Abstract
Aims: To determine the risks of suicide attempt (SA) and suicidal drug overdose (SDO) following the admission for head injury of patients with depression. Design: We analyzed the NHIRD data of patients aged ≥20 years who had received depression diagnoses between 2000 and 2010. They were divided into cohorts of those with admission for head injury (DHI) and those without it (DWI) during the follow-up period and compared against a sex-, age-, comorbidity-, and index-date-matched cohort from the general population. Setting: The Taiwan National Health Insurance Research Database (NHIRD). Participants/Cases: We analyzed the NHIRD data of patients (≥20 years) who had received depression diagnoses between 2000 and 2010. Intervention(s): Regular interventions. Measurements: We calculated the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of SA and SDO in these cohorts after adjustment for age, sex, and comorbidities. Findings: Up to the end of 2011, our results revealed extremely high incidences of SA and SDO with 63.3 and 88.6 per 10,000 person-years, respectively, in the DHI cohort. The DHI cohort had a 37.4-times higher risk for SA and a 17.1-times higher risk for SDO compared with the comparison group and had aHRs of 14.4 and 16.3, respectively, for poisoning by medicinal substances and poisoning by tranquilizers compared with patients in the DWI cohort. Patients with DHI aged <50 years, of female sex, with high incomes, living in more urbanized areas, and without other comorbidities had extraordinarily higher risks for SA. Conclusions: The risks of SA and SDO were proportionally increased by head injury in patients with depression in Taiwan. Our findings provide crucial information to implement efficient suicide prevention strategies in the future.
Highlights
Depression is a common brain disorder worldwide and is characterized by key symptoms of low and depressed mood, loss of interest and pleasure, fatigue, and reduced energy for at least 2 weeks [1].Depression can be a solitary disorder with an idiopathic cause, or it can be coexisting with another disease, which increases the complexity and care burden of the depression itself
37.4-times higher risk for suicide attempt (SA) and a 17.1-times higher risk for suicidal drug overdose (SDO) compared with the comparison group and had adjusted hazard ratios (aHRs) of 14.4 and 16.3, respectively, for poisoning by medicinal substances and poisoning by tranquilizers compared with patients in the DWI cohort
The risks of SA and SDO were proportionally increased by head injury in patients with depression in Taiwan
Summary
Depression is a common brain disorder worldwide and is characterized by key symptoms of low and depressed mood, loss of interest and pleasure, fatigue, and reduced energy for at least 2 weeks [1]. Depression can be a solitary disorder with an idiopathic cause, or it can be coexisting with another disease, which increases the complexity and care burden of the depression itself. The prevalence rate of coexisting depression in patients with various neurological disorders, such as stroke, multiple sclerosis, Parkinson’s disease, or epilepsy, is 20–50% [2]. Patients with depression usually experience low self-confidence, guilt feeling with self-blame, and suicidal ideation. Depression is known as the main psychiatric disorder associated with suicidal behavior or suicide attempt (SA) [3,4]. Depression is usually underdiagnosed and undertreated even in developed Western countries [5,6]
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