Predictors for suicidal ideation after occupational injury
Introduction
Suicide is among the leading causes of death worldwide (Kessler et al., 2005). In industrialized countries, population rates of suicide keep increasing in the past several decades despite of various preventive efforts. The global mortality rate is around 16 per 100,000, or one death every 40 seconds (WHO, 2009). In Taiwan, suicide was the ninth leading cause of death in 1997–2009. From 1991 to 2009, suicide rates in Taiwan increased from 7.2 to 17.6 per 100,000 person-year (Department of Health, 2009). As the mean age of suicide death is 49.2 years old (Lin and Lu, 2008), the life-year loss has been significant in Taiwan.
Suicidal ideation has been considered an important indicator for suicide attempts and completed suicide (Mann et al., 2005). The lifetime prevalence of suicidal ideation, plan, attempts ranged from 2.8% to 18.5%, 0.7% to 3.9%, and 0.4% to 5.9%, respectively (Weissman et al., 1999, Kessler et al., 2005, Lee et al., 2010). Following manifesting suicidal ideation, 34% of people transit to a suicidal plan, and 72% in turn transit from suicidal plan to an attempt (Kessler et al., 1999). Therefore, detection of suicidal ideation has also been considered an important step in suicidal prevention.
Many factors have been documented as risk factors for suicidality in the general population. Personal factors include ages of young adolescents (Nock et al., 2008) and elderly (Szanto et al., 2002), male gender (Nock et al., 2008), unmarried/divorced (Nock et al., 2008, Lee et al., 2010), unemployment (Chang et al., 2010), and special occupations as doctors, psychiatrists, nurses, policemen, frontline workers, and blue collar workers (Wilhelm et al., 2004). Suicidal behaviors in the relatives or friends have also been associated with suicidal ideation (Lee et al., 2010).
In addition to personal factors, traumatic event has been known to predispose suicidal ideation and behavior (Krysinska et al., 2009). The definition of trauma in the fourth version of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (APA, 1994) is “an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of self and others and the person's response involved intense fear, helplessness, or horror.” After a trauma experience, several factors are reported to affect suicidality, including trauma-related medical morbidity, neuropsychiatric sequels after head injury (Deb et al., 1998), substance abuse, disabilities (Ryb et al., 2006), and social isolation(Esposito and Clum, 2002).
Occupational injuries are an important cause of trauma worldwide. The incidence of nonfatal occupational injuries in the US was 3.9 to 6.0 cases per 100 full-time equivalent workers and almost 3.7–4.0 million cases per year in the period 2003–2008 (Bureau of Labor statistics, 2009). In Taiwan, occupational injury incidence rate was 0.43% in 2010 (Bureau of Labor Insurance, 2010a), and more than 1500 million NT dollars spent on the inpatient hospitalization payment due to occupational injury from 1950 to 2010 (Bureau of Labor Insurance, 2010b). However, to our knowledge, research evaluating suicidality in the workers and risk factors among worker after occupational injuries was lacking.
The purpose of this study was 1) to determine the rate of suicidal ideation after occupational injuries, 2) to investigate the predictors for suicidal ideation, and their contribution using the method of population attributable risk.
Section snippets
Study subjects
Our study subjects were injured workers who had been hospitalized for 3 days or longer and received Inpatient Hospitalization Benefit of Occupational Accident Medical Benefits from Labor Insurance between February 1 and August 31, 2009. This study was approved by the Institutional Review Board of the National Taiwan University Medical Center.
In this cross-section study, we conducted a questionnaire survey using a self-reported questionnaire. The questionnaire was sent to all subjects at 3 months
Prevalence and demographic correlates of suicidal ideation
Between February and August in 2009, a total of 4498 workers were hospitalized for 3 days or longer after occupational injury and received the payments from the Labor insurance bureau. After sending them the questionnaires at 3 months after the injury, 2096 (47.6%) workers completed the questionnaires, either directly answered the questionnaire, or responded to our phone calls. Among those who did not participate, 1299 (28.9%) did not answer the phone, 707 (15.7%) refusal to answer the
Discussion
Although post-traumatic stress disorder (PTSD) and major depressive disorder were reported to be increased after events of traumatic injuries (Asmundson et al., 1998, O'Donnell et al., 2004), suicidal ideation has seldom been studied before, especially after occupational injury. Our study on suicidal ideation after occupational injuries found that prevalence rate of suicidal ideation at 3 months after occupational injury was 8.3%. Self-rated injury severity above serious level, total hospital
Acknowledgements
Support for this study was provided by grants IOSH98-M315 from the Institute of Occupational Safety & Health, Council of Labor Affairs, Taiwan, R.O.C.
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