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Healthcare utilization, psychiatric disorders, and physical illnesses shortly before suicide mortality in adolescents in Taiwan

Published online by Cambridge University Press:  01 December 2021

Wan-Chen Lee
Affiliation:
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
Jou-Yin Lai
Affiliation:
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
Chun-Hung Pan
Affiliation:
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan Department of Psychology, National Chengchi University, Taipei, Taiwan
Sheng-Siang Su
Affiliation:
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
Tien-Wei Yang
Affiliation:
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
Shang-Ying Tsai
Affiliation:
Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
Chiao-Chicy Chen
Affiliation:
Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
Chian-Jue Kuo*
Affiliation:
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
*
Author for correspondence: Chian-Jue Kuo, E-mail: tcpckuo@seed.net.tw

Abstract

Background

This study examined the pattern of medical utilization and the distribution of comorbidities shortly before death among adolescents who died from suicide and compared these data with those of living controls.

Methods

From Taiwan's National Health Insurance Research Database, this study identified adolescents aged 10–19 years who died from suicide (n = 935) between 1 January 2000, and 31 December 2016, by linking each patient with the national mortality database. The researchers conducted a nested case–control study through risk set sampling, and for each case, 20 age- and sex-matched controls (n = 18 700) were selected from the general population. The researchers applied conditional logistic regression to investigate differences in medical utilization and physical and psychiatric comorbidities between cases and controls.

Results

Cases had a higher proportion of contact with the psychiatric department but a similar proportion of contact with any non-psychiatric medical department within 1 year before suicide compared with controls. There were 18.6% of adolescent suicide victims who only had contacted with a psychiatric department 3 months before suicide. Moreover, cases had a higher proportion of contact with non-psychiatric services within 3 months before suicide, particularly with emergency, surgery, and internal medicine departments. Cases had higher risks of several psychiatric disorders and physical illnesses, including heart diseases, pneumonia, and ulcer disease, than did controls.

Conclusions

The findings of increased medical utilization and higher risks of physical and psychiatric comorbidities in adolescent suicide victims are crucial for developing specific interventions to prevent suicide in this population.

Type
Original Article
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

*

Drs CH Pan and CJ Kuo contributed equally to this study.

