Loneliness and suicide risks in the general population before and during first-year COVID-19 in Taiwan.

PURPOSE: Loneliness is a critical issue affecting the general population. Current evidence from national surveys of loneliness is scarce. The study aimed to examine the impact of COVID-19 pandemic on the prevalence of loneliness and its associating suicide risks in Taiwan. METHODS: Four annual telephone interview surveys were performed by the Taiwan Suicide Prevention Center in 2015-2017 and 2020 during COVID outbreak. Each year the sample was randomly selected by stratifying the general public in different geographical areas and fulfilled a questionnaire collecting information including loneliness, psychological distress, and suicide risk assessment. All the data were analyzed using SPSS25 analysis. RESULTS: A total of 8460 participants were recruited. The average prevalence of loneliness was 12.6 %. Feelings of loneliness was significantly correlated with psychological distress and most risk factors relating to suicide. The odds of loneliness for lifetime suicidal ideation, lifetime suicide attempt, and future suicide intent were 4.9, 5.1, and 9.2, respectively. During the COVID-19 period, loneliness and suicidality demonstrated a noteworthy decline trend, whereas "no one trustworthy to talk to" was the only item that showed significant increase under the pandemic and also impacted on loneliness. CONCLUSION: Nearly one in ten Taiwanese people felt lonely before and during COVID-19. Loneliness was closely linked with various suicide risk factors such as lifetime suicide ideation and attempt or future intention. Although psychological distress and suicide risk were not increased during COVID-19, maintaining trustful relationships to seek support appeared to be critical to prevent the risks of loneliness or suicide.

Hemispheric lateralization of semantic processing before and after aripiprazole treatment in first-episode psychosis or ultra-high risk state.

Whether aberrant language-related lateralization can be improved after antipsychotic treatment in drug-free patients with first-episode psychosis or ultra-high risk state is little known. We aimed to investigate the improvement in lateralization of semantic processing after antipsychotic treatment and associated clinical and cognitive changes. Twenty-one drug-free patients with first-episode psychosis or ultra-high risk state underwent functional magnetic resonance imaging with a semantic task, neuropsychological testing, and clinical assessments with the Positive and Negative Syndrome Scale before and after 6 weeks of aripiprazole treatment. A lateralization index of the region of interest, i.e., inferior frontal gyrus, was calculated and correlated with the behavioral indices of the semantic task, Positive and Negative Syndrome Scale scores, and language-related neuropsychological test scores. After treatment, the lateralization index of the inferior frontal gyrus was significantly increased, which was related to reduced activation of the right inferior frontal gyrus. The increase in the lateralization index was significantly associated with the increase in verbal fluency score. A higher baseline accuracy of the semantic task was associated with a higher post-treatment lateralization index of the inferior frontal gyrus and greater improvement of the total score and positive subscore of the Positive and Negative Syndrome Scale. Our findings indicated aripiprazole treatment significantly increased semantic processing-related lateralization in the inferior frontal gyrus in drug-free patients with first-episode psychosis or ultra-high risk state. A higher baseline accuracy might predict a higher post-treatment lateralization index and greater symptom improvement.

Prevalence of bullying victimization and its association with self-perceived health, psychopathology, and suicidality: A nationwide population-based survey in Taiwan.

BACKGROUND: The current study aimed to assess the prevalence of bullying victimization (BV) and its association with psychopathology and suicidality in a nationwide general population. METHODS: The target population were all the people living in Taiwan, the study samples were obtained by the following processes. A computer-assisted telephone interview was performed to identify potential respondents using telephone numbers selected with the stratified proportional randomization method. Self-reported data were evaluated. Moreover, data obtained using the validated Brief Symptom Rating Scale (BSRS-5) and Concise Mental Health Checklist (CMHC) were used to evaluate psychopathological symptoms and overall suicidal risks, respectively. Results were further analyzed using the chi-square tests and logistic regression model. RESULTS: In total, 1930 respondents from a national general population survey were included in the analysis. The weighted prevalence of lifetime BV in the general population was 13.5%. Based on the chi-square analysis, individuals exposed to BV were at high risk for psychopathology (a BSRS-5 score of ≥6 (x2 = 45.5, P ≤ .001) and high BSRS-5 scores for all five items). Bullying exposure was significantly associated with lifetime suicide ideation and suicide attempt (x2 = 85.7, P ≤ .001; x2 = 17.0, P ≤ .001, respectively). The help-seeking behavior of respondents exposed to bullying did not differ significantly (x2 = 4.6, P = .327). CONCLUSION: Bullying exposure is associated with recent psychopathology and lifetime suicidality. Multifactorial interactive processes contribute to long-term harmful health implications in adulthood. Nevertheless, further research on the relevant mechanisms associated with bullying and potential interventions that can decrease morbidity must be conducted.

The impact of COVID-19 stressors on psychological distress and suicidality in a nationwide community survey in Taiwan.

