INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has caused significant mental distress in populations globally. At the frontline of the pandemic, emergency departments (EDs) are the prime setting to observe the effects of the pandemic on the mental health of the population. We aimed to describe the trend of mental health-related ED attendances at an acute hospital in Singapore before and during the various stages of the COVID-19 pandemic. METHODS: This is a retrospective, descriptive study of patients who presented to the ED between 1 January 2019 and 31 December 2020. Patients diagnosed with mental health-related systematised nomenclature of medicine who visited the ED during this period were identified and were placed into mental health diagnosis categories for analysis. A comparison was made between patients who presented before the pandemic (2019) and during the pandemic (2020). RESULTS: During the study periods, we identified 1,421 patients, of whom 27 were excluded due to non-mental health-related diagnoses, leaving 1,394 patients for analysis. There was a 36.7% increase in mental health-related ED presentations from 2019 to 2020. The proportion of higher-acuity mental health-related ED attendances and number of suicide attempts also increased. CONCLUSION Our study described an increase in the proportion of high-acuity mental health-related ED attendances during the COVID-19 pandemic. Emergency physicians must be cognisant of the effects of the pandemic on mental health. Further research should be conducted to better equip the healthcare system for handling all aspects of the pandemic.
Humans ; COVID-19/psychology* ; Emergency Service, Hospital/statistics & numerical data* ; Retrospective Studies ; Singapore/epidemiology* ; Male ; Female ; Adult ; Middle Aged ; Mental Disorders/diagnosis* ; Mental Health ; SARS-CoV-2 ; Tertiary Care Centers ; Pandemics ; Aged ; Suicide, Attempted/statistics & numerical data* ; Young Adult ; Adolescent

INTRODUCTION: The rising rate of adolescent suicide, and the burden of self-harm and mental health disorders, pose significant threats to Singapore's future health outcomes and human potential. This study sought to examine the risk profile and healthcare utilisation patterns of Singaporean adolescents who presented to the emergency department (ED) for suicidal or self-harm behaviour. METHOD: A retrospective review of medical records for patients aged 10 to 19 years who visited Singapore's KK Women's and Children's Hospital ED for suicidal or self-harm attempts from January to December 2021 was conducted. RESULTS: A total of 221 patients were identified, with a predominance of female patients (85.5%) over males (14.5%). The mean age was 14.2 ± 1.4 years. Intentional drug overdose (52.0%) was the most commonly used method. Significantly more females presented for intentional paracetamol overdose (46.6% versus [vs] 28.1%, P=0.049), whereas jumping from a height was more common among males (18.8% vs 5.8%, P=0.022). The most frequently observed mental health challenges were stress-related and emotional coping difficulties (50.7%), followed by mood and anxiety symptoms (53.4%). A history of self-harm and suicidal behaviours were the most common psychosocial risk factors. Within the year prior to their ED presentation, 15.4% had accessed healthcare services for mild medical ailments, 19.5% for medically unexplained symptoms, and 17.2% for previous self-harm or suicide attempts. CONCLUSION Most cases involved psychosocial and emotional regulation difficulties, some of which displayed sex-specific patterns, rather than complex psychiatric disorders. The identified predictive factors can help inform Singapore's National Mental Health and Well-being Strategy, to guide targeted and transdiagnostic interventions in schools and community settings.
Humans ; Adolescent ; Singapore/epidemiology* ; Female ; Male ; Suicide, Attempted/psychology* ; Emergency Service, Hospital/statistics & numerical data* ; Self-Injurious Behavior/psychology* ; Retrospective Studies ; Child ; Young Adult ; Drug Overdose/epidemiology* ; Risk Factors ; Acetaminophen/poisoning* ; Patient Acceptance of Health Care/statistics & numerical data* ; Sex Factors