References

Agerbo, E., Nordentoft, M., & Mortensen, P. B. (2002). Familial, psychiatric, and socioeconomic risk factors for suicide in young people: Nested case-control study. British Medical Journal, 325, 74. doi: 10.1136/bmj.325.7355.74CrossRefGoogle ScholarPubMed
Ahmedani, B. K., Peterson, E. L., Hu, Y., Rossom, R. C., Lynch, F., Lu, C. Y., … Simon, G. E. (2017). Major physical health conditions and risk of suicide. American Journal of Preventive Medicine, 53, 308315.CrossRefGoogle ScholarPubMed
Asarnow, J. R., Porta, G., Spirito, A., Emslie, G., Clarke, G., Wagner, K. D., … Brent, D. A. (2011). Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: Findings from the TORDIA study. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 772781.CrossRefGoogle ScholarPubMed
Auerbach, R. P., Millner, A. J., Stewart, J. G., & Esposito, E. C. (2015). Identifying differences between depressed adolescent suicide ideators and attempters. Journal of Affective Disorders, 186, 127133.CrossRefGoogle ScholarPubMed
Bahmanyar, S., Sparen, P., Rutz, E. M., & Hultman, C. M. (2009). Risk of suicide among operated and non-operated patients hospitalised for peptic ulcers. Journal of Epidemiology and Community Health, 63, 10161021.CrossRefGoogle ScholarPubMed
Ballard, E. D., Cwik, M., Van Eck, K., Goldstein, M., Alfes, C., Wilson, M. E., … Wilcox, H. C. (2017). Identification of at-risk youth by suicide screening in a pediatric emergency department. Prevention Science, 18, 174182.CrossRefGoogle Scholar
Bould, H., Mars, B., Moran, P., Biddle, L., & Gunnell, D. (2019). Rising suicide rates among adolescents in England and Wales. Lancet (London, England), 394, 116117.CrossRefGoogle ScholarPubMed
Brundin, L., Erhardt, S., Bryleva, E. Y., Achtyes, E. D., & Postolache, T. T. (2015). The role of inflammation in suicidal behaviour. Acta Psychiatrica Scandinavica, 132, 192203.CrossRefGoogle Scholar
Campo, J. V. (2012). Annual research review: Functional somatic symptoms and associated anxiety and depression – developmental psychopathology in pediatric practice. Journal of Child Psychology and Psychiatry, 53, 575592.CrossRefGoogle ScholarPubMed
Chang, H. J., Lai, Y. L., Chang, C. M., Kao, C. C., Shyu, M. L., & Lee, M. B. (2012). Gender and age differences among youth, in utilization of mental health services in the year preceding suicide in Taiwan. Community Mental Health Journal, 48, 771780.CrossRefGoogle ScholarPubMed
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40, 373383.CrossRefGoogle ScholarPubMed
Curtin, S. (2020). State suicide rates among adolescents and young adults aged 10–24: United States, 2000–2018. National Vital Statistics Reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 69, 110.Google Scholar
De Berardis, D., Fornaro, M., Valchera, A., Cavuto, M., Perna, G., Di Nicola, M., … Tomasetti, C. (2018). Eradicating suicide at its roots: Preclinical bases and clinical evidence of the efficacy of ketamine in the treatment of suicidal behaviors. International Journal of Molecular Sciences, 19, 2888. doi: 10.3390/ijms19102888CrossRefGoogle ScholarPubMed
De Hert, M., McKenzie, K., & Peuskens, J. (2001). Risk factors for suicide in young people suffering from schizophrenia: A long-term follow-up study. Schizophrenia Research, 47, 127134.CrossRefGoogle ScholarPubMed
Eliacik, K., Kanik, A., Bolat, N., Mertek, H., Guven, B., Karadas, U., … Bakiler, A. R. (2017). Anxiety, depression, suicidal ideation, and stressful life events in non-cardiac adolescent chest pain: A comparative study about the hidden part of the iceberg. Cardiology in the Young, 27, 10981103.CrossRefGoogle Scholar
Farand, L., Renaud, J., & Chagnon, F. (2004). Adolescent suicide in Quebec and prior utilization of medical services. Canadian Journal of Public Health, 95, 357360.CrossRefGoogle ScholarPubMed
Fleischmann, A., Bertolote, J. M., Belfer, M., & Beautrais, A. (2005). Completed suicide and psychiatric diagnoses in young people: A critical examination of the evidence. American Journal of Orthopsychiatry, 75, 676683.CrossRefGoogle Scholar