COVID-19 stressors and psychological stress response are important correlates of suicide risks under the COVID-19 pandemic. This study aimed to investigate the prevalence of COVID-19 stress, its impact on mental health and associated risk factors among the general population during the outbreak of COVID-19 in July 2020 throughout Taiwan. A nationwide population-based survey was conducted using a computer-assisted telephone interview system with a stratified, proportional randomization method for the survey. The questionnaire comprised demographic variables, psychological distress assessed by the five-item Brief Symptom Rating Scale and independent psychosocial variables including COVID-19 stressors, loneliness, suicidality, and health-related self-efficacy. In total, 2094 respondents completed the survey (female 51%). The COVID-19 stress was experienced among 45.4% of the participants, with the most prevalent stressors related to daily life and job/financial concerns. Higher levels of suicidality, loneliness, and a lower level of self-efficacy had significantly higher odds of having COVID-19 stress. The structural equation model revealed that COVID-19 stress was moderately associated with psychological distress and mediated by other psychosocial risk factors. The findings call for more attention on strategies of stress management and mental health promotion for the public to prevent larger scales of psychological consequences in future waves of the COVID-19 pandemic.

Prevalence and Correlates of Prescription Drug Misuse in a Nationwide Population Survey in Taiwan.

BACKGROUND: Prescription drug misuse (PDM) is a critical mental health issue relating to psychiatric morbidity. This study investigated the prevalence of PDM and its associated psychopathology and psychosocial factors in the general population in Taiwan. METHODS: The survey randomly selected a representative sample >15 year-olds using the stratified proportional randomization method. The measurements included demographic variables, previous experience with PDM, self-rated physical and mental health, health self-efficacy, risk factors for suicidality, and psychological distress. RESULTS: The weighted one-year prevalence of PDM was 8.5% (n = 180) among 2126 participants. Those with psychological distress and lifetime suicide ideation (23.3%) or suicide attempts (5.0%) were significantly associated with PDM. PDM was also prevalent among those with poorer self-rated health and lower self-efficacy. Insomnia (OR = 1.52), depression (OR = 1.77), and low self-efficacy (OR = 2.29) had higher odds of PDM after adjustment in the logistic regression model. CONCLUSIONS: Individuals who misused prescription drugs had a higher prevalence of psychological distress and suicidality and lower levels of self-rated health. Prescription drug misuse problems should be screened for early prevention when prescribing medications for people with insomnia, depression, or lower perceived health beliefs or conditions.

Sex-Specific Moderation Effect of Age on the Associations Between Insomnia Symptoms and Various Psychological Distresses.

BACKGROUND: Insomnia is closely related to psychological distress. This study aims to examine the role of age and sex in the association between various psychological distresses and insomnia symptoms. PARTICIPANTS AND METHODS: This population-based study used data provided by cumulative respondents of the annual survey of the Taiwan Suicide Prevention Center between 2006 and 2019. Potential respondents were aged ≥15 years and were selected by a stratified proportional randomization method according to the distribution of population size, sex, and age in different geographic areas of Taiwan. The Five-Item Brief Symptom Rating Scale was used to measure insomnia symptoms and four psychological distresses: depression, anxiety, hostility, and inferiority. The independent relationship between insomnia symptoms with depression, anxiety, hostility, and inferiority was further examined according to age and sex. RESULTS: A total of 28,649 participants were included (women, 50.2%). The four types of psychological distress correlated differentially with insomnia symptoms. Concerning interaction effects, sex moderated the interaction effects between age with depression, anxiety, and hostility. In men, and not in women, age moderated the relationship between insomnia symptoms and all four psychological distresses. Specifically, the effect sizes of the associations between insomnia symptoms and depression, anxiety, and hostility showed an age-dependent decreasing trend in men. CONCLUSION: The associations between psychological distresses and insomnia symptoms varied in strength and according to age in a sex-specific manner.

Suicidal ideation, psychopathology, and help-seeking in 15 to 19-year-old adolescents in Taiwan: A population-based study 2015-2019.

BACKGROUND: Suicide in the young population has been an urgent issue worldwide. The study aimed to assess the overall prevalence of suicide ideation and the associations between adolescent suicide and psychiatric distress/ psychiatric morbidity, as well as the myths and help-seeking behavior of adolescents with suicide ideation. METHOD: The nationwide community-based telephone interviews were conducted with adolescents aged between 15 to 19 for five consecutive years (2015-2019). The measurements included demographic variables, the five-item Brief Symptom Rating Scale (BSRS-5), and help-seeking experiences of formal medical services or psychological consultations. Stepwise multiple regression analysis was performed to examine which of the five symptoms and demographic variables had discriminative validity for suicidal ideation. RESULTS: Among 727 participants, the prevalence of lifetime and one-week suicidal ideation was 11.4% and 2.8%, respectively. Adolescents with lifetime/ one-week suicidal ideation and with psychiatric morbidity (BSRS-5≥6) sought psychiatric service more than their counterparts (p<0.001). Female, depression, hostility, and anxiety were significantly associated with suicidal ideation in adolescents. LIMITATIONS: Telephone interview and structured questionnaire. CONCLUSION: Adolescents with psychiatric morbidity who have sought help should be carefully monitored for suicidal ideation by parents, teachers, mental health workers, and psychiatric specialists altogether.

