Suicide with psychiatric diagnosis and without utilization of psychiatric service

<p>Abstract</p> <p>Background</p> <p>Considerable attention has been focused on the study of suicides among those who have received help from healthcare providers. However, little is known about the profiles of suicide deceased who had psychiatric illnesses but made no contact with psychiatric services prior to their death. Behavioural model of health service use is applied to identify factors associated with the utilization of psychiatric service among the suicide deceased.</p> <p>Methods</p> <p>With respect to completed suicide cases, who were diagnosed with a mental disorder, a comparison study was made between those who had (contact group; n = 52; 43.7%) and those who had not made any contact (non-contact group; n = 67; 56.3%) with a psychiatrist during the final six months prior to death. A <it>sample </it>of 119 deceased cases aged between 15 and 59 with at least one psychiatric diagnosis assessed by the Structured Clinical Interview for DSM-IV-TR (SCID I) were selected from a psychological autopsy study in Hong Kong.</p> <p>Results</p> <p>The contact and non-contact group could be well distinguished from each other by "<it>predisposing</it>" variables: age group & gender, and most of the "<it>enabling"</it>, and "<it>need" </it>variables tested in this study. Multiple logistic regression analysis has found four factors are statistically significantly associated with non-contact suicide deceased: (i) having non-psychotic disorders (OR = 13.5, 95% CI:2.9-62.9), (ii) unmanageable debts (OR = 10.5, CI:2.4-45.3), (iii) being full/partially/self employed at the time of death (OR = 10.0, CI:1.6-64.1) and (iv) having higher levels of social problem-solving ability (SPSI) (OR = 2.0, CI:1.1-3.6).</p> <p>Conclusion</p> <p>The non-contact group was clearly different from the contact group and actually comprised a larger proportion of the suicide population that they could hardly be reached by usual individual-based suicide prevention efforts. For this reason, both universal and strategic suicide prevention measures need to be developed specifically in non-medical settings to reach out to this non-contact group in order to achieve better suicide prevention results.</p

Silent suicides: studies on the non-contact group of suicide

Background: Substantial attention has been given to studying suicides among those who had been in contact with healthcare providers. However, effective suicide prevention must target both users (contact) and non-users of healthcare services (non-contact). The non-contact group has been under-researched and prevention programs are often designed based on studies that over-rely on samples of the contact group. Using both quantitative and qualitative methods, this thesis aims to retrospectively explore and explain the profiles and service-use patterns of the non-contact group alongside service utilization models. The quantitative studies, which aimed to identify factors associated with the non-contact groups, were conducted based on the samples drawn from the psychological autopsy study of suicides (aged 15-59) in Hong Kong (2003-2005). Study 1: Portfolio analysis of the non-contact group with psychiatric illnesses Considering psychiatric illness as the basic “evaluated need” for psychiatric service-use, it was controlled for in the comparison between the contact (n=52; 43.7%) and non-contact group (n=67; 56.3%). The non-contact group was associated with having relatively stable employment, a higher level of problem solving ability, unmanageable debts, and non-psychotic disorders. They were evidently different from the contact group, while accounting for a larger proportion of the suicide population. Study 2: Study of suicides without psychiatric illnesses Twenty-nine suicide cases without any psychiatric diagnoses were compared to live controls without diagnoses (n=135), and live controls (n=15) and deceased (n=86) with non-psychotic diagnoses. They were not significantly different to the groups with psychiatric illness on the level of impact from various life events, either acute or chronic, including relationship, family, legal, physical, and job insecurity. However, with fewer signs of detectable abnormalities such as previous suicide attempts, they were not given timely attention from healthcare or psychosocial services. Alternative preventive measures are suggested to address the service needs arising from their negative life events. Study 3: Study of suicides with distress from job insecurity Suicides who were employed at time of death tended to make no contact with healthcare services. They were single, lived alone, earned less income, and suffered from depression. Chronic job insecurity, which was partially mediated by psychiatric illness, was found to influence their non-contact pattern. This could be due to fear of job loss or being stigmatized at work if they decided to receive treatment. Strengthening mental health programs and financial management in workplaces is suggested. Study 4: Study of perceptions towards pathway to care among patients survived from near-lethal suicide attempts The personal accounts of patients that survived from near-lethal suicide attempts revealed that the higher their suicide intent, the lower their perceived needs and the greater their resistance to receiving healthcare services. Themes associated with their non-contact pattern were irrelevancy, non-usefulness and self-reliance. Their views were detouring or against the pathway to care. Conclusion: The non-contact pattern of suicides cannot be explained by conventional service-use models. They showed a distinctive profile from the contact group, and it is suggested that they be helped through proactive prevention programs and / or population-based preventive measures, e.g. restriction of suicide means.published_or_final_versionSocial Work and Social AdministrationDoctoralDoctor of Philosoph