OBJECTIVES: Among the Korean elderly (those 65 years of age and older), the suicide rate is 80.3/100 000 people, which is ten times higher than the Organization for Economic Cooperation and Development average. Because South Korea is rapidly becoming an aging population, this high elderly suicidal rate will only get worse. Although the size of the elderly suicide problem is quite large, previous research in South Korea has surveyed restricted areas and not the entire country. Even though the factors that affect elderly suicide are complicated, there has been little research into these influencing factors. Thus, this research uses the national survey data (Community Health Survey) that was obtained in 2009. Additionally, we analyze factors affecting elderly suicidal ideation and attempts as well as the paths of these effects. METHODS: Community Health Survey data obtained by the Korea Centers for Disease Control and Prevention in 2009 was used for this study. We additionally examined the factors that affect suicide with chi-squared tests, t-tests, Pearson's correlation test, and path analysis. RESULTS: Depressive symptoms and suicidal ideation are the only factors that directly affect suicidal attempts. Demographic, behavioral, and physical activity factors have indirect effects on suicidal attempts. CONCLUSIONS: Depression has the strongest influence on suicidal ideation and attempts. Demographic, behavioral, and physical activity factors affect suicidal attempts mostly through depressive symptoms. In addition, there is a path that suggests that demographic, behavioral, and physical activity factors affect suicidal attempts not through depression symptoms but only through suicidal ideation. This means that the elderly who do not have depression symptoms attempt suicide according to their own situations and characteristics.
Aged ; Databases, Factual ; Depression ; Factor Analysis, Statistical ; Female ; Health Behavior ; Humans ; Male ; Models, Theoretical ; Motor Activity ; Republic of Korea ; Risk Factors ; Suicidal Ideation ; Suicide, Attempted/psychology/*statistics & numerical data ; Surveys and Questionnaires

Suicide is a leading cause of death among Korean adolescents. Many suicide attempting adolescents often are discharged against medical advice in the emergency department. The aim of the present study was to determine the risk factors for discharge against medical advice (DAMA) after self-inflicted injury or attempted suicide in the emergency department. We extracted data on adolescents (10-19 yr old) from the national emergency department information system; we used data from 2007 and 2011. A total of 6,394 adolescents visited EDs after self-inflicted injury or attempted suicide. Among these patients, the median age was 17 yr (Interquatile range, 15-18 yr), 83.2% were between 15-19 yr of age, and 63.3% were female. Poisoning was the most common method of attempted suicide, while hanging and fall were the most common methods of fatality. The rate of DAMA from the ED was 22.8%. Independent risk factors for DAMA included female gender (odds ratio [OR], 1.49), older age adolescents (OR, 1.96), residence in a metropolitan/large city area (OR, 1.49), and discharge at night (OR, 1.38). These risk factors should be considered in establishing management and counseling plans for patients discharged against medical advice by community services and EDs.
Adolescent ; Adult ; Child ; Cross-Sectional Studies ; Emergency Service, Hospital/utilization ; Female ; Humans ; Male ; Patient Discharge/*statistics & numerical data ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Self-Injurious Behavior/*psychology ; Suicide, Attempted/*psychology ; Treatment Refusal/*psychology ; Young Adult

OBJECTIVES: The purpose of this study was to investigate the association between suicidal behavior and patterns of alcohol consumption in Korean adults. METHODS: This study was based on data provided by the Korea National Health and Nutritional Examination Survey from 2007 to 2011. A total of 42 347 subjects were included in the study, of whom 19 292 were male and 23 055 were female. Logistic regression analysis was performed to assess the association between patterns of alcohol consumption and suicidal behavior. RESULTS: Among the study subjects, 1426 males (11.3%) and 3599 females (21.2%) had experienced suicidal ideation, and 106 males (0.8%) and 190 females (1.1%) had attempted suicide during the previous 12 months. Alcohol Use Disorders Identification Test (AUDIT) scores were found to be associated with suicidal ideation in males and associated with both suicidal ideation and suicide attempts in females. Alcoholic blackouts were associated with suicidal ideation and suicide attempts in males, and were also associated with suicidal ideation in females. CONCLUSIONS: In this study, we found that certain patterns of alcohol consumption were associated with suicidal behaviors. In particular, only alcoholic blackouts and categorized AUDIT scores were found to be associated with suicidal behavior in males. We therefore suggest that further research is needed to examine this relationship prospectively and in other settings.
Adult ; Aged ; Alcohol Drinking/*psychology ; Alcohol-Related Disorders/pathology ; Asian Continental Ancestry Group ; Demography ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Nutrition Surveys ; Republic of Korea ; Sex Factors ; Suicidal Ideation ; Suicide, Attempted/*psychology/statistics & numerical data

