Background. There are few cross-national comparisons of the rates of suicide ideation and attempts across diverse countries. Nine independently conducted epidemiological surveys using similar diagnostic assessment and criteria provided an opportunity to obtain that data. Methods. Suicide ideation and attempts were assessed on the Diagnostic Interview Schedule in over 40000 subjects drawn from the United States, Canada, Puerto Rico, France, West Germany, Lebanon, Taiwan, Korea and New Zealand. Results. The lifetime prevalence rates/100 for suicide ideation ranged from 2·09 (Beirut) to 18·51 (Christchurch, New Zealand). Lifetime prevalence rates/100 for suicide attempts ranged from 0·72 (Beirut) to 5·93 (Puerto Rico). Females as compared to males had only marginally higher rates of suicidal ideation in most countries, reaching a two-fold increase in Taiwan. Females as compared to males had more consistently higher rates for suicide attempts, reaching a two- to three-fold increase in most countries. Suicide ideation and attempts in most countries were associated with being currently divorced/separated as compared to currently married. Conclusions. While the rates of suicide ideation varied widely by country, the rates of suicide attempts were more consistent across most countries. The variations were only partly explained by variation in rates of psychiatric disorders, divorce or separation among countries and are probably due to cultural features that we do not, as yet, understand.

Darbo tikslas: Nustatyti kompensuojamųjų antidepresantų skyrimo pokyčius bei ypatumus ir savižudybių kitimo dinamiką Lietuvoje 2003 – 2005 metais bei įvertinti bendras antidepresantų suvartojimo ir savižudybių tendencijas. Metodas: Kompensuojamųjų antidepresantų suvartojimo 2003 – 2005 metais duomenys buvo gauti iš Valstybinės ligonių kasos. Vaistai suklasifikuoti pagal ATC sistemą, o jų suvartojimo standartizavimui ir kiekybiniam įvertinimui taikyta DDD metodika ir suvartojimas išreikštas DDD vienetais 1000 gyventojų. Savižudybių statistiniai duomenys gauti iš Statistikos departamento prie Lietuvos Respublikos Vyriausybės, suskaičiuotos kiekinės savižudybių išraiškos išreikštos savižudybėmis/1000 gyventojų. Rezultatai: Kompensuojamųjų antidepresantų suvartojimas Lietuvoje 2003 – 2005 metais padidėjo 35,42 %. Labiausiai šį augimą lėmė kitų antidepresantų suvartojimo augimas (išaugo 284,75 %) ir SSRI suvartojimo augimas (išaugo 20,66 %). TCA suvartojimas sumažėjo 4,6 %, o amitriptilino suvartojimo procentinė dalis nuo kitų antidepresantų suvartojimo sumažėjo nuo 14,44 % iki 11,8 %. Savižudybių skaičius, tenkantis tūkstančiui gyventojų, Lietuvoje 2003 – 2005 metais sumažėjo 13,51 %. Sumažėjo tiek vyrų, tiek moterų savižudybių dažnis. Tose pačiose vyrų ir moterų amžiaus grupėse, moterų kompensuojamųjų antidepresantų suvartojimas yra 3,5 ir daugiau karto didesnis, negu vyrų, o vyrų savižudybių dažnis yra 5 ir daugiau kartų didesnis, negu moterų. Išvados: Didėjantis... [toliau žr. visą tekstą] / Objective: To evaluate trends in the use of compensatory antidepressants and suicide rates in Lithuania in 2003 – 2005 period and to evaluate tendencies between consumption of compensatory antidepressants and suicide rates. Methods: Data about consumption of compensatory antidepressants in 2003 – 2005 years was obtained from the State patient fund under the Ministry of Health. All drugs were classified according to ATC system and DDD methodology was used for standardization of their consumption and quantitative evaluation. The results were expressed as DDDs/1000 inhabitants. Statistical data about suicide rates was obtained from Department of Statistics to the Government of the Republic of Lithuania, and quantity of suicides was expressed as suicides/1000 inhabitants. Results: The consumption of compensatory antidepressants in 2003 – 2005 period increased by 35,42 %. This growth of total consumption was determined by rapid increase in consumption of other antidepressants (ATC N06AX) (increased by 284,75 %) and SSRIs (increased by 20,66 %). The consumption of compensatory TCA decreased by 4,6 % and the proportion of consumption of amitryptiline with consumption of all antidepressants decreased from 14,44 % to 11,8 %. Suicide rate per 1000 inhabitants decreased by 13,51 % in Lithuania in 2003 – 2005. Decrease was in both male and female suicide rates. In the same groups of ages of males and females consumption of compensatory antidepressants within the females is 3,5 and more... [to full text]

Background. There are few cross-national comparisons of the rates of suicide ideation and attempts across diverse countries. Nine independently conducted epidemiological surveys using similar diagnostic assessment and criteria provided an opportunity to obtain that data. Methods. Suicide ideation and attempts were assessed on the Diagnostic Interview Schedule in over 40000 subjects drawn from the United States, Canada, Puerto Rico, France, West Germany, Lebanon, Taiwan, Korea and New Zealand. Results. The lifetime prevalence rates/100 for suicide ideation ranged from 2·09 (Beirut) to 18·51 (Christchurch, New Zealand). Lifetime prevalence rates/100 for suicide attempts ranged from 0·72 (Beirut) to 5·93 (Puerto Rico). Females as compared to males had only marginally higher rates of suicidal ideation in most countries, reaching a two-fold increase in Taiwan. Females as compared to males had more consistently higher rates for suicide attempts, reaching a two- to three-fold increase in most countries. Suicide ideation and attempts in most countries were associated with being currently divorced/separated as compared to currently married. Conclusions. While the rates of suicide ideation varied widely by country, the rates of suicide attempts were more consistent across most countries. The variations were only partly explained by variation in rates of psychiatric disorders, divorce or separation among countries and are probably due to cultural features that we do not, as yet, understand.

本文研究目的旨在探討所得不均度對自殺率之影響，採用臺灣2004年至2010年23個縣市的追蹤資料（panel data），使用行政院主計處家庭收支調查報告之年度原始資料，計算自2004年至2010年台灣地區23縣市之吉尼係數作為所得不均度代理變數。 實證結果顯示吉尼係數對總自殺率、男性與25至44歲年齡組自殺率的效果是不顯著的正相關。本文認為，2004至2010年吉尼係數均維持在0.34左右，而且變化不大，以及樣本年度不足，可能是實證結果不顯著的原因之一。此外，由於用以計算吉尼係數之可支配所得並未納入資本利得，導致吉尼係數偏低亦可能是實證結果不顯著的另一個原因。 然而，吉尼係數對於男性自殺率及25至44歲自殺率估計係數的大小卻是值得注意，隱含這二個族群非常關注所得分配的公平性，建議政府在短期政策上可就獨厚富人之賦稅不公平現況加以改善，以達杜漸防微之效。 / This study investigates the impact of income inequality on suicide rate in Taiwan. Using panel data of 23 countries for the period 2004-2010, As a proxy for income inequality, Gini coefficients based on the Survey of Family Income and Expenditure, compiled by the Department of Government of Budget. Empirical results show Gini coefficient has a positive but statistically insignificant effect on total, male and aged 25-44 suicide rates. This paper argues that the Gini coefficient remain around 0.34 for the period of 2004-2010 without significant change, and only 7 years of data may be part of the reason why empirical result is not significant, another reason that might cause Gini coefficient lower is one of the element "disposable income" it did not included capital gain. However, the most noteworthy feature is the magnitude of the Gini coefficients for male and aged 45-64. In other words, these two groups are concerned on the fairness of income distribution. In order to prevent the suicide rate goes higher, government should change the unfair taxes that benefit the riches right away.