Effects of the Transport Support Scheme on employment and commuting patterns among public rental housing residents in Hong Kong

Since 1973, the Hong Kong Special Administrative Region (“HKSAR”) government has succeeded in decentralizing its population from the overcrowded urban area to the satellite towns. During this time, many low-income people had also relocated to the new satellite towns for affordable public rental housing (“PRH”) where originally the government expected manufacturing factories in urban areas to relocate there during suburbanisation. However, instead, the factories mostly moved to Mainland China, while service jobs still clustered at the central business districts in Hong Kong, resulting in “Spatial Mismatch” between jobs and residents in the new towns. Poor people living in PRH may suffer from high travel costs for remote job opportunities and are thus more likely to be unemployed than their urban counterparts. To tackle this problem, in 2007, the HKSAR government launched the Transport Support Scheme (“TSS”) that provides transport allowance to job seekers and low-income employees in the four remote districts to encourage cross-district employment. In this study, the effectiveness of this scheme in reducing unemployment and extending the commuting distances for job opportunities for the PRH residents are evaluated. A difference-in-difference model is used to compare the probabilities of being unemployed and the commuting distances between residents in the eligible and the non-eligible areas before and after the launch of the TSS. It is observed that the TSS has significantly decreased the probability of unemployment among the PRH residents living in the four eligible districts, especially among the young and middle-aged male residents. Conditional upon employment, the TSS also increased cross-district employment among the middle-aged female residents. This study provides strong evidence on the effectiveness of the TSS and casts practical implications for transport support policies in compact cities that heavily rely on their public transport system

Rates (%) of recovered, improved, no change, and deteriorated between post-test and follow-up assessment for anxiety and stress symptoms, DASS21.

<p>Rates (%) of recovered, improved, no change, and deteriorated between post-test and follow-up assessment for anxiety and stress symptoms, DASS21.</p

Basic information of students separated by professional-led group, teacher-led group, and control group.

<p>Basic information of students separated by professional-led group, teacher-led group, and control group.</p

Effects of Community-Based Caring Contact in Reducing Thwarted Belongingness Among Postdischarge Young Adults With Self-Harm: Randomized Controlled Trial

BackgroundFor patients with self-harm behaviors, the urge to hurt themselves persists after hospital discharge, leading to costly readmissions and even death. Hence, postdischarge intervention programs that reduce self-harm behavior among patients should be part of a cogent community mental health care policy. ObjectiveWe aimed to determine whether a combination of a self-help mobile app and volunteer support could complement treatment as usual (TAU) to reduce the risk of suicide among these patients. MethodsWe conducted a pragmatic randomized controlled trial on discharged patients aged between 18 and 45 years with self-harm episodes/suicide attempts, all of whom were recruited from 4 hospital emergency departments in Hong Kong. Participants were randomly assigned to one of three groups: (1) mobile app + TAU (“apps”), (2) mobile app + volunteer support + TAU (“volunteers”), or (3) TAU only as the control group (“TAU”). They were asked to submit a mobile app–based questionnaire during 4 measurement time points at monthly intervals. ResultsA total of 40 participants were recruited. Blending volunteer care with a preprogrammed mobile app was found to be effective in improving service compliance. Drawing upon the interpersonal-psychological theory of suicide, our findings suggested that a reduction in perceived burdensomeness and thwarted belongingness through community-based caring contact are linked to improvement in hopelessness, albeit a transient one, and suicide risk. ConclusionsA combination of volunteer care with a self-help mobile app as a strategy for strengthening the continuity of care can be cautiously implemented for discharged patients at risk of self-harm during the transition from the hospital to a community setting. Trial RegistrationClinicalTrials.gov NCT03081078; https://clinicaltrials.gov/study/NCT0308107

Demographics and usage of Internet platforms of all youths surveyed.

<p>Demographics and usage of Internet platforms of all youths surveyed.</p