This study explored the relationship of the subjective socioeconomic position (SEP) as well as the objective SEP with the rate of suicide attempts in 74,186 adolescents from the 2012 Korea Youth Risk Behavior Web-based Survey (KYRBS). The SEP was measured by the Family Affluence Scale (FAS) and the self-rated household economic status. The low perceived SEP for either the high or low FAS score was related to the elevated likelihood of suicide attempts in both genders. As compared with the adolescents in both the high level of perceived SEP and FAS score after adjusting for other confounding factors, the middle school students were more likely to attempt suicide in both low level of perceived SEP and FAS score (OR, 1.81; 95% CI, 1.18-2.78 for boys, OR, 1.46; 95% CI, 1.13-1.90 for girls). The high school students were more likely to attempt suicide in the low perceived SEP and high FAS score (OR, 1.44; 95% CI, 1.14-1.81 for boys, OR, 1.29; 95% CI, 1.07-1.56 for girls). In conclusion, the relationship of subjective SEP is important in suicide attempts as much as objective SEP and far more important in the high school students.
Adolescent ; Data Collection ; Female ; Humans ; Internet ; Male ; Odds Ratio ; Republic of Korea ; *Socioeconomic Factors ; Students/psychology ; Suicide, Attempted/*statistics & numerical data

INTRODUCTIONThe aims of the study were to identify the prevalence and sociodemographic and clinical correlates of suicidal behaviours using data from a cross-sectional survey among those with major depressive disorder (MDD) in Singapore.

MATERIALS AND METHODSThe Singapore Mental Health Study (SMHS) was a cross-sectional epidemiological study that surveyed Singapore residents (Singapore citizens and permanent residents) aged 18 years and above. The assessment of mental disorders was established using version 3.0 of the Composite International Diagnostic Interview (CIDI 3.0). For the purposes of this study, suicidal behaviour was assessed by questions which were asked to respondents who answered positively to the screening questions in the CIDI 3.0 "Depression" module.

RESULTSThe prevalence of suicidal ideation, plan and attempt among those with lifetime MDD was 43.6%, 13.7% and 12.3%, respectively. We found that suicidal ideation, plan and attempt were significantly associated with ethnicity, education and income. The rate of those who had sought some professional help was higher among those with suicidal plan (71.7%) and attempt (72.3%) as compared to those with suicidal ideation (48.7%) and those with MDD but no suicidal behaviour (29%).

CONCLUSIONIndividuals with MDD and suicidal behaviour do differ from their non-suicidal counterparts as they have a different sociodemographic and clinical profile. There is a need for more research and a better understanding of this population which in turn could lead to the development and implementation of relevant interventions.

Adolescent ; Adult ; Aged ; Cross-Sectional Studies ; Depressive Disorder, Major ; complications ; psychology ; Female ; Humans ; Male ; Middle Aged ; Singapore ; Socioeconomic Factors ; Suicidal Ideation ; Suicide, Attempted ; statistics & numerical data ; Young Adult

OBJECTIVETo explore the relationship between distorted weight perception and suicide ideation among normal weight adolescents in Guangdong province.

METHODSThis study used the data of Guangdong Provincial Youth Health Risk Behavior Survey in 2004 and 2007. To identify the association between distorted weight perception and suicide ideation, a logistic regression analysis was performed. The effects of age, economic status, mother's education, mental health, and depression were also adjusted.

RESULTSA total of 12 729 people participated in this study, 6096 males and 6633 females. The prevalence of suicide ideation among normal weight adolescents was 13.58% (1729/12 729) in the past 12 months, with higher prevalence in girls (16.15%, 1071/6633) than that in boys (10.79%, 658/6096) (χ(2) = 77.71, P = 0.00). It was common that the adolescents misperceived their weight. Only 44.93% (5719/12 729) of normal weight students correctly perceived their body weight while 43.52% (5540/12 729) of them overestimated their weight and 11.43% (1455/12 729) underestimated their weight. The distorted weight perception in girls (65.58%, 4350/6633) was higher than that in boys (43.39%, 2645/6096) (χ(2) = 993.91, P = 0.00). Distorted weight perception was significantly associated with suicide ideation after controlling for factors age, economic status, mother's education, mental health, and depression. The students who overestimate their body weight were more likely to have suicide ideation than that who correctly perceived their weight (OR = 1.43, 95%CI: 1.27 - 1.61).