世界衛生組織表示「先前有過自殺行為的人，再度自殺的機率比一般人高」，因此如何針對自殺企圖者提供即時的關懷與介入服務，是世界各國重要的自殺防治策略之一。本研究希望針對曾有過自殺企圖的個案，經由統計模型的配適來找出自殺企圖個案的「自殺危險因子」，區別出再度自殺的高危險個案，以方便將人力及醫療資源投入到最需要被協助的個案上。 本研究的反應變項為「重複自殺企圖次數」，但是由於資料中「零值」的人數相當多，此外也呈現出變異數大於平均數的現象，因此我們採用可以同時處理Zero-inflated及Over-dispersion情況的廣義Zero-inflated卜瓦松迴歸模型 (Generalized Zero-inflated Poisson Regression Model)來進行資料的配適。我們得知重複自殺企圖之高風險因子有「65歲以上」、「曾患有精神疾病」、「不確定是否曾患有精神疾病」及「離婚」之個案，而「治癒」可能性較高的因子為「45~64歲」、「因情感因素自殺」、「已婚」之個案。藉由模型也可以進一步估計自殺企圖個案之再企圖機率，並且對自殺企圖個案進行分層，以進行不同程度的關懷與訪視，藉以提昇關懷的即時性及有效性。 / World Health Organization (WHO) has indicated that suicide attempt rate is much higher among those who have ever had suicide attempts. Hence, how to express concerns and provide timely consultations for suicide reattempters has become one of the key issues in suicide prevention. In this study, we try to identify the risk factors associated with suicide reattempters, and predict high-risk cases so that the limited resources can be distributed effectively. The primary variable of interest is the number of repeated suicide attempt for a suicide attempter after his/her index attempt. However, there are more zeros and greater variability in the data than that would be predicted by a Poisson model. We hence fit the data using a zero-inflated generalized Poisson regression model, a model that is frequently used for modeling over-dispersed count data with too many zeros. We find that the risk factors for repeated suicide attempts are those who are 65 or older, those who are classified as psychiatric disorders and those diagnostically uncertain cases, and those who are divorced. We also find that non-repeaters are more likely among those who are between 45 to 65 of age, married, and having a suicide attempt history due to an emotional reason. Through the use of the model, we can also estimate a subject’s reattempt probability, classify them, and provide them with suitable care and attention accordingly.

The diploma thesis deals with problems of depression in older people. Mainly the work is focused on identifying and analyzing the role of nurses in screening for depression in older people in primary care, acute care, long-term care and home care. This thesis was focused on theoretical direction and was used the method of design and demonstration. In this thesis was set one main goals with five research questions. The main goal was to identify and analyze the role of nurses in screening for depression in the elderly. RQ 1: What is the role of the nurse in screening for depression in the elderly? RQ 2: What is the role of the nurse in the primary care in screening for depression in the elderly? RQ 3: What is the role of the nurse in screening for depression in hospitalized patients in acute care? RQ 4: What is the role of the nurse in screening for depression in seniors in long-term and home care? RQ 5: What rating scales and methods are used in screening for depression in the elderly? The thesis introduce the concept of depression. The following are specified the causes of and the important factors that affect depression in the elderly. It also deals the differences in the clinical symptomatology of depression in old age. It explains possibilities and various barriers in the diagnosis of depression. Another chapter introduces complete geriatric examination, diagnostic classification systems, possible screening methods and scales for detection of depression in the elderly population. It also deals methods of pharmacological and non-pharmacological treatment and its possible complications associated with older age. By reason of increased suicide rate caused by depressive disorder the issue of suicidal behavior in the elderly is introduced. The next chapter deals with the nursing process, which is used by nurses in practice. It consists of the evaluation of the patient's health condition, making nursing diagnosis, creating nursing plan and subsequent implementation and evaluation. The nursing process is also needy for providing quality care. The nursing process in the stage of nursing diagnosis, introduces possible nursing diagnosis for a patient suffering from depression, which are based on the latest classification. Finally is described the role of nurses in screening for depression in the elderly in different health facilities and their contribution to the timely evaluation of depression in the elderly. This chapter introduces the role of nurses, nursing screening and collaboration with a physician. The role of nurses in screening for depression in different medical facilities is based on the first phase of the nursing process of assessment. On the basis of objective and subjective information, the nurse will assess the overall health and mental condition of the patient. Primarily, it was investigated what is the role of the nurse in screening for depression. On the basis of content analysis and synthesis it was necessary to used and processed domestic and foreign literature. A number of relevant sources are the results of various studies and Meta-analyzes, mostly from abroad, but also from the Czech Republic. The thesis can serve as a basis for nurses. The result of this thesis is to create e-learning material available for students in the Faculty of Health and Social Sciences of South Bohemia in Ceske Budejovice in the tutorial called Moodle.