Abstract
Objective: To determine the risks of suicide attempt (SA) and suicidal drug overdose (SDO) after head trauma in patients with sleep-disordered breathing (SDB) by using the National Health Insurance Research Database of Taiwan.Methods: We analyzed the data of patients aged ≥20 years who were diagnosed with SDB between 2000 and 2012. We further divided them into two cohorts [with admission for head injury (SBI) and without (SBN)], and we compared them against sex-, age-, comorbidity-, and index-date-matched healthy individuals. The adjusted hazard ratios (aHRs) and 95% confidence intervals of SA and SDO were calculated with adjustment of age, sex, and comorbidities.Results: Approximately 0.61% of patients among the overall 142,063 patients with SDB had SA, with 535 and 335 patients included in the SBN and SBI cohorts, respectively. Compared with patients with SBN, a significantly higher risk of SA was observed in patients with SBI (aHR = 2.22), especially in those aged under 50 years (aHR = 2.48). Notably, a SDO incidence of 1.20% was noted in patients with SDB, and the SBI cohort had a 1.81-fold higher risk for SDO when compared with the SBN cohort.Conclusion: The risks of subsequent SA and SDO are proportionally increased by the effects of head trauma with a moderating role of SDB, especially in those aged <50 years. SDB and head trauma can increase suicide behaviors individually and synergistically.
Highlights
More than 800,000 people die because of suicide per year worldwide, with a progressive increase over the past few decades [1]
Compared with patients with SBN, a significantly higher risk of suicide attempt (SA) was observed in patients with SBI, especially in those aged under 50 years
The SDB, SBN, and SBI cohorts had higher risks of drug or medicinal substance overdose than the comparison cohort
Summary
More than 800,000 people die because of suicide per year worldwide, with a progressive increase over the past few decades [1]. The rates of suicide attempt (SA) increase with age. Men have a lower rate of SA than women; men exhibit higher lethality of suicide than women [1]. A study conducted in European countries has estimated the rates of suicidal lethality in men compared with women (13.9 vs 4.1%) [2]. The primary reason for this sex difference is the difference in suicidal methods adopted by men and women. Self-intoxication is the most frequently chosen method in women [3]. We believe that identifying individuals with a possibly higher risk of SA and interrupting their suicidal behaviors are the significant challenges of suicide prevention
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