INTRODUCTION: Adolescent depression is prevalent, and teen suicide rates are on the rise locally. A systemic review to understand associated risk and protective factors is important to strengthen measures for the prevention and early detection of adolescent depression and suicide in Singapore. This systematic review aims to identify the factors associated with adolescent depression in Singapore. METHODS: A systematic search on the following databases was performed on 21 May 2020: PubMed, EMBASE and PsycINFO. Full texts were reviewed for eligibility, and the included studies were appraised for quality using the Newcastle Ottawa Scale. Narrative synthesis of the finalised articles was performed through thematic analysis. RESULTS: In total, eight studies were included in this review. The four factors associated with adolescent depression identified were: (1) sociodemographic factors (gender, ethnicity); (2) psychological factors, including childhood maltreatment exposure and psychological constructs (hope, optimism); (3) coexisting chronic medical conditions (asthma); and (4) lifestyle factors (sleep inadequacy, excessive internet use and pathological gaming). CONCLUSION The identified factors were largely similar to those reported in the global literature, except for sleep inadequacy along with conspicuously absent factors such as academic stress and strict parenting, which should prompt further research in these areas. Further research should focus on current and prospective interventions to improve mental health literacy, targeting sleep duration, internet use and gaming, and mitigating the risk of depression in patients with chronic disease in the primary care and community setting.
Humans ; Singapore/epidemiology* ; Adolescent ; Risk Factors ; Depression/etiology* ; Protective Factors ; Male ; Female ; Life Style ; Suicide

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

Background: Suicide among adolescents is a critical global health problem. Identifying risk factors for suicide in adolescents is crucial because it is one of the most severe mental health issues and can result in loss of life. Risk factors serve as indicators that have the potential to bring life to an end. However, people around adolescents often display indifference and even tend to overlook the suicide risk factors experienced by them. Objective: This study aimed to explore the risk factors for suicide in adolescents in Indonesia. Methods: This study used qualitative descriptive research design conducted at State Vocational High Schools (SMKN) and Puskesmas. Data collection was done through Focus Group Discussion (FGD) of 10 students, and in-depth interviews of eight participants (two parents of adolescents who attempted suicide, two guidance counseling teachers, two adolescents who attempted suicide, and two mental nurses) The data were analyzed using thematic analysis. Results: The risk factors for suicide experienced by adolescents are biological, psychological, and social factors. These risk factors for suicide are stressors that contribute to adolescents engaging in suicidal behavior. Identifying the risk factors experienced by adolescents is crucial for suicide prevention. Conclusion The risk factors that lead to suicide in adolescents encompass biological, psychological, and social factors. A thorough understanding of suicide among parents, teachers, and peers can significantly assist in implementing suitable prevention measures and interventions for adolescent suicide.
Adolescent ; Risk Factors ; Biological Factors ; Psychology ; Social Factors ; Suicide

Sodium nitrite (SN, NaNO2) is a water-soluble, white-yellow crystalline powder with broad applications in food preservation, automotive maintenance, and animal control. It is a strong oxidizing agent that can oxidize hemoglobin iron (Fe) to its oxidized state, leading to methemoglobin formation. An increasing trend of suicide cases by SN ingestion has been reported globally following its popularization in online suicide forums providing detailed instructions of its use solely or as part of a “suicide kit.” We report a case of a 21-year-old male who was found continuously vomiting, with blood per orem and cyanosis of the mouth and digits. Within minutes of the onset of symptoms, the patient lost consciousness and was pronounced dead on arrival at the nearest emergency room. Autopsy findings showed lip erosions, hemorrhage, and perioral and peripheral cyanosis. Internal examination showed characteristic bright red muscle discoloration, dark brown arterial blood, red-brown congested visceral organs, and hyperemic esophageal and gastric mucosa. Methemoglobin studies from sampled arterial blood showed elevated levels (17.5%). Further investigation of the decedent’s belongings, social media posts, and recent online purchases reinforced the intentional sodium nitrite ingestion. While there are plenty of reported SN poisoning in suicide cases internationally, limited reports have been published locally. Death by SN poisoning is preventable with Methylene blue. The role of forensic pathologists through autopsy may be the last chance to detect such cases. The lack of systemic death investigation, experts, and local laboratories to reliably detect the signs of SN poisoning may have affected the low detection rate of cases locally. Further reporting of cases can raise the awareness of medical professionals that is fundamental to the ultimate saving of lives.

