Differences in Incidence and Risks of Suicide Attempt and Suicidal Drug Overdose between Patients with Epilepsy with and without Comorbid Depression

Objective: To determine the differences in the incidences and risks of suicide attempt (SA) and suicidal drug overdose (SDO) between patients with epilepsy with and without comorbid depression by using data from Taiwan’s National Health Insurance Research Database. Methods: We analyzed data of patients (≥20 years) who had received epilepsy diagnoses between 2000 and 2012; the diagnosis date of epilepsy was defined as the index date. The epilepsy patients were divided into the cohorts, with and without comorbid depression, and compared against a cohort from the non-affected population. We calculated adjusted hazard ratios and the corresponding 95% confidence intervals for SA and SDO in the three cohorts after adjustment for age, sex, and comorbidities. Results: The incidences of SA and SDO in the cohort with epilepsy and depression were 42.9 and 97.4 per 10,000 person-years, respectively. The epilepsy with depression cohort had 21.3 times of SA risk; and 22.9 times of SDO risk than did the comparison cohort had a 6.03-fold increased risk of SA and a 2.56-fold increased risk of SDO than did the epilepsy patients without depression. Moreover, patients’ age <65 years, and female sex would further increase the risk of SA in patients with epilepsy and comorbid depression. Conclusion: Risks of SA and SDO in patients with epilepsy are proportionally increased when depression is coexisted. Our findings provide crucial information for clinicians and the government for suicide prevention and to question whether prescribing a large number of medications to patients with epilepsy and depression is safe.

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Increased Risks of Suicide Attempt and Suicidal Drug Overdose Following Admission for Head Injury in Patients with Depression

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16193524 ◽

2019 ◽

Vol 16 (19) ◽

pp. 3524 ◽

Cited By ~ 3

Author(s):

Harnod ◽

Lin ◽

Shen ◽

Kao

Keyword(s):

Head Injury ◽

Suicide Attempt ◽

Drug Overdose ◽

Comparison Group ◽

Research Database ◽

Hazard Ratios ◽

Medicinal Substances ◽

Taiwan National Health Insurance ◽

Crucial Information

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.

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Mortality Risk and Risk Factors in Patients with Posttraumatic Epilepsy: A Population-Based Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16040589 ◽

2019 ◽

Vol 16 (4) ◽

pp. 589 ◽

Cited By ~ 3

Author(s):

Wei-Jun Lin ◽

Tomor Harnod ◽

Cheng-Li Lin ◽

Chia-Hung Kao

Keyword(s):

Mortality Risk ◽

International Classification Of Diseases ◽

Population Based ◽

Research Database ◽

Posttraumatic Epilepsy ◽

Medical Visits ◽

Hazard Ratios ◽

Increased Risk ◽

Classification Of Diseases ◽

The Government

Aim: Use the National Health Insurance Research Database of Taiwan to determine whether patients with posttraumatic epilepsy (PTE) have an increased risk of mortality. Methods: Patients ≥20 years old ever admitted because of head injury (per International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 850–854 and 959.01) during 2000–2012 were enrolled into a traumatic brain injury (TBI) cohort. The TBI cohort was divided into with PTE (ICD-9-CM code 345) and posttraumatic nonepilepsy (PTN) cohorts. We compared the PTE and PTN cohorts in terms of age, sex, and comorbidities. We calculated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of all-cause mortality risk in these cohorts. Results: Patients with PTE had a higher incidence rate (IR) of mortality than did patients with TBI alone (IR per 1000 person-years: 71.8 vs. 27.6), with an aHR 2.31 (95% CI = 1.96–2.73). Patients with PTE aged 20–49, 50–64, and ≥65 years had, respectively, 2.78, 4.14, and 2.48 times the mortality risk of the PTN cohort. Patients with any comorbidity and PTE had 2.71 times the mortality risk as patients in the PTN cohort. Furthermore, patients with PTE had 28.2 increased hospital days and 7.85 times as frequent medical visits per year compared with the PTN cohort. Conclusion: Taiwanese patients with PTE had approximately 2 times the mortality risk and an increased medical burden compared to patients with TBI only. Our findings provide crucial information for clinicians and the government to improve TBI outcomes.

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Depression is associated with subsequent risk of pleural empyema

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753466620951048 ◽

2020 ◽

Vol 14 ◽

pp. 175346662095104

Author(s):

Yi-Chen Shen ◽

Kuang-Ming Liao ◽

Yen-Sung Lin ◽

Yu-Jhen Huang ◽

Cheng-Li Lin ◽

...