Fontanella, C. A., Warner, L. A., Steelesmith, D., Bridge, J. A., Sweeney, H. A., & Campo, J. V. (2020). Clinical profiles and health services patterns of Medicaid-enrolled youths who died by suicide. JAMA Pediatrics, 174, 470477.CrossRefGoogle Scholar
Fralick, M., Sy, E., Hassan, A., Burke, M. J., Mostofsky, E., & Karsies, T. (2019). Association of concussion with the risk of suicide: A systematic review and meta-analysis. JAMA Neurology, 76, 144151.CrossRefGoogle ScholarPubMed
Glenn, C. R., Kleiman, E. M., Kellerman, J., Pollak, O., Cha, C. B., Esposito, E. C., … Boatman, A. E. (2020). Annual research review: A meta-analytic review of worldwide suicide rates in adolescents. Journal of Child Psychology and Psychiatry, 61, 294308.CrossRefGoogle ScholarPubMed
Goodwin, R. D., & Stein, M. B. (2002). Generalized anxiety disorder and peptic ulcer disease among adults in the United States. Psychosomatic Medicine, 64, 862866.Google ScholarPubMed
Gould, M. S., Greenberg, T., Velting, D. M., & Shaffer, D. (2003). Youth suicide risk and preventive interventions: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 386405.CrossRefGoogle ScholarPubMed
Hauser, M., Galling, B., & Correll, C. U. (2013). Suicidal ideation and suicide attempts in children and adolescents with bipolar disorder: A systematic review of prevalence and incidence rates, correlates, and targeted interventions. Bipolar Disorders, 15, 507523.CrossRefGoogle ScholarPubMed
Hawton, K., Saunders, K. E., & O'Connor, R. C. (2012). Self-harm and suicide in adolescents. Lancet (London, England), 379, 23732382.CrossRefGoogle ScholarPubMed
Hielscher, E., DeVylder, J., Hasking, P., Connell, M., Martin, G., & Scott, J. G. (2021). Mediators of the association between psychotic experiences and future non-suicidal self-injury and suicide attempts: Results from a three-wave, prospective adolescent cohort study. European Child and Adolescent Psychiatry, 30, 13511365.CrossRefGoogle ScholarPubMed
Kelleher, I., Clarke, M. C., Rawdon, C., Murphy, J., & Cannon, M. (2013). Neurocognition in the extended psychosis phenotype: Performance of a community sample of adolescents with psychotic symptoms on the MATRICS neurocognitive battery. Schizophrenia Bulletin, 39, 10181026.CrossRefGoogle ScholarPubMed
Lanas, A., & Chan, F. K. L. (2017). Peptic ulcer disease. Lancet (London, England), 390, 613624.CrossRefGoogle ScholarPubMed
Lee, E. T. (1992). Statistical methods for survival data analysis. New York: John Wiley and Sons.Google Scholar
Lee, J., Bang, Y. S., Min, S., Ahn, J. S., Kim, H., Cha, Y. S., … Kim, M. H. (2019). Characteristics of adolescents who visit the emergency department following suicide attempts: Comparison study between adolescents and adults. BMC Psychiatry, 19, 231. doi: 10.1186/s12888-019-2213-5CrossRefGoogle ScholarPubMed
Levenstein, S., Rosenstock, S., Jacobsen, R. K., & Jorgensen, T. (2015). Psychological stress increases risk for peptic ulcer, regardless of Helicobacter pylori infection or use of nonsteroidal anti-inflammatory drugs. Clinical Gastroenterology and Hepatology, 13, 498506.CrossRefGoogle ScholarPubMed
Lin, J. J., Chang, S. S., & Lu, T. H. (2010). The leading methods of suicide in Taiwan, 2002–2008. BMC Public Health, 10, 480. doi: 10.1186/1471-2458-10-480CrossRefGoogle Scholar
Lin, J. J., & Lu, T. H. (2006). Association between the accessibility to lethal methods and method-specific suicide rates: An ecological study in Taiwan. Journal of Clinical Psychiatry, 67, 10741079.CrossRefGoogle ScholarPubMed
Liu, C. Y., Hung, Y. T., Chuang, Y. L., Chen, Y. J., Weng, W. S., Liu, J. S., & Liang, K. Y. (2006). Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. Journal of Health Management (Chinese), 4, 122.Google Scholar
Lund-Sorensen, H., Benros, M. E., Madsen, T., Sorensen, H. J., Eaton, W. W., Postolache, T. T., … Erlangsen, A. (2016). A nationwide cohort study of the association between hospitalization with infection and risk of death by suicide. JAMA Psychiatry, 73, 912919.CrossRefGoogle ScholarPubMed
