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Original research
Risk of dementia after charcoal-burning suicide attempts: a nationwide cohort study in Taiwan
  1. Shan-Yueh Chang1,2,
  2. Wu-Chien Chien3,4,5,
  3. Chi-Hsiang Chung4,5,6,
  4. Hsin-An Chang7,8,
  5. Yu-Chen Kao7,8,9,
  6. Hui-Wen Yeh7,10,11,12,
  7. Yu-Ching Chou5,
  8. Chung-Kan Peng1,13,
  9. Chih-Hao Shen1,2,13,
  10. Nian-Sheng Tzeng7,8
  1. 1 Division of Pulmonary and Critical Medicine, Department of Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
  2. 2 Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
  3. 3 Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
  4. 4 Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
  5. 5 School of Public Health, National Defense Medical Center, Taipei, Taiwan
  6. 6 Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
  7. 7 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
  8. 8 Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
  9. 9 Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan
  10. 10 Department of Nursing, Tri-Service General Hospital, and School of Nursing, National Defense Medical Center, Taipei, Taiwan
  11. 11 Department of Nursing, Kang-Ning University, Taipei, Taiwan
  12. 12 Institute of Bioinformatics and System Biology, National Chiao Tung University, Hsin-Chu, Taiwan
  13. 13 Hyperbaric Oxygen Therapy Center, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
  1. Correspondence to Dr. Nian-Sheng Tzeng, Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center,Tapei 144, Taiwan; pierrens{at}mail.ndmctsgh.edu.tw

Abstract

This study aimed to investigate the association between charcoal-burning suicide attempts and the risk of developing dementia. A nationwide, matched cohort, population-based study enrolled a total of 4103 patients with newly diagnosed charcoal-burning suicide attempts, between 2000 and 2010, which were selected from the National Health Insurance Research Database of Taiwan, along with 12,309 controls matched for sex and age. After adjusting for confounding factors, Fine and Gray’s competing risk analysis was used to compare the risk of developing dementia during the 10-year follow-up period. Of the enrolled patients (n=16,412), dementia developed in 303 (1.85%), including 2.56% in the study group (105 in 4103) and 1.61% (198 in 12,309) in the control group. The Fine and Gray’s survival analysis revealed that the patients with charcoal-burning suicide attempts were likely to develop dementia, with a crude HR of 5.170 (95% CI 4.022 to 6.644, p<0.001). After adjusting for age, sex, comorbidity, geographic area and urbanization level of residence, and monthly insured premium, the adjusted HR was 4.220 (95% CI 3.188 to 5.586, p<0.001). Suicide attempts were associated with an increased risk of degenerative dementia in this study. Patients with charcoal-burning suicide attempts had a fourfold risk of dementia than the control group.

  • dementia
  • psychopathology
  • risk

http://dx.doi.org/10.1136/jim-2018-000759

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    Footnotes

    • Contributors S-YC and N-ST conceived of the study, participated in its design and coordination, data interpretation, performed the statistical analysis, and drafted the manuscript. W-CC, C-HC, and H-WY participated in the design of the study and data interpretation. H-AC and Y-CK participated in the design of the study and data interpretation. C-KP, C-HS, and Y-CC participated in the statistical analysis and data interpretation. S-YC wrote the paper. All authors have read and approved the final manuscript as submitted.

    • Funding This work was supported by Tri-Service General Hospital Research Foundation grant numbers TSGH-C105-130, TSGH-C106-002, and TSGH-C107-004. Data for this study were based on the National Health Insurance Research Database provided by the National Health Insurance Administration of the Ministry of Health and Welfare, Taiwan, and managed by the National Health Research Institutes, Taiwan. The interpretation and conclusions contained in this article do not represent those of the National Health Insurance Administration, the Ministry of Health and Welfare, or the National Health Research Institutes.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval This study was conducted in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki). The Institutional Review Board of the Tri-Service General Hospital approved this study and waived the need for individual consents since all the identification data were encrypted in the NHIRD (IRB No 1-104-05-145).

    • Provenance and peer review Not commissioned; externally peer reviewed.