Association between new-onset liver cirrhosis and suicide risk in South Korea: A nationwide cohort study

Abstract

Background/Aims: Current evidence suggests that liver cirrhosis (LC) causes severe psychological stress and depression, which are risk factors for suicide. Although previous studies reported the association between LC and suicidal thoughts, little is known of its effect on suicidal deaths. Therefore, this study was undertaken to investigate the effect of new-onset LC on suicide.Methods: From the National Health Insurance Service-National Sample Cohort of South Korea, 5,809 incident LC patients and 11,618 risk-set controls matched by propensity score were selected for follow-up. The incidence rate of suicide was estimated using a generalized estimating equation with a Poisson distribution. Effect size was presented as a hazard ratio (HR) using Cox’s proportional hazards model.Results: The incidence rate of suicide was 143.3 cases per 100,000 person years (95% confidence interval [CI], 100.2–205.1) among the LC cohort. The LC patients were 2.37 times more likely to commit suicide compared with matched controls (HR, 2.37; 95% CI, 1.44–3.88). Increased suicide risk was evident within the first 2 years of the follow-up period (HR, 2.59; 95% CI, 1.20–5.60) and among the 18–49-year-old age group (HR, 3.72; 95% CI, 1.45–9.56).Conclusions: Our study found increased risk of suicide in patients with new onset LC, especially during the early period following diagnosis and in younger patients. To decrease this suicide risk, a regular and continuous social support system is required.

Development of Open-Angle Glaucoma in Adults With Seropositive Rheumatoid Arthritis in Korea

“…Although the cohort was constructed retrospectively, this study was able to address many of the limitations inherent in a retrospective design through risk-set matching with time-dependent propensity score. 31 First, association between RA and risk of developing POAG was observed with time-dependent propensity score matching to adjust for confounders. 32 As with propensity score, we estimated hazard components from the Cox proportional hazard model, with January 1, 2004, as the baseline and RA as the event.…”

Association between new-onset Parkinson’s disease and suicide risk in South Korea: a nationwide cohort study

“…The PD onset date was defined as the first hospitalization or second outpatient visit, whichever occurred first. The second outpatient visit was considered the date of PD diagnosis to avoid an immortal time bias [ 23 ], which is the interval between the first and second outpatient visits [ 24 ]. Thus, beginning on January 1, 2004, patients with new-onset PD were enrolled and followed up in the event PD cohort on the index date (i.e., time zero).…”

“…The National Health Insurance Service Senior–National Sample Cohort (NHIS-NSC) was constructed retrospectively, although this study was designed to mimic a prospective study. Therefore, here we solved many limitations inherent to retrospective design through risk-set matching with time-dependent propensity scores [ 23 , 25 ]. First, the association between PD and suicide risk was observed with time-dependent propensity score matching to adjust for confounding factors [ 26 ].…”

“…The number of comorbidities in each individual was assessed as a diagnostic code by using the Quan ICD-10 coding algorithm of CCI scores [ 27 ]. Patients who were prescribed antihypertensive, antidiabetic, lipid-lowering, and antidepressive agents for more than 90 days were considered to use the drug [ 23 ]. Second, to mimic a prