirmed cases with long COVID-19, anxiety, depression, loneliness, feelings of inferiority, social disconnection, perceived burdensomeness, psychiatric disorder as well as stressful life events (e.g., bereavement). However, the main risk factor was the resultant psychological distress. Therefore, promoting mental health literacy and increasing self-awareness about psychopathology were key elements of suicide prevention strategies in the post-pandemic era. Thus, a self-reported and valid short-form scale is needed for early detection and triage of psychological distress among vulnerable people to provide adequate help.
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Suicide is a leading cause of death in the United States, with people living in rural areas disproportionately impacted by higher suicide rates. Limited access to healthcare, poorer socioeconomic conditions, stigma surrounding mental health treatment, and greater access to firearms all contribute to increased rates of suicide in rural communities. In this article, the authors review the various suicide prevention programs that have been implemented in rural patient populations across the United States. Studies that evaluated the impact of an intervention on mental health outcomes or suicide risk in a rural patient population were included in this narrative review. Suicide prevention strategies are categorized by type of intervention or program, including telehealth services, digital health initiatives, post-hospitalization outreach, and community-based interventions for at-risk patients. Findings from existing studies are synthesized. While the literature on rural suicide prevention programs is limited, studies to date suggest that community-based strategies with wrap-around services and telehealth programs that increase rural access to mental health care may be most effective for alleviating the burden of suicide in rural communities. Longer-term research studies in rural populations that measure suicide rates pre- and post-intervention are needed to inform future research, health policies, and clinical interventions.
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Suicidal behavior is one of the most important public health issues in Taiwan. Suicide- related studies indicate that, apart from the coexisting risk factors, the probability of co-morbid physical and psychiatric disorders is high. Moreover, genome-wide association studies (GWAS) on suicidal behavior have been expected to contribute comprehensive information toward the possible prevention and treatment plans in recent years. However, the results of serial studies have not been consistent findings, unfortunately. Part of the reason may be related to the heterogeneity of genes, and the possible mechanism of polygene regulation and environmental factors in suicidal behavior. In addition to summarizing the recent clinical findings of biometrical research in this review article, we also emphasize the importance of including co-morbidities of medical illness and screening for specific epidemiological factors such as age group in future genetic studies of suicidal behavior.
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Taiwan's crude suicide rate for the ages of 15-24 years has increased gradually in recent years. The causes of suicide are multi-factorial, of which depression is the major psychopathological factor. Considering Taiwan's work on the mental health of adolescents, depression has applicated the medical model over the years, following the guidelines of psychiatry, which emphasizes the diagnosis of symptoms and drug treatment. In realistic terms, multivariate evaluation, intervention, and the formation of a nationwide network for the care of depression in adolescents are important. This article introduces a supportive group for depressive adolescents established by the Dun-An Social Welfare Foundation. The contents include five stages of the depressive group: design stage, organization stage, executive stage, finish stage, and evaluation stage. The therapeutic principles are ＂to explore resources of self- stress managementand to utilize the ＂creation of six-part story method ＂ to help clients describe important issues in life and to learn how to revise stress coping styles. The ＂creation of six-part story method ＂ is the so-called BASICPH stress-coping model, where clients learn self-coping styles when facing stress in different states.
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Individuals facing the loss of their loved one due to suicide are referred to as survivors of suicide loss (SoS). Suicide is a tragedy that will cause long lastingeffects on the people left behind. Every suicide will affect at least six relatives and friends around them. MacKay Memorial Hospital established the first suicide prevention center in Taiwan in 2005. Since then, the Suicide Prevention Center has served 363 bereaved cases and 3,552 counseling services have been provided. In order to provide better support for cases with suicidal ideation and suicidal bereaved families, MacKay Memorial Hospital has a team that consists of a psychiatrist, a psychologist, and a social worker, mainly to accompany this group of people. This companionship has become a routine service for SoS. Everyone has the right to grieve. Grief needs to be seen, only that the grief can be slowly healed.
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Suicide is a major public health issue worldwide. Take Vietnam as an example, more than 7500 people die by suicide every year and more than 20-fold of people may have suicide attempts. However, there are limited resources and services providing care for suicide and survivors in Vietnam. Suicide is an issue that illustrates the need for holistic care, which involves discovering the purpose and meaning of the suicidal patients' lives and their families and helping to integrate body, mind, and spirit. In addition, the core concept of nursing education is holistic care. Nurses are first-line gatekeepers of patients to reduce the risk of a health condition, and daily nursing practice offers nurses the most opportunities to identify early signs of mental distress or suicidal thoughts. However, professional training in health care has put less emphasis on teaching or learning about suicide prevention than on other topics. This nursing policy recommendation in gatekeeper traning programs for nurses aimed to provide significant evidence-based guideline standards and comprehensive SWOT analysis to provide effective resources for future intervention in nursing education and the policy.
