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: To investigate the differences in non-suicidal self-injury (NSSI) behaviors between only-child and non-only-child adolescents with mood disorders. METHODS: A three-stage sampling method was used to perform a cross-sectional survey of 529 adolescents, aged 12-18 years, who had mood disorders and NSSI behaviors. These adolescents were sampled from the outpatient service of 20 mental hospitals in 9 provinces of China from August to November 2020. A self-made questionnaire was used to collect general demographic data. The Functional Assessment of Self-Mutilation, Beck Scale for Suicide Ideation, Kessler Psychological Distress Scale, Stress Mindset Measure-General, Multidimensional Scale of Perceived Social Support, Multidimensional Students' Life Satisfaction Scales, and Rosenberg Self-Esteem Scale were used to collect the information on self-injury behaviors and psychological factors in these adolescents. RESULTS: A total of 529 adolescents with mood disorders and NSSI behaviors were surveyed, among whom 375 were only-child adolescents and 154 were non-only-child adolescents. Compared with the non-only-child group, the only-child group had a significantly higher total score of Functional Assessment of Self-Mutilation (P<0.05) .The type and frequency of self-injury in the only-child group were significantly higher than those in the non-only-child group (P<0.05). Psychological analysis showed that compared with the non-only-child group, the only-child group had a significantly lower score of self-esteem (P<0.05) and significantly higher scores of psychological distress and depressive symptoms (P<0.05). The multiple linear regression analysis showed that the score of suicidal ideation was positively correlated with the frequency of NSSI behaviors in both only-child and non-only-child adolescents with mood disorders (P<0.05); in the only-child adolescents, the level of self-esteem was negatively correlated with the frequency of NSSI behaviors (P<0.05), and the score of stress perception was positively correlated with the frequency of NSSI behaviors (P<0.05); in the non-only-child adolescents, the score of anxious emotion was positively correlated with the frequency of NSSI behaviors (P<0.05). CONCLUSIONS Among the adolescents with mood disorders and NSSI behaviors, the only-child adolescents tend to have a higher frequency of self-injury and poorer mental health, and therefore, the only-child adolescents with mood disorders and NSSI behaviors need more attention.
Adolescent ; Cross-Sectional Studies ; Humans ; Mood Disorders ; Risk Factors ; Self Mutilation ; Self-Injurious Behavior/psychology* ; Suicide, Attempted/psychology*

The burden of suicide increases globally in ages 15-19 as they are more vulnerable to risky behaviors [8]. The Young Adult Fertility and Sexuality Study of 2013 (YAFS4) suggests further analysis and accounting for other related variables to determine if a true relationship between educational attainment and suicide is reflected. An analytic cross-sectional study was employed using secondary data from the YAFS4. The proportion of suicide attempt among the different education levels and its confounders was determined using point and interval estimates, whereas the association between educational attainment and suicide attempt was determined through multiple logistic regression analysis. Results revealed a high prevalence of suicide attempt among those with 'No schooling/Elementary' (38.36%), who have used alcohol (36.15%) and drugs (50.82%), and identified as 'bisexual' or with an 'identity crisis' (52.00%). Overall, there was an association between educational attainment and suicide attempt. The odds of suicide attempt was 1.69 times higher among those with “No schooling/Elementary” as compared to those “College Graduates or Higher”, and was the only group found to be statistically significant even after controlling for socioeconomic status. An association exists between educational attainment and suicide attempt, wherein having a lower level of education has higher odds of suicide attempt. The study suggests that interventions start as early as elementary school and focus on the out-of-school youth. Additionally, future research may also look further into the confounding effects of socioeconomic status and the mechanisms involved.
Educational Status ; Suicide, Attempted ; Adolescent