OBJECTIVES: To study the relationship between traditional Chinese cultural beliefs and suicide risk in Chinese medical postgraduate students. METHODS: The Chinese Traditional Cultural Belief Scale (CTCBS) and Suicidal Behavior Questionnaire (SBQ-R) were used to investigate 541 medical postgraduate students in a medical university. RESULTS: The total score of traditional Chinese cultural belief of the medical postgraduate students was 49.68±6.85, and 66.9% of them had a clear cultural belief. The detection rate of suicide risk among the medical postgraduates was 15.7%, and 20.1% of them reported suicidal ideation within the past year. Traditional Chinese cultural belief was negatively correlated with suicide risk among the medical postgraduates (r=-0.210, P<0.001), and those with higher levels of cultural belief had lower SBQ-R scores (F=6.255, P<0.01). The medical postgraduates with lower cultural beliefs had a higher detection rate of suicide risk (28.6% vs 21.2% vs 12.7%). The students with high suicide risks had significantly lower total scores and all the dimension scores of CTCBS (P<0.001). CONCLUSIONS Most medical postgraduates have clear traditional Chinese cultural beliefs, which can be beneficial to reduce suicide risk among the students.
Humans ; Students, Medical/psychology* ; Surveys and Questionnaires ; Suicide/psychology* ; Suicidal Ideation ; China/ethnology* ; Culture ; Female ; Male ; Risk Factors ; Adult ; Young Adult ; East Asian People

This paper summarizes a lecture on psychiatry and spirituality, which examined research onthe relationship between religion, spirituality and mental health, and discussed theimportance of addressing spiritual issues in psychotherapy. In this article, religion andspirituality are first differentiated from one another. Next, research on the relationshipbetween religion and mental health is examined. Third, a theoretical model is presentedexplaining how religious involvement may affect mental and social health. Fourth, a review of religious/spiritually-integrated psychotherapy is presented with a focus ondepression/anxiety, moral injury, and PTSD. Finally, further resources for more informationabout the topic is provided. Because many people in the Philippines are religious, and religionaffects mental health one way or the other, it cannot be ignored by psychiatrists who practicein this country.
Religion ; Spirituality ; Depression ; Anxiety ; Suicide ; Substance-Related Disorders ; Stress Disorders, Post-Traumatic ; Psychotherapy

OBJECTIVES: To explore the characteristics of postmortem examination, chemical examination and scene investigation of deaths caused by oral diphenidol hydrochloride poisoning, and so as to provide a reference for proper settlement and prevention of such deaths. METHODS: The data of 22 deaths caused by oral diphenidol hydrochloride poisoning in a city from January 2018 to August 2020 were collected, including case details, scene investigations, autopsies, chemical examinations and digital evidence. Thirty-one cases of deaths caused by oral diphenidol hydrochloride poisoning reported in previous literature were also collected. RESULTS: In the 53 oral diphenidol hydrochloride poisoning death cases, 50 cases were suicide, 2 cases were accidental, while 1 case was undetermined. Fifty-two cases were found in the medical records or crime scene investigation reports with doses ranging from 775 mg to 12 500 mg, and 23 deceased were detected with postmortem blood concentrations ranging from 2.71 mg/L to 83.1 mg/L. Clinical symptoms were recorded in 6 patients, including conscious disturbance and convulsion. Among the 45 cases which were performed with external examination, 23 cases autopsied. CONCLUSIONS Most of the deceased of oral diphenidol hydrochloride poisoning were suicide. No significant correlation was found between dose and blood concentration through the retrospective analysis of cases.
Humans ; Retrospective Studies ; Piperidines ; Autopsy ; Suicide ; Poisoning

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 patient is a 36-year-old- male who was bullied by peers and was emotionally abused by his father for being effeminate and preferring to play with dolls. These adverse childhood experiences made him vulnerable to depression. He told himself that he could no longer rely on anyone else but himself and took pride in his independence. He gave his best with his endeavors and did not settle for mediocrity, frequently reviewing his work. During the pandemic, he experienced several hardships such as disruption of activities, inability to meet the financial needs of his family and unemployment. He found himself struggling but surviving. While in a work-from-home arrangement, he was so frustrated about his internet connection that he complained on social media. The internet company then threatened him of possible legal charges and felt stuck in a hopeless situation. This affected his day-to-day activities until he felt so overwhelmed that he attempted suicide by ingesting multiple medications. He was then brought to the emergency room and was admitted. He was diagnosed to have Major Depressive Disorder and was started on antidepressants. Psychotherapy focused on identifying stressors and strengthening adaptive coping mechanisms while he was admitted at an isolation facility. He then followed up at the outpatient department of a tertiary government hospital in Mindanao with noted improvement in mood and functionality overtime. During admission, he was also diagnosed to have Diabetes Mellitus and COVID-19, which added to his burden as these were the biologic factors that were correlated to his depression. The case highlighted the interplay between the effects of multiple traumatic experiences in a vulnerable individual and thus necessitating a holistic management.
Depressive Disorder, Major ; Psychiatry ; Suicide