Aim
No previous studies, to our knowledge, have investigated the association between psychiatrist density and suicide, accounting for individual‐ and area‐level characteristics.
Methods
We ...investigated all suicide cases in 2007‐2017 identified from the national cause‐of‐death data files, with each suicide case matched to 10 controls by age and sex and each suicide case/control assigned to one of the 355 townships across Taiwan. Our primary outcome was the odds ratio (OR) of suicide and its 95% confidence interval (CI) estimated via multilevel models, which included both individual‐ and area‐level characteristics. Townships with no psychiatrists were compared with the quartiles of townships with psychiatrists (density per 100,000 population): quartile 1 (Q1) (0.01–3.02); quartile 2 (Q2) (3.02–7.20); quartile 3 (Q3) (7.20–13.82); and quartile 4 (Q4) (>13.82).
Results
A total of 40,930 suicide cases and 409,300 age‐ and sex‐matched controls were included. We found that increased psychiatrist density was associated with decreased suicide risk (Q1: adjusted OR aOR, 0.95 95% CI, 0.90–1.01; Q2: aOR, 0.90 95% CI, 0.85–0.96; Q3: aOR, 0.89 95% CI, 0.83–0.94; Q4: aOR, 0.89 95% CI, 0.83–0.95) after adjusting for individual‐level characteristics (employment state, monthly income, physical comorbidities, and the diagnosis of psychiatric disorders) and area socioeconomic characteristics.
Conclusions
The psychiatrist density–suicide association suggests an effect of increased availability of psychiatric services on preventing suicide. Suicide prevention strategies could usefully focus on enhancing local access to psychiatric services.
Aims
We aimed to investigate the trajectories of absolute and relative risks of cause‐specific mortality among patients discharged from inpatient psychiatric services.
Methods
We conducted a national ...matched cohort study (2002–2013) using data from the Taiwan National Health Insurance database linked to national cause‐of‐death data files. Patients discharged from inpatient psychiatric care without prior psychiatric hospitalizations were individually matched to 20 comparison individuals based on sex and age. The rates, rate differences, and relative risks (hazard ratios, HRs) of cause‐specific mortality were calculated at six follow‐up periods post‐discharge. Cumulative mortality incidence was assessed at 5 years of follow‐up.
Results
The mortality risks of all causes were increased among patients (n = 158 065) relative to comparison individuals (n = 3 161 300). Mortality rate differences were greater for natural causes, while relative risks (HRs) were higher for unnatural causes. Suicide was the leading cause of death within the first year of discharge, while circulatory and respiratory diseases were the leading causes of death from the second year. The mortality rates and HRs for all causes of death (except homicide) were highest during the first 3 months. The elevated risk of unnatural‐cause mortality declined rapidly after discharge but remained high in the long term; in contrast, risk elevation for natural‐cause mortality was more stable over time. Approximately one‐eighth of patients (12.9%, 95% confidence interval 12.7–13.7%) died within 5 years of follow‐up.
Conclusions
Integrated physical and mental health care is needed to reduce excess mortality, particularly during the first 3 months post‐discharge, among psychiatric patients.
More than half of the world's population now lives in urban areas. Understanding the spatial distribution of suicide in these settings may inform prevention. Previous analyses of the spatial ...distribution of suicide in cities have largely been conducted in Western nations. We investigated the spatial pattern of suicide and factors associated with its spatial distribution in Taipei City, Taiwan. We estimated smoothed standardized mortality ratios for overall suicide and suicide by sex/age group across 432 neighborhoods (mean population size: 5500) in Taipei City (2004–2010) using Bayesian hierarchical models. A range of area-level characteristics including socioeconomic deprivation, social fragmentation, income inequality, and linking social capital were investigated for their associations with suicide mortality. Overall suicide rates were below average in the city center, whereas above average rates were found in some suburbs. The cartogram highlighted the concentration of suicide burden in one western area of the city. Male suicides demonstrated generally similar spatial patterning across age groups, while the geographic distribution of female suicides differed by age. After adjusting for other variables, two area characteristics were found to be associated with area suicide rates: the proportion of divorced/separated adults (rate ratio RR per one standard deviation increase = 1.08, 95% confidence interval 1.01–1.16), an indicator of social fragmentation; and median household income (RR = 0.80, 0.73–0.86), an indicator of socioeconomic deprivation. There was a 1.8-fold difference in suicide rates between neighborhood quintiles with the lowest and the highest median household income, with middle-aged males showing the largest gradient (3.2-fold difference). The geography of suicide in Taipei City showed spatial patterning and socioeconomic correlates distinct from cities in Western nations. There is a need for future research to better understand the correlates of change in the geographic distribution of suicide throughout the process of urban development.