Keyword(s):

Confidence Interval ◽

Comparison Group ◽

Pleural Empyema ◽

Research Database ◽

Depression Group ◽

Hazard Ratios ◽

Increased Risk ◽

Using Data ◽

Number Of Individuals ◽

Subsequent Risk

Background: Respiratory system infections are prevalent in patients with depression. However, it remains unclear if patients with depression are at an increased risk of developing pleural empyema. Methods: We conducted a retrospective cohort study using data from the National Health Insurance Research Database of Taiwan. The depression group included 42,283 newly diagnosed patients between 2000 and 2012. The comparison group included the same number of individuals without depression, frequency matched for age, sex, comorbidities, and the year of diagnosis. The occurrence of pleural empyema was monitored until the end of 2013. Results: The overall incidence of pleural empyema was 1.32-fold higher in the depression group than in the comparison group (3.94 versus 2.97 per 10,000 person-years), with an adjusted hazard ratio of 1.33 (95% confidence interval, 1.27−1.40). Stratified analyses by age, sex, and comorbidity revealed that the crude and adjusted hazard ratios of pleural empyema associated with depression were significant in all subgroups. The 30-day mortality for pleural empyema was higher, but not significantly, in the depression group compared to the comparison group (10.7% versus 6.4%, adjusted odds ratio = 2.23, 95% confidence interval, 0.77−6.49). Conclusion: An association between depression and the development of pleural empyema may exist; however, more evidence is required to support this association. The reviews of this paper are available via the supplemental material section.

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Hysterectomies Are Associated with an Increased Risk of Depression: A Population-Based Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm7100366 ◽

2018 ◽

Vol 7 (10) ◽

pp. 366 ◽

Cited By ~ 1

Author(s):

Tomor Harnod ◽

Weishan Chen ◽

Jen-Hung Wang ◽

Shinn-Zong Lin ◽

Dah-Ching Ding

Keyword(s):

International Classification Of Diseases ◽

Population Based ◽

Research Database ◽

Predisposing Factor ◽

Post Surgery ◽

Hazard Ratios ◽

Increased Risk ◽

Classification Of Diseases ◽

Hormone Use ◽

The Government

Using the National Health Insurance Research Database of Taiwan, we investigated whether undergoing a hysterectomy increases the risk of depression. A total of 7872 patients aged 30–49 years who underwent a hysterectomy from 2000 to 2013 were enrolled as the hysterectomy group. The comparison group was randomly selected from women who had never undergone a hysterectomy and was four times the size of the hysterectomy group. We calculated adjusted hazard ratios and 95% confidence intervals (CIs) for depression [The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 296.2, 296.3, 300.4, 311] in these cohorts after adjusting for age, comorbidities, oophorectomy, and hormone therapy. The overall incidence of depression was 1.02 and 0.66 per 100 person-years in the hysterectomy and comparison cohorts, respectively, yielding an adjusted hazard ratio of 1.35 (95% CI = 1.22–1.50) for depression risk. When we stratified patients by age, comorbidities, oophorectomy, and hormone use, hysterectomy increased the risk of depression. Hysterectomy, oophorectomy, and post-surgery hormone use were associated with an increased risk of depression when they occurred alone, but conferred a greater risk if they were considered jointly. Hysterectomy would be a predisposing factor for increased risk of subsequent depression. Our findings provide vital information for patients, clinicians, and the government for improving the treatment strategy in the future.

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Increasing Risks of Suicide Attempt and Suicidal Drug Overdose After Head Trauma in Patients With Sleep-Disordered Breathing: A Population-Based Study

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.533784 ◽

2020 ◽

Vol 11 ◽

Author(s):

Dorji Harnod ◽

Cheng-Li Lin ◽

Tomor Harnod ◽

Chia-Hung Kao

Keyword(s):

Suicide Attempt ◽

Head Trauma ◽

Drug Overdose ◽

Sleep Disordered Breathing ◽

Population Based ◽

Research Database ◽

Hazard Ratios ◽

Suicide Behaviors ◽

Disordered Breathing

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.

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Sibling Alcohol Use Disorder Is Associated With Increased Risk for Suicide Attempt

Clinical Psychological Science ◽

10.1177/21677026211025041 ◽

2021 ◽

pp. 216770262110250

Author(s):

Mallory E. Stephenson ◽

Sara Larsson Lönn ◽

Jessica E. Salvatore ◽

Jan Sundquist ◽

Kenneth S. Kendler ◽

...

Keyword(s):

Alcohol Use ◽

Suicide Attempt ◽

Alcohol Use Disorder ◽

Cox Regression ◽

Population Based ◽

Swedish Population ◽

Sibling Pairs ◽

Increased Risk ◽

Using Data ◽

Shared Genetic

The association between having a sibling diagnosed with alcohol use disorder (AUD) and risk for suicide attempt may be attributable to shared genetic liability between AUD and suicidal behavior, effects of environmental exposure to a sibling’s AUD, or both. To distinguish between these alternatives, we conducted a series of Cox regression models using data derived from Swedish population-based registers with national coverage. Among full sibling pairs (656,807 males and 607,096 females), we found that, even after we accounted for the proband’s AUD status, the proband’s risk for suicide attempt was significantly elevated when the proband’s sibling was affected by AUD. Furthermore, the proband’s risk for suicide attempt was consistently higher when the sibling’s AUD registration had occurred more recently. Our findings provide evidence for exposure to sibling AUD as an environmental risk factor for suicide attempt and suggest that clinical outreach may be warranted following a sibling’s diagnosis with AUD.

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The Association Between Pleural Empyema and Peripheral Arterial Disease in Younger Patients: A Retrospective National Population-Based Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.621330 ◽

2021 ◽

Vol 8 ◽

Author(s):

Tzu-Yuan Wang ◽

Hsin-Hung Chen ◽

Chun-Hung Su ◽

Sheng-Pang Hsu ◽

Chun-Wei Ho ◽

...

Keyword(s):

Cohort Study ◽

Peripheral Arterial Disease ◽

Pleural Empyema ◽

Arterial Disease ◽

Population Based ◽

Rank Test ◽

Research Database ◽

Increased Risk ◽

Using Data ◽

Peripheral Arterial

Background: To investigate the relationship between pleural empyema (PE) and peripheral arterial disease (PAD).Methods: We conducted a retrospective cohort study using data from the National Health Institute Research Database. Univariable and multivariable Cox's proportional hazard regressions were performed to investigate the association between PE and the risk of PAD. Kaplan–Meier method and the differences were assessed using a log-rank test.Results: The overall incidence of PAD was higher in the PE cohort than in the non-PE cohort (2.76 vs. 1.72 per 1,000 person-years) with a crude hazard ratio (HR) of 1.61 [95% confidence interval (CI) = 1.41–1.83]. After adjustment for age, gender, and comorbidities, patients with PE were noted to be associated with an increased risk of PAD compared with those without PE [adjusted HR (aHR) = 1.18, 95% CI = 1.03–1.35]. Regarding the age-specific comparison between the PE and non-PE cohorts, PAD was noted to be significantly high in the ≤ 49 years age group (aHR = 5.34, 95% CI = 2.34–10.1). The incidence of PAD was higher in the first 2 years, with an aHR of 1.35 (95% CI = 1.09–1.68) for patients with PE compared with those without PE.Conclusion: The risk of PAD was higher if patients with PE were younger than 49 years and within the 2-year diagnosis of PE.

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Occult Blood in Feces Is Associated with Increased Risk of Psoriasis

Dermatology ◽

10.1159/000518625 ◽

2021 ◽

pp. 1-8

Author(s):

Hyun Jung Lee ◽

Kyungdo Han ◽

Hosim Soh ◽

Seong-Joon Koh ◽

Jong Pil Im ◽

...

Keyword(s):

Intestinal Inflammation ◽

Surrogate Marker ◽

Occult Blood ◽

National Health Insurance System ◽

Inflammatory Conditions ◽

Hazard Ratios ◽

Increased Risk ◽

Inflammatory Bowel ◽

Using Data ◽

Adjusted Model

Background: The fecal immunochemistry test (FIT) has been proposed as a surrogate marker of intestinal inflammation. Psoriasis is a chronic inflammatory skin disease that is linked to underlying systemic inflammatory conditions, including inflammatory bowel disease. Methods: We investigated the association between occult blood in feces and the risk of psoriasis using data from the National Health Insurance System. This study was conducted involving 1,395,147 individuals who underwent health examinations from January 2009 to December 2012 and were followed up until the end of 2017. Results: The incidence of psoriasis (per 1,000 person-years) was 3.76 versus 4.14 (FIT-negative versus FIT-positive group) during a median follow-up of 6.68 years. In the multivariable-adjusted model, the hazard ratios for psoriasis were 1.03 for one positive FIT result, 1.12 for two positive FIT results, and 1.34 for three positive FIT results compared with negative FIT results. Conclusion: The risk of psoriasis was significantly increased in patients with positive FIT results compared to the FIT-negative population.