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Background: Suicide crisis syndrome (SCS) was described as a pre-suicidal mental state, which could be assessed with the Suicide Crisis Inventory (SCI-2).Early identification of imminent risk for suicide attempts is critical to provide timely intervention. The suicide narrative was reported to precede and closely associate with the SCS. The present study aimed to examine the validity of the abbreviated Suicide Narrative Inventory (SNI) to identify psychological distress and suicidality among community residents in Taiwan. Methods: An anonymous online survey with structured questions on suicide risk was conducted in April and May of 2021. The questionnaire contained demographics, SNI, SCI-2, the 5-item Brief Symptom Rating Scale (BSRS-5), and questions about suicidality to measure psychological distress as well as suicidality. Confirmatory factor analyses (CFA) and internal consistency of the SNI were performed. We also tested the convergent validity of the SNI with SCI-2, the BSRS-5 scores, and suicide assessments. The ROC curve analysis was used to determine the validity of the SNI to identify the recent one-week SI. Moreover, stepwise multiple regression was used to examine whether SNI total/subscale and SCI-2 score significantly contribute to one-week suicidal ideation (SI). Moreover, path analysis was conducted to examine the associations of the SNI and SCI-2 with one-week SI. Results: In total, 4846 participants were recruited online. Results of the seven-factor CFA of the SNI indicated a good model fit. The SNI total and subscale scores showed excellent internal consistency and good convergent validity with all items of the SCI-2, BSRS-5, and suicidality. Stepwise multiple regression revealed that SCI and perceived burdensomeness significantly explained 33.4% of the variance of past-week SI. The ROC curve demonstrated that the optimal cut-off (98/99) of the SNI could significantly identify the presence of one-week SI. The study indicated that the SNI had good psychometric properties with a seven-factor solution and could significantly determine past-week suicidal ideation. Conclusion: The SNI was a valid tool to assess the near-term suicide risk and recent suicidal ideation.
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Background: Suicide is an important public issue globally, but large-scale studies of the medical services used by suicide patients are lacking. This study aimed to reveal the medical services utilization and diagnoses before suicide death. Methods: This was a national data linkage study. Cause of Death Data and the National Health Insurance Research Database (NHIRD) were used to collect the medical services utilization of suicide patients within a year prior to death; a control group was paired by 10 times the amount. Logistic regression was used to calculate odds ratios (ORs), and the ORs and prevalence were used to calculate the population attributable fraction (PAF). Results: Among the visits to out-patient and emergency departments, the suicide group visited the psychiatry department the most (OR = 9.9, 95% CI = 9.6-10.2). Among the usage of in-patient services, the suicide group visited the emergency department the most (OR = 41, 95% CI = 36.5-130.9), and the psychiatry department was ranked third (OR = 6.3, 95% CI = 6.3-6.8). As for diagnoses of the suicide group, mental disorders were the most common diagnoses in out-patient and emergency departments (OR = 4.8, 95% CI = 4.7-4.9, PAF = 0.38) and in in-patient departments (OR = 4.5, 95% CI = 4.3-4.7, PAF = 0.25). Drug-induced mental disorders were the most used diagnoses among mental disorders in out-patient and emergency departments (OR = 51, 95% CI = 42.8-61.8, PAF = 0.01), and personality disorders were the most used diagnoses among mental disorders in inpatient departments (OR = 20.5, 95% CI = 13.5-31.2, PAF = 0.01). Malignant neoplasms were the second most common physical illness under the sequence of PAF among out-patient and emergency departments (PAF = 0.05, OR = 2.9, 95% CI = 2.8-3.1) and was also ranked the second among in-patient departments (PAF = 0.03, OR = 1.3, 95% CI = 1.2-1.4). Conclusion: Our study is the first national data linkage suicide death analysis on medical services usage and diagnosis. The patients visiting psychiatry and emergency departments, and those with diagnoses of mental disorders, should be treated with caution, especially those with personality disorders and drug-related disorders. Patients seen in the oncology department and diagnosed with malignant neoplasms need special attention due to their suicide risk.
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Background: The COVID-19 pandemic is an unprecedented global health crisis that may cause mental health problems and heighten suicide risk. A large number of people in Taiwan experienced home quarantine due to COVID-19 infection or close contact. This study aimed to introduce the Tainan City Government Model that provided mental health care for people under home quarantine and investigate psychological distress and suicidality to estimate the needs for psychological intervention among individuals with different COVID-19 related conditions. Method: The city government set up an Application ＂Tainan City Government Health Care Cloud＂ to provide BSRS-5 for people to self-monitor, give immediate feedback, and send mental health information including stress management skills online according to the test results simultaneously. All individuals legally required for home quarantine or ordinary people, aged 15 or older, who registered online and completed the related questionnaire were recruited for the study from May 1 to June 30, 2022. A five-item Brief Symptom Rating Scale (BSRS-5) was used to triage the psychological distress. An additional question was used to assess the recent one-week suicidal ideation (SI). Chi-squared test and multiple regression were performed to estimate the associations of psychological distress, suicidality and COVID-19 related conditions. Results: The participants included 14,179 males and 18,269 females. The COVID-19 related conditions were divided into close contact (n=5,707), confirmed COVID-19 infection (n=6,413), and close contact then confirmed case (n=1,426). Among the participants, the prevalence of psychiatric morbidity and suicidal ideation in recent one week were 11.7% and 2.8%, respectively. Insomnia presented the highest rate (57.5%), followed by anxiety (39.3%), depression (36.0%), hostility (31.8%) and inferiority (18.0%). The females presented a significantly higher prevalence of individual psychopathology and psychiatric morbidity. The close contact then confirmed case group had the highest prevalence of psychiatric morbidity (13.9%), followed by the close contact group (12.7%), confirmed cases (12.4%), and ordinary people (11.1%). Stepwise regression analysis on one-week SI indicated that inferiority (β=0.328), depression (β=0.120), hostility (β=0.055) and insomnia (β=0.048) significantly selected to explain 21.4% of the variance of SI. Conclusion: During the COVID-19 pandemic, online use of the BSRS-5 to triage the psychological distress of the individuals at home quarantine and to provide timely service was a convenient and efficient strategy for suicide prevention and mental health promotion.