OBJECTIVES: This study aimed to determine the factors associated with suicide attempt among psychiatry inpatients aged 15 to 24 years old, admitted for suicidal ideations or behavior at The Medical City during a five-year study period, January 2013 to December 2017; to describe the demographic and clinical profile of these patients; and to determine if there was an association between demographic and clinical factors as well as suicidal attempt in this population. METHODOLOGY: This retrospective chart review, investigated the association between demographic and clinical variables, and suicide attempt in a sample of suicidal psychiatry inpatients aged 15-24 years old, during a 5-year study period. The sample was subdivided into two subsets according to the presence or absence of suicide attempts in their lifetime. The demographic and clinical variables were then collected, analyzed, and compared between the two groups. RESULTS: The present study reviewed 199 charts of suicidal psychiatry inpatients aged 15-24 years old hospitalized from 2013 to 2017 at The Medical City. The present study found an increasing trend in the number of psychiatric inpatients aged 15 to 24 who were confined for suicidal ideation and/or behavior over the course of the study period. Of the 199 subjects included in the study, 119 (59.8%) had attempted suicide, while 80 (40.2%) had not. CONCLUSION On comparison of the demographic and clinical factors among patients with a suicide attempt versus without an attempt, sex was found to be significantly associated with an attempt (p-value = 0.01). Specifically, the odds of a suicide attempt was twice higher among females (odds ratio = 2.27). Among the other demographic and clinical variables studied, no sufficient statistical evidence was found to declare significant statistical association with suicide attempt. This suggests that etiological factors related to suicide attempts for male and females may differ, hence such nuances need to be taken into account in the clinical assessment and design of interventions to prevent suicide.
Suicide, Attempted ; Adolescent

OBJECTIVES: This study described the prevalence of suicidal ideation and suicide attempts among adult patients diagnosed with psoriasis. METHODOLOGY: A Knowledge and Belief survey composed of: 1) a questionnaire on medical, psychiatric and psoriasis profile and 2) a knowledge, attitude and belief questionnaire was developed validated and translated to both English and Filipino. The survey questionnaire was uploaded in the internet using a free site Kwiksurvey.com. Psor Phil (an organization of patients with psoriasis) had sent email invitations to 699 members to answer an on line survey, which would be available for 9 days. The data on suicide ideation and attempt were analyzed and presented. RESULTS: A total of 120 entries were included in the study. The response rate of the survey was (120/699) 17.16%. A total of 17/120 (14.17%) reported suicidal ideation and a total of 9 /120 (7.5%) reported suicidal attempt. CONCLUSION The reported prevalence of suicidal ideation was higher compared to other studies. Patients disclosed suicidal ideation to friends rather than family members or doctors.
Humans ; Suicidal Ideation ; Suicide, Attempted ;

OBJECTIVES: The purpose of this study was to analyze the characteristics and factors affecting the survival of inpatients admitted following a suicide attempt. METHODS: A total of 3,095 cases retrieved from the Korean National Hospital Discharge In-depth Injury Survey data (from 2011 to 2015) were grouped according to survival and death and analyzed using descriptive statistics chi-square and logistic regression analysis. RESULTS: The following factors had statistically significant risks on reducing survival: female (OR = 2.352, p < 0.001), 40–59 years old (OR = 0.606, p = 0.014), over 60 years old (OR = 0.186, p < 0.001), poisoning (OR = 0.474, p = 0.009), hanging (OR = 0.031, p < 0.001), jumping (OR = 0.144, p < 0.001), conflicts with family (OR = 2.851, p < 0.001), physical diseases (OR = 1.687, p = 0.046), mental health problems (OR = 2.693, p < 0.001), financial problems (OR = 3.314, p = 0.002), 2014 (OR = 2.498, p = < 0.001) and 2015 (OR = 2.942, p = 0.005). CONCLUSION: The survival group that had a history of attempted suicide (high-risk suicide group), should be further characterized. It is necessary to identify the suicide methods and risk factors for suicide prevention management policies and to continuously expand the management policy according to these characteristics.
Female ; Hospitalization ; Humans ; Inpatients ; Logistic Models ; Mental Health ; Poisoning ; Risk Factors ; Suicide ; Suicide, Attempted

