Depression and suicide risk among low-income individuals not only share common epidemiological patterns but may also be driven by underlying bidirectional mechanisms. On one hand, the social causation hypothesis suggests that financial stress, food insecurity, and unstable housing significantly increase the risk of developing depression. On the other hand, the social drift hypothesis indicates that depression often leads to impaired occupational functioning, job loss, and financial decline, creating a feedback loop where poverty exacerbates depression, and depression, in turn, perpetuates poverty. In this context, we hypothesized that depressed patients from low-income backgrounds would have a higher propensity for suicide, as the risk may arise both because of poverty and as a consequence of untreated or chronic depression. This is also consistent with behavioral economic evidence showing that clinical depression alters time and risk preferences and consumption-related dysfunction. We acknowledge the feedback loop where depression exacerbates poverty and vice versa, thus further increasing suicide risk among low-income individuals. To evaluate this, we utilized the Taiwan National Health Insurance Research Database to examine whether depression in low-income individuals is significantly associated with an elevated risk of suicide. The present cohort study obtained data from the National Health Insurance Research Database. From a total of 1,936,512 patients included in the Longitudinal Health Insurance Dataset between 2000 and 2015, 771 low-income participants who had suffered from depression and 3084 controls matched for gender and age were selected. Cox proportional hazard regression analysis was employed to explore the hazard ratio, and 95% confidence intervals (CIs) for low income being associated with the risk of developing psychiatric disorders during the 16-year follow-up period were calculated. Of the 771 low-income, depressed patients and 3084 control participants, 60 (8514.66 per 105 person-years) and 138 (36,269.29 per 105 person-years) developed suicidal thoughts, respectively. The Cox regression model revealed an adjusted hazard ratio (AHR) of 1.771 (95% CI = 1.289–2.432, P < .001) after adjusting for all the covariates. Depression among low-income individuals was associated with Charlson Comorbidity Index (AHR = 1.097; 95% CI = 1.004–1.186, P = 1.186). Factors of suicide methods by using Cox regression included other gases and vapors (AHR = 8.149; 95% CI = 5.926–11.196, P < .001), and cutting and piercing (AHR = 2.789; 95% CI = 2.021–3.864, P < .001). Depression and low income are independent risk factors for suicide. Depressed low-income patients are at higher risk of developing suicidal thoughts compared with depressed non-low-income patients. Among suicide methods, gases and vapors have the highest risk. Therefore, clinicians should pay attention to the income level of depressed patients.

The psychosocial and health consequences of ocular conditions that cause visual impairment (VI) are extensive and include impaired daily activities, social isolation, cognitive impairment, impaired functional status and functional decline, increased reliance on others, increased risk of motor vehicle accidents, falls and fractures, poor self-rated health, and depression. We aimed to determine whether VI increases the likelihood of a poor prognosis, including mental illness, suicide, and mortality over time. In this large, location, population-based, nested, cohort study, we used data from 2000 to 2015 in the Taiwan National Health Insurance Research Database (NHIRD), which includes diagnoses of all the patients with VI. Baseline features, comorbidities, and prognostic variables were evaluated using a 1:4-matched cohort analysis. Furthermore, comparisons were performed using Cox regression and Bonferroni-correction (for multiple comparisons) to study the association between VI and poor prognosis (mental illness, suicide). The study outcome was the cumulative incidence of poor prognosis among the visually impaired and controls. A two-tailed Bonferroni-corrected p < 0.001 was considered statistically significant. Among the 1,949,101 patients enlisted in the NHIRD, 271 had been diagnosed with VI. Risk factors for poor prognosis and the crude hazard ratio was 3.004 (95% confidence interval 2.135–4.121, p < 0.001). Participants with VI had an increased risk of poor prognosis according to the sensitivity analysis, with a poor prognosis within the first year and first five years. VI was associated with suicide and mental health risks. This study revealed that patients with VI have a nearly 3-fold higher risk of psychiatric disorders, including anxiety, depression, bipolar, and sleep disorders, than the general population. Early detection through comprehensive examinations based on increased awareness in the clinical context may help maintain visual function and avoid additional complications.

Background/Objectives: According to the 2023 Ministry of Health and Welfare statistics, the suicide rate among adolescents aged 15 to 24 has steadily increased since 2018, from 3.7 to 5.5 per 100,000 populations, reaching a recent high. Although previous studies have pointed out that the future risk of suicide of those who had suffered from abuse was higher than that of the general population, researchers seldom focused on adolescent groups. Therefore, the aim of this study was to explore the risk of suicide after youth violence and the impact of subsequent comorbid mental illness and suicide risk. Methods: This retrospective matched cohort study analyzed data from the NHIRD, covering the period from 2000 to 2015. A total of 976 cases aged 10–18 who had experienced violence were included in this study. Controlled grouping was conducted by 1:10 matching based on gender, age, and the time of medical treatment, and a control group who had not experienced violence was selected for comparison. We used the Cox proportional hazards model to analyze the risk of suicide among adolescents after exposure to violence. Results: The suicide rate among adolescents who have experienced violence was significantly higher than that of the control group after 15 years of follow-up (1.0% vs. 0.5%). The prevalence of mental illness or disorders in adolescents exposed to violence was significantly higher than in the control group (45.2% vs. 40.1%). Among adolescents who had experienced violence, the methods of suicide included poisoning (solid and liquid) (53.6% vs. 43.2%), hanging (1.2% vs. 0.6%), firearms (2.4% vs. 0%), and cutting instruments (27.4% vs. 22.8%), all of which were significantly higher than in the control group. After adjusting for gender, age, residential area, and mental health comorbidities, the risk of suicide in those who had experienced violence was 1.475 times that of the control group (95% CI = 1.125–1.933; p = 0.005). Conclusions: In this study, female, younger age, and comorbid mental disorders were identified as risk factors for suicide among the adolescent victims of violence. Exposure to youth violence was associated with an increased prevalence of emotional disorders, including depression and social isolation, which subsequently elevated the suicide risk. These findings underscore the urgent need for governmental attention to the mental health of adolescent victims of violence. Implementing targeted psychological support and intervention programs could play a crucial role in mitigating the risk of suicide among this vulnerable population.