•Marked variations in suicide were found across neighbourhoods in Taipei City.•Low suicide rates were shown in the city center compared to some suburbs.•Around 60% of the variations could be explained by area characteristics studied.•Income and divorced/separated adults were linked with neighborhood suicide rates.•Socioeconomic inequality in suicide rates was strongest in middle-aged men.
We examined the relationships between individuals’ life satisfaction and individual-, household- and neighbourhood-level characteristics and evidence for cross-level interactions. We used data on ...individuals’ life satisfaction and a range of individual- and household-level characteristics from the Hong Kong Panel Study of Social Dynamics (2011) with linkage to neighbourhood-level aggregated data extracted from the 2011 census. The neighbourhood-level variables included the poverty rate and four factors derived from factor analysis based on 21 variables. Multilevel models were used to allow for the hierarchical nature of the data. Most of the variance in life satisfaction could be explained by individual- and household-level characteristics. Neighbourhood-level characteristics accounted for a small proportion (around 5% or less) of the variance. Most of the individual- and household-level characteristics studied were associated with life satisfaction. Life satisfaction was negatively associated with local poverty rate and three neighbourhood factors (deprivation, social fragmentation and ageing). There was evidence of cross-level interactions. For example, the level of life satisfaction decreased with an increasing neighbourhood poverty rate among individuals who did not receive Comprehensive Social Security Assistance (CSSA), but CSSA recipients had a higher level of life satisfaction in areas with higher poverty rates. The negative effect of neighbourhood poverty on life satisfaction was more marked in individuals who rented or owned their homes than in those who lived in public housing. Our results have implications for urban policies that may improve life satisfaction such as financial and housing support for high risk individuals.
BackgroundPrevious studies investigating the independent effects of neighbourhood-level factors on depression are rare within the Asian context, especially in the elderly population.MethodsData for ...29 099 older adults aged 65 years or above who have received health examinations at elderly health centres in Hong Kong in 2008–2011 were analysed. Using multilevel regression modelling, the cross-sectional associations of neighbourhood social attributes (neighbourhood poverty, ethnic minority, residential stability and elderly concentration) and physical (built) attributes (recreational services and walkability) with depression outcomes (depressive symptoms and depression) after adjusting for individual-level characteristics were investigated. Gender interaction effects were also examined.ResultsNeighbourhood poverty was associated with both depressive symptoms and depression in the elderly. Neighbourhood elderly concentration, recreational services and walkability were associated with fewer depressive symptoms. The association between neighbourhood poverty and elderly depressive symptoms was found in women only and not in men.ConclusionPolicies aimed at reducing neighbourhood poverty, increasing access to recreational services and enhancing walkability might be effective strategies to prevent depression in older adults in the urban settings.
•Charcoal-burning (CB) suicides persistently showed a distinct profile in Hong Kong.•However, the difference in some characteristics in CB and non-CB suicides diminished.•The CB method may have ...gradually diffused to other vulnerable group such as older people.•New methods for suicide may attract a new vulnerable group in the initiation period.
The use of barbecue charcoal gas for suicide led to more than 50,000 deaths in Asia since the rise of its use from 1998. Little is known whether the profile of charcoal-burning suicides changed over time.
Hong Kong's suicide data (2002–2013) were extracted from the Coroner's files. The detailed characteristics were compared between suicide by charcoal-burning and non-charcoal-burning methods, and between charcoal-burning suicides of different periods (2002–2005 vs 2006–2009 vs 2010–2013).
People who died by suicide using charcoal burning (n = 2,188) were more likely to be male, aged 30–49 years, married (2002–2005 only), have debt, or live alone, and were less likely to have past or current psychiatric treatment or medical illness than non-charcoal-burning suicides (n = 9,666) across the three four-year periods. By contrast, compared to charcoal-burning suicides in 2002–2005, those in more recent periods (2006–2009 and 2010–2013) were more likely to be aged 50+, non-married, live alone (2006–2009 only), or have current psychiatric treatment or medical illness, and were less likely to be male (2006–2009 only), unemployed, or have debt.
There could be under-reporting of certain characteristics for charcoal-burning suicides in the Coroner's files.
Charcoal-burning suicides persistently showed a distinguishable profile in Hong Kong, whilst changes in certain characteristics suggested a ‘diffusion’ of the method to some other groups such as older individuals. Responsible media reporting and restricting online information about new suicide methods could be potentially important prevention strategies in the early stage, whilst other strategies are needed when the methods become more commonly used.
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