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Abstract W P165: Acetaminophen Use and Risk of Stroke and Myocardial Infarction in a Hypertensive Population

Stroke ◽

10.1161/str.46.suppl_1.wp165 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Rachael L Fulton ◽

Matthew Walters ◽

Anna Dominiczak ◽

Gordon Mcinnes ◽

Peter A Meredith ◽

...

Keyword(s):

Myocardial Infarction ◽

Prescription Data ◽

Arterial Blood ◽

Retrospective Data Analysis ◽

Hazard Ratios ◽

Increased Risk ◽

Risk Patients ◽

Matched Design ◽

Using Data ◽

The Uk

Introduction: Recent data suggest self-reported acetaminophen use is associated with increased risk of cardiovascular events and that acetaminophen causes a modest rise in arterial blood pressure. There are no randomized studies, studies using verified prescription data or studies in high risk patients that investigate this relationship. Hypothesis: We aimed to assess the relationship between acetaminophen prescription data and risk of stroke and myocardial infarction in patients with hypertension. Methods: We performed a retrospective data analysis using data contained within the UK Clinical Research Practice Datalink. This includes verified prescription data. Multivariable Cox proportional hazard models were used to estimate hazard ratios for stroke or MI associated with acetaminophen use over a 10-year period. Acetaminophen exposure was a time dependent variable. A propensity matched design was also used to reduce potential for confounding. Results: We included 24496 hypertensive individuals aged 65-years or older. Of these, 10878 were acetaminophen exposed and 13618 were not. There was no relationship between risk of stroke, MI or any vascular event and acetaminophen exposure on adjusted analysis (OR 1.09, 95% CI 0.86 to 1.38; OR 0.98, 95% CI 0.76 to 1.27; OR 1.17, 95% CI 0.99 to 1.37 respectively). Results in the propensity matched sample (n=4000 per group) were similar and high frequency users (defined as receiving a prescription for >75% of months) were also not at increased risk. Conclusions: In summary, use of acetaminophen was not associated with an increased risk of stroke or myocardial infarction in a large cohort of hypertensive patients.

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Gout Augments the Risk of Cardiovascular Disease in Patients With Psoriasis: A Population-Based Cohort Study

Frontiers in Immunology ◽

10.3389/fimmu.2021.703119 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zhiyong Chen ◽

Yiwen Xu ◽

Miao Chen ◽

Ran Cui ◽

Yu-Hsun Wang ◽

...

Keyword(s):

Risk Factors ◽

Propensity Score Analysis ◽

Population Based ◽

Research Database ◽

Kaplan Meier ◽

Hazard Ratios ◽

Score Analysis ◽

Increased Risk ◽

Traditional Risk Factors ◽

And Gender

ObjectivePatients with psoriasis (PsO) have a high frequency of concomitant gout and increased risk of cardiovascular diseases (CVD). We aimed to estimate the synergistic impact of gout on the risk of CVD in patients with PsO.MethodsA population-based cohort of patients registered in the National Health Insurance Research Database of Taiwan between 2000 and 2013 was stratified according to the presence of PsO and gout. Propensity score analysis was used to match age and gender at a ratio of 1:4. Cox proportional hazard models and subgroup analyses were used to estimate the hazard ratios (HRs) for CVD adjusted for traditional risk factors. The Kaplan–Meier method was used to plot the cumulative incidence curves.ResultsPatients with combined PsO and gout (n = 97), PsO alone (n = 388), gout alone (matched, n = 388) and matched controls (n = 388) were identified. Compared with the patients with PsO alone, the patients with combined PsO and gout had a significantly higher risk of CVD (relative risk 2.39, 95% CI 1.56 to 3.65). After adjustment for traditional risk factors, the risk of CVD was higher in patients with gout alone (HR 2.16, 95% CI 1.54 to 3.04) and in patients with combined PsO and gout (HR 2.72, 95% CI 1.73 to 4.28).ConclusionsGout augments the risk of CVD independently of traditional risk factors in patients with PsO.

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