CONCLUSIONThe prevalence of distorted weight perception was high and it significantly associated with suicide ideation.

Adolescent ; Body Weight ; Female ; Humans ; Male ; Self Concept ; Students ; psychology ; Suicide, Attempted ; psychology ; statistics & numerical data ; Surveys and Questionnaires

OBJECTIVES: Although cigarette smoking is known to be related to the exacerbation of asthma symptoms, several studies have indicated that the prevalence of cigarette smoking among asthmatic adolescents is similar to or even higher than that among non-asthmatic adolescents. The aim of this study was to evaluate the relationship between asthma and cigarette use behaviors and whether or not the presence of suicidal ideation modifies this relationship among Korean adolescents. METHODS: We analyzed data from the 2008 Korea Youth Risk Behavior Web-based Survey, which included a nationally representative sample of middle and high school students. Multiple logistic regression models were used to calculate odd ratios and 95% confidence intervals of cigarette use behaviors among current asthmatics, former asthmatics, and non-asthmatics, after adjusting for gender, grade, school records, socioeconomic status, current alcohol use, and suicidal ideation. RESULTS: Of 75 238 study participants, 3.5% were current asthmatics and 4.5% were former asthmatics. Compared with non-asthmatics, asthmatics were more likely to report current cigarette use, frequent and heavy cigarette use, and cigarette use before 13 years of age. There were statistically significant interactions between asthma and suicidal ideation in cigarette use behaviors. CONCLUSIONS: This study demonstrated that asthmatic adolescents are more likely than non-asthmatic adolescents to engage in cigarette use behaviors and the presence of suicidal ideation is an effect modifier of the relationship between asthma and cigarette use behaviors. Particular attention should be paid to the awareness of health risks of cigarette smoking and mental health problems among asthmatic adolescents.
Adolescent ; Adolescent Behavior ; Age Factors ; Asthma/*complications/epidemiology/*psychology ; Female ; Health Behavior ; Humans ; Male ; Republic of Korea/epidemiology ; Risk-Taking ; Smoking/epidemiology/*psychology ; Socioeconomic Factors ; *Suicidal Ideation ; Suicide, Attempted/psychology/statistics & numerical data

PURPOSE: The suicide rate of adolescents in Korea is increasing annually. Therefore, this research was done to identify the suicide attempt rate of middle and high school students and to identify factors that influence suicidal attempts. METHODS: The Korea Youth Health Risk Behavior Web-based Survey (2007) was used as data. Discriminant analysis and logistic regression were performed to analyze the data depending on gender to consider the gender difference in assessing the influence of each independent variable on suicidal attempts. RESULTS: Discriminant analysis according on gender showed that 13 factors correlated with suicidal attempts for boys, and 20 factors for girls. The most highly correlated factors were smoking, depression and inhalation experience. For inhalation experience, boys had 2.7 times higher possibility of suicide attempts (95% CI 1.8-3.0) and girls, a 2.4 times higher possibility (95% CI 1.7-3.5). CONCLUSION: The results of the study indicate a need to classify adolescents for expectation of suicide risk and high danger for suicidal attempts through, and introduce suicide prevention programs for these adolescents. In particular, it is necessary to start intervention with students who smoke, have sexual and inhalation experiences and high levels of depression.
Adolescent ; Adolescent Behavior/*psychology ; Adolescent Psychology ; Depression ; Discriminant Analysis ; Female ; Humans ; Inhalant Abuse ; Logistic Models ; Male ; Questionnaires ; Risk Factors ; Sex Factors ; Smoking ; Stress, Psychological ; Suicide, Attempted/*prevention & control/statistics & numerical data