Ying-Yeh Chen M.D., Sc.D. Attending Psychiatrist, Taipei City Psychiatric Center Associate Professor, National Yang-Ming University

Transcription

1 Ying-Yeh Chen M.D., Sc.D. Attending Psychiatrist, Taipei City Psychiatric Center Associate Professor, National Yang-Ming University

2 1. Pattern of suicide in Taiwan and Taipei City 2. Suicide attempters surveillance system in Taipei City 3. Suicide and mortality after attempted suicide in Taipei City

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4 Suicde deaths per 100, Male suicide rate Female suicide rate

5 Suicide deaths per 100, Solid /liquid poisoning Charcoal burning Hanging Jumping

6 25.0 Suicide deaths per 100, Taipei Taiwan

7 Jumping, 210 (20%) Solid /liquid poisoning, 61 (6%) Taipei, Others, 139 (13%) Hanging, 341 (31%) Charcoal burning, 324 (30%) Jumping, 1223 (10%) Solid /liquid poisoning, 1996 (16%) Taiwan, Others, 1181 (10%) Hanging, 4047 (34%) Charcoal burning, 3677 (30%) Jumping, 129 (21%) Others, 91 (15%) Solid /liquid poisoning, 69 (11%) Taipei, Charcoal burning, 5 (1%) Hanging, 333 (52%) Others, 805 (12%) Jumping, 563 (8%) Solid /liquid poisoning, 2031 (31%) Taiw an, Charcoal burning, 83 (1%) Hanging, 3148 (48%)

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9 Taiwan has a well-established cause of death recording system; surveillance system for nonfatal suicidal behaviors was established at 2006 Taipei City established surveillance system for non-fatal suicidal behaviors in Oct The strongest predictor of suicide is previous deliberate self-harm, which was found in 40%- 60% of suicide completers

10 Service-based suicide prevention program established in 2003 All hospital Emergency Departments in Taipei City are all required to report cases of selfinflicted injury to the suicide prevention center

11 The medical staff in the emergency department is required to complete a structured case note for all self-harm cases Case managers will contact attempters and offer care and other case management services

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13 To assess suicide and non-suicide mortality outcomes among individuals who attempted suicide during in Taipei City To examine if suicide method used in the index attempt predict future suicide deaths

14 Consecutive suicide attempters reported to the surveillance system during Jan 2004 and Dec (N=8343). Each person s earliest recorded attempt during the study period was used as the index episode. Individuals who died in the index attempt (N=202), less than 15 years of age (N=60), not Taiwanese citizens (N=98) and those whose National ID number was not available (N=382) were excluded from the analysis. N= 7601 (Female: 5285; Male: 2316)

15 A prospective cohort study, evaluating the mortality outcomes of a consecutive sample of suicide attempters presenting to emergency departments at hospitals in Taipei City during Jan 2004 and Dec Mortality was determined by linking the unique identification number of each self-harm individual to official death records Taiwan from 2004 to 2008

16 The cumulative mortality rates for suicide and non-suicide deaths were presented by means of life-table analysis. Standardized mortality ratios (SMRs) were calculated to compare the mortality of suicide attempters with those of the general population. Cox proportional hazards model was used to estimate the hazard ratios for associations between predictors and mortality outcomes.

17 Suicide within 1st year Suicide during follow up Characteristics No of attempts N (%) N (%) of suicides during follow-up Total (1.6) 201 (2.6) Sex Male (2.9) 92 (4.0) Female (1.1) 109 (2.1) Age (0.8) 25 (1.3) (1.4) 105 (2.8) (3.0) 51 (3.9) (2.8) 20 (3.8)

18 Attempted suicide Suicide within 1st year Suicide during follow up Methods used in index attempt N (%) N (%) N (%) of suicides during follow-up S/L poisoning 5144 (67.7) 69 (1.3) 116 (2.26) Wrist cutting 1502 (19.8) 15 (1.0) 29 (1.93) Charcoal burning 356 ( 4.7) 13 (3.7) 19 (5.34) Jumping 87 ( 1.1) 1 (1.1) 1 (1.15) Hanging 77 ( 1.0) 12 (15.6) 13 (16.88) Others 433 ( 5.7) 14 (3.2) 23 (5.31)