Luoma, J. B., Martin, C. E., & Pearson, J. L. (2002). Contact with mental health and primary care providers before suicide: A review of the evidence. American Journal of Psychiatry, 159, 909916.CrossRefGoogle Scholar
Ministry of Health and Welfare (Taiwan) (2020). Statistics in suicide mortality in Taiwan: 2004–2019. Taipei, Taiwan.Google Scholar
Moskos, M. A., Olson, L., Halbern, S. R., & Gray, D. (2007). Utah youth suicide study: Barriers to mental health treatment for adolescents. Suicide and Life-Threatening Behavior, 37, 179186.CrossRefGoogle ScholarPubMed
Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the national comorbidity survey replication adolescent supplement. JAMA Psychiatry, 70, 300310.CrossRefGoogle ScholarPubMed
Orsolini, L., Latini, R., Pompili, M., Serafini, G., Volpe, U., Vellante, F., … De Berardis, D. (2020). Understanding the complex of suicide in depression: From research to clinics. Psychiatry Investigation, 17, 207221.CrossRefGoogle ScholarPubMed
Pelkonen, M., & Marttunen, M. (2003). Child and adolescent suicide: Epidemiology, risk factors, and approaches to prevention. Paediatric Drugs, 5, 243265.CrossRefGoogle ScholarPubMed
Renaud, J., Berlim, M. T., McGirr, A., Tousignant, M., & Turecki, G. (2008). Current psychiatric morbidity, aggression/impulsivity, and personality dimensions in child and adolescent suicide: A case-control study. Journal of Affective Disorders, 105, 221228.CrossRefGoogle ScholarPubMed
Renaud, J., Berlim, M. T., Seguin, M., McGirr, A., Tousignant, M., & Turecki, G. (2009). Recent and lifetime utilization of health care services by children and adolescent suicide victims: A case-control study. Journal of Affective Disorders, 117, 168173.CrossRefGoogle ScholarPubMed
Renaud, J., Seguin, M., Lesage, A. D., Marquette, C., Choo, B., & Turecki, G. (2014). Service use and unmet needs in youth suicide: A study of trajectories. Canadian Journal of Psychiatry, 59, 523530.CrossRefGoogle Scholar
Rhodes, A. E., Sinyor, M., Boyle, M. H., Bridge, J. A., Katz, L. Y., Bethell, J., … Skinner, R. (2019). Emergency department presentations and youth suicide: A case-control study. Canadian Journal of Psychiatry, 64, 8897.CrossRefGoogle ScholarPubMed
Rodway, C., Tham, S. G., Ibrahim, S., Turnbull, P., Kapur, N., & Appleby, L. (2020). Children and young people who die by suicide: Childhood-related antecedents, gender differences and service contact. BJPsych Open, 6, e49. doi: 10.1192/bjo.2020.33CrossRefGoogle Scholar
Ruch, D. A., Steelesmith, D. L., Warner, L. A., Bridge, J. A., Campo, J. V., & Fontanella, C. A. (2021). Health services use by children in the welfare system who died by suicide. Pediatrics, 147, e2020011585. doi: 10.1542/peds.2020-011585CrossRefGoogle Scholar
Singhal, A., Ross, J., Seminog, O., Hawton, K., & Goldacre, M. J. (2014). Risk of self-harm and suicide in people with specific psychiatric and physical disorders: Comparisons between disorders using English national record linkage. Journal of the Royal Society of Medicine, 107, 194204.CrossRefGoogle ScholarPubMed
Stenager, K., & Qin, P. (2008). Individual and parental psychiatric history and risk for suicide among adolescents and young adults in Denmark: A population-based study. Social Psychiatry and Psychiatric Epidemiology, 43, 920926.CrossRefGoogle Scholar
Viilo, K. M., Timonen, M. J., Hakko, H. H., Sarkioja, T., Meyer-Rochow, V. B., & Rasanen, P. K. (2005). Lifetime prevalences of physical diseases and mental disorders in young suicide victims. Psychosomatic Medicine, 67, 241245.CrossRefGoogle ScholarPubMed
World Health Organization (2019). Suicide in the world: Global health estimates. Geneva, Switzerland: World Health Organization.Google Scholar
Zhang, J., Xiao, S., & Zhou, L. (2010). Mental disorders and suicide among young rural Chinese: A case-control psychological autopsy study. American Journal of Psychiatry, 167, 773781.CrossRefGoogle ScholarPubMed
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