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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
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
Jou-Yin Lai
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
Chun-Hung Pan
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan Department of Psychology, National Chengchi University, Taipei, Taiwan
Sheng-Siang Su
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
Tien-Wei Yang
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
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
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*
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:



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.


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.


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.


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.

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

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


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