19 Total attempts (N=7601) Male, N=2316 Female, N=5285 Suicide mortality (N=201) Non-suicide mortality (N=315) Female, N=109 Male, N=92 Female, N=134 Male, N=181

20 45-64, N=1321 Total attempts (N=7601) unknown, N=18 65+, N= , N= , N=3778 Suicide mortality (N=201) Non-suicide mortality (N=315) 65+, N= ,N= , N= , N= , N= , N= , N= , N=73

21 Total attempts (N=7601) N=77 N=433 N=87 N=356 unknown, N=2 Suicide mortality (N=201) N=23 N=13 N=1 N=19 N=1502 N=29 N=116 N=5144

22 0.08 Cumulative mortality rate Years of follow-up Suicide Non-suicide All causes

23 Cumulative mortality rate Years of follow-up Male Female

24 Cumulative mortality rate Years of follow-up

25 Cumulative mortality rate Years of follow-up S/L poisoning Wrist cutting Charcoal burning Jumping Hanging Others

26 Cumulative mortality rate Years of follow-up Male Female

27 Cumulative mortality rate Years of follow-up

28 SMR (95% CI) All causes 6.90 (6.32, 7.52) Suicide (51.04, 61.93) Non-suicide mortality 4.41 (3.94, 4.93) Malignant neoplasm 3.49 (2.77, 4.34) Heart disease 3.99 (2.75, 5.61) Cerebral vascular disease 3.92 (2.53, 5.78) Others 5.01 (4.25, 5.78) Accident 7.86 (4.93, 11.91)

29 Hazard ratio (95%CI) Unadjusted Adjusted for age for sex S/L poisoning Wrist cutting 0.85 (0.57, 1.28) 1.03 (0.68, 1.55) Charcoal burning 2.50 (1.54, 4.06)*** 2.07 (1.26, 3.40)** Jumping 0.52 (0.07, 3.69) 0.50 (0.07, 3.59) Hanging 9.46 (5.33, 16.79)*** 7.16 (3.98, 12.88)*** Others 2.43 (1.55, 3.80)*** 2.00 (1.26, 3.16)**

30 Method at index attempt Men No (%) using same method at eventual suicide Women No (%) using same method at eventual suicide S/L poisoning 11 (22.9) 13 ( 19.1) Wrist cutting 0 ( 0.0) 0 ( 0.0) Charcoal burning 8 (88.9) 7 ( 70.0) Jumping 0 ( 0.0) 0 ( 0.0) Hanging 8 (80.0) 3 (100.0) Others 3 (21.4) 2 ( 22.2) Total 30 (32.6) 25 ( 22.9)

31 Country/author Sample size F-U years Suicide death All causes Sweden (Nordstrom et al, 1995) % 11.0% Denmark (Nordentoft et al, 1993) % 31.4% Finland (Ostamo et al) % 14.8% Finland (Suokas et al, 2001) % 21.7% UK (Hawton et al, 2003) UK(Cooper et al, 2005) >=3 Sweden(Runeson et al, 2010) Southern Taiwan (Chen VC et al, 2011) Taipei, Taiwan (Chen et al, --) % 1.7% 2.4% 3.0% 0.26% 0.52% 0.75% 4.2% 11.8% 2% 4.4% 1.6% 2.6% % 13.4% 3.3% 6.8%

32 In the 1st year, 1.6% completed suicide and 1.7% died by other causes of deaths During 3-5 years F-U, 6.8% died, among which 40% died from suicide. Significant increase in suicide (SMR=58.9) and nonsuicide mortality (SMR=4.4) among attempters Attempted suicide by hanging and charcoal burning significantly increased risk of later suicide deaths. Those who used hanging and charcoal burning at index attempt tended to maintain the same method

33 Cases who did not visit ER were not included to the analysis Only the first attempt was indexed, repetitive attempts were not considered

34 Thank you for your attention!