We report an extremely rare case of a patient with hypoxic-ischemic brain injury who recovered consciousness and motor and cognitive functions due to paradoxical response after zolpidem administration. A 32-year-old woman who had attempted suicide by hanging was admitted. The patient had stabilized in a state of drowsy mentality, quadriparesis, dysphagia, and impaired cognition. Brain magnetic resonance imaging was suggestive of hypoxic ischemic brain injury and unilateral infarction in the right posterior cerebral artery territory. Due to sleep disturbance, zolpidem was administered, and paradoxically consciousness level and function returned to near-normal during the duration of the drug-effect. In addition to previous reports, our case characteristically showed remarkable motor and cognitive function recovery, not only consciousness level. The drug-effect time was gradually decreased after 18 months and absent after 3 years. We have reviewed related literature and discussed possible neuropharmacological and neurobiological mechanism.
Adult ; Brain Injuries ; Brain ; Cognition ; Consciousness ; Deglutition Disorders ; Female ; Humans ; Hypoxia-Ischemia, Brain ; Infarction ; Infarction, Posterior Cerebral Artery ; Magnetic Resonance Imaging ; Posterior Cerebral Artery ; Quadriplegia ; Suicide, Attempted

OBJECTIVES: This study examined the factors associated with suicidal behavior in psychiatric inpatients. METHODS: The medical records of 208 psychiatric inpatients were reviewed retrospectively. The factors related to suicide attempts and ideation at the time of admission, and during outpatient follow-up, were investigated. RESULTS: In total, 120 patients (57.7%) with a history of at least one suicide attempt, and 163 patients (78.4%) who reported active suicide ideation (e.g., a suicide plan or intention to commit suicide) at the time of admission were reviewed. Being unmarried or divorced, substance abuse, impulsivity, and a poor social support system were associated with a history of suicide attempts. The suicidal ideation group had significantly higher rates of coexisting depression, severe depressive symptoms, hopelessness, and impulsivity, as well as a lower incidence of moral objection to suicide and high religiosity. In total, 15 out of 193 patients (7.8%) who were followed-up at outpatient clinics attempted suicide after discharge. Patients who attempted suicide or reported suicidal ideation at the outpatient clinic after discharge were significantly more likely to have a history of previous suicide attempts, or have had active suicide ideation at the time of admission. Good social support and high responsibility to family were inversely associated with suicidal ideation as an outpatient. CONCLUSION: A history of suicide attempts and ideation at the time of hospital admission were the risk factors for future outpatient suicidal behavior. Further study is warranted to develop a checklist and assessment measures of the various risk and protective factors associated with suicidal behavior.
Ambulatory Care Facilities ; Checklist ; Depression ; Divorce ; Follow-Up Studies ; Humans ; Impulsive Behavior ; Incidence ; Inpatients ; Intention ; Medical Records ; Outpatients ; Protective Factors ; Retrospective Studies ; Risk Factors ; Single Person ; Substance-Related Disorders ; Suicidal Ideation ; Suicide ; Suicide, Attempted

OBJECTIVE: This study examined the clinical characteristics of suicide attempters who exposed their suicidal intension to suggest an active intervention strategy for suicide prevention based on the regional emergency medical service system. METHODS: A prospective database of suicide attempters who visited the emergency department of Chungbuk National University Hospital between October 2013 and December 2017 was used. All of the adult patients who provided consent for the initial assessment for suicidal attempters were eligible, excluding cases with unknown exposure of suicidal intension. The primary and secondary endpoints were the risk factors affecting exposure to the suicidal intension and characteristics of the exposure group. The adjusted odds ratios (AORs) of exposure to suicidal attempts after adjusting for potential confounders was calculated. RESULTS: Of a total 1,035 suicidal attempters enrolled, 332 (32.1%) were included in the exposure group. The exposure group was more likely to have an educational level above high school and no religion, and have suicidal characteristics at night time (18:00–08:00), under the influence of alcohol, suicidal plan before 1 week, and suicidal method involving asphyxia (P<0.05). The exposure group was more likely to have no guardian (AORs, 1.46; 95% confidence interval [CI], 1.00–2.12), use methods involving asphyxia (AORs, 2.07; 95% CI, 1.46–2.91), and attempt suicide at night (18:00 to 08:00) (AORs, 1.38; 95% CI, 1.05–1.83) compared to the no exposure group. CONCLUSION: Models need to be established, where regional mental health welfare center, local government, fire headquarter, and tele-communication companies can participate in the implementation of an active intervention strategy.
Adult ; Asphyxia ; Chungcheongbuk-do ; Emergency Medical Services ; Emergency Service, Hospital ; Fires ; Humans ; Local Government ; Mental Health ; Methods ; Odds Ratio ; Prospective Studies ; Risk Factors ; Suicidal Ideation ; Suicide ; Suicide, Attempted