Adherence to World Health Organization guideline on suicide reporting by media in Taiwan: A surveillance study from 2010 to 2018.

BACKGROUND/PURPOSE: Significant associations between suicide behaviors and inappropriate suicide reports in the media have been reported. The study aimed to examine the quality of long-term suicide reports under surveillance by the Taiwan Suicide Prevention Center (TSPC). METHODS: The TSPC conducted daily surveillance with timely feedback and interactive approaches with the media professionals. To examine the reporting trends under the surveillance, daily adherence to the 12-item World Health Organization (WHO) guidelines was analyzed for print media published between 2010 and 2018, and for online media in 2017 and 2018. The trend analysis using the Cochran-Armitage test was performed to estimate the significance of adherence changes. RESULTS: In total, 5529 print reports and 16,445 person-event items from online media were reviewed. The number of suicide reports in print newspapers markedly decreased while it increased for online media. Surveillance of print media showed statistical significance of the improvement of reporting adherence to all guideline items except one item ("Do not publish photo or suicide notes"). Adherence rates were high (∼90%) for 6 of the 12 items over the study duration. Marked improvement was observed in three items: reporting details, giving simplistic reasons, and providing helpline resources. However, both "Highlight the alternatives to suicide" and "Work closely with health authorities to present the facts" items had the lowest adherence. Online media had similar findings and adherence profile as the print media. CONCLUSION: The quality of suicide reports significantly improved in most WHO guideline items. Development of psychiatric-media liaisons may be beneficial for further improvement.

Psychological distress of suicide attempters predicts one-year suicidal deaths during 2007-2016: A population-based study.

BACKGROUND/PURPOSE: Of the risk factors for suicide, prior attempt is regarded as one of the strongest for subsequent attempts or completed suicide. This large-scale cohort study aims to examine whether the distress level of individual mental symptoms and general psychopathology measured at the index attempt can predict subsequent suicide death within one year. METHODS: The participants were 104,441 suicide attempters first reported to the Taiwan National Suicide Surveillance System during 2007-2016, who completed the five-item Brief Symptom Rating Scale (BSRS-5) at the index attempt. Kaplan-Meier survival curve analysis with log-rank test and Cox regression model were used to examine whether the level of psychological distress could predict the cumulative incidence of re-attempted suicidal death in the following year. RESULTS: In total, 1254 (1.2%) participants subsequently killed themselves within one year. Survival curves analysis and Cox regression modelling indicated that levels of distress of individual items (i.e., suicide ideation, depression, inferiority, anxiety, hostility and insomnia) and total BSRS-5 scores were significantly correlated with the incidence of subsequent suicidal death within one year for both genders. CONCLUSION: The study revealed that self-rated psychological distress was a significant and sustained predictor of re-attempted suicide death within one year after the index attempt. These results imply that suicide is not only an issue of acute crisis, but also a prolonged problem of lasting psychological distress. The BSRS-5 assessment could provide a symptom profile on which to develop a pertinent person-centered approach to prevent subsequent suicide attempts.

Morphine for Intravenous Patient-Controlled Analgesia May Inhibit Delirium Tremens: A Case Report and Literature Review.

Alcoholism is common among trauma patients and often lacks the appropriate monitoring. Alcohol withdrawal syndrome (AWS), including delirium tremens (DT), can be associated with significant postoperative morbidity and mortality. However, appropriate acute pain management may protect against delirium; the administration of intravenous patient-controlled analgesia (IV - PCA) may not only alleviate pain, but also reduce the incidence of post-operative delirium. IV-PCA is widely used today; however, little attention has been paid to its influence on the development of AWS or DT post-surgery. Here we present a case in which the administration of IV-PCA may have delayed the onset of DT that interfered with postoperative care and the initiation of psychiatric consultation. The literature was reviewed to determine the potential mechanisms behind the effects of IV-PCA on the onset of AWS or DT.IV-PCA may delay the onset of DT. It is imperative to take into consideration trauma patients' psychiatric history including answers to questions on alcoholism, so that when an IV-PCA is administered and then discontinued, adequate interventions to prevent further morbidity associated with AWS and DT can be initiated in sufficient time.

Upper gastrointestinal bleeding in an end-stage renal disease patient treated with fluoxetine.

The defective platelets of end-stage renal disease patients might be further incapacitated by the antiplatelet effect of selective serotonin reuptake inhibitor, and bleeding tendency in these patients could be aggravated. Here we demonstrate an end-stage renal disease patient who was admitted for duodenal ulcer bleeding during the treatment with fluoxetine, and the bleeding did not stop by various active treatments until the cessation of fluoxetine.