Background/Objectives: According to 2023 Ministry of Health and Welfare statistics, the suicide rate among adolescents aged 15 to 24 has steadily increased since 2018, from 3.7 to 5.5 per 100,000 populations, reaching a recent high. Although previous studies have pointed out that the risk of suicide in the future of those who had suffered from abuse was higher than that of the general population, seldom the researches focused on adolescent groups. Therefore, this aim of the study was exploring the risk of suicide after youth abuse and the impact of subsequent comorbid mental illness and suicide risk. Methods: This retrospective matched-cohort study analyzed data from the NHIRD covering the period from 2000 to 2015.A total of 976 cases aged 10-18 who had experienced abuse. Controlled group was conducted by 1:10 matching based on gender, age and time of medical treatment, and a control group who had no experienced violence was selected for comparison. We used the Cox proportional hazards model to analyze the risk of suicide among adolescents after exposure to violence. Results: The suicide rate among adolescents who have experienced violence was significantly higher than that of the control group after 15 years of follow-up (1.0% vs. 0.5%). The prevalence of mental illness or disorders in adolescents exposed to violence was significantly higher than in the control group (45.2% vs. 40.1%). Among adolescents who had experienced violence, the methods of suicide included poisoning (solid and liquid) (53.6% vs. 43.2%), hanging (1.2% vs. 0.6%), firearms (2.4% vs. 0%), and cutting instruments (27.4% vs. 22.8%), all of which were significantly higher than in the control group. After adjusting for gender, age, residential area, and mental health comorbidities, the risk of suicide in those who had experienced Abuse was 1.475 times that of the control group (95% CI = 1.125–1.933; P = 0.005). Conclusions: In this study, female gender, younger age, comorbid depression, and substance abuse were identified as risk factors for suicide among adolescent victims of violence. Exposure to youth violence was associated with an increased prevalence of emotional disorders, including depression and social isolation, which subsequently elevated the suicide risk. These findings underscore the urgent need for governmental attention to the mental health of adolescent victims of violence. Implementing targeted psychological support and intervention programs could play a crucial role in mitigating the risk of suicide among this vulnerable population.

BACKGROUND The 2003 SARS outbreak led to both acute health impacts and lasting effects on survivors and their families. OBJECTIVE Study investigates the increased risk of accidental and intentional injuries among SARS survivors and their relatives, with implications for future pandemics, including COVID-19. METHODS This retrospective cohort study utilized data from Taiwan’s National Health Insurance Research Database, focused on 285 individuals diagnosed with SARS in 2003 and 699 of their relatives, matched in a 1:10 ratio with controls. Injury risks were assessed using Fine and Gray’s competing risk models, adjusting for sociodemographic and clinical covariates, over a follow-up period of up to 15 years. RESULTS SARS survivors had a higher risk of accidental injuries (AHR = 1.631, 95% CI: 1.184–2.011, p < 0.001), as did their relatives (AHR = 1.572, 95% CI: 1.148–1.927, p < 0.001). Subgroup analysis showed elevated risks of poisoning and falls among survivors, while relatives had higher risks of traffic accidents, poisoning, medical incidents, falls, and crushing injuries. CONCLUSIONS SARS survivors and relatives face increased injury risks, highlighting long-term physical and psychosocial vulnerabilities after severe infectious outbreaks. These findings suggest healthcare systems should provide preventive and supportive measures to mitigate long-term impacts for those affected by pandemics.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The 2003 SARS outbreak led to both acute health impacts and lasting effects on survivors and their families. Objective: Study investigates the increased risk of accidental and intentional injuries among SARS survivors and their relatives, with implications for future pandemics, including COVID-19. Methods: This retrospective cohort study utilized data from Taiwan’s National Health Insurance Research Database, focused on 285 individuals diagnosed with SARS in 2003 and 699 of their relatives, matched in a 1:10 ratio with controls. Injury risks were assessed using Fine and Gray’s competing risk models, adjusting for sociodemographic and clinical covariates, over a follow-up period of up to 15 years. Results: SARS survivors had a higher risk of accidental injuries (AHR = 1.631, 95% CI: 1.184–2.011, p < 0.001), as did their relatives (AHR = 1.572, 95% CI: 1.148–1.927, p < 0.001). Subgroup analysis showed elevated risks of poisoning and falls among survivors, while relatives had higher risks of traffic accidents, poisoning, medical incidents, falls, and crushing injuries. Conclusions: SARS survivors and relatives face increased injury risks, highlighting long-term physical and psychosocial vulnerabilities after severe infectious outbreaks. These findings suggest healthcare systems should provide preventive and supportive measures to mitigate long-term impacts for those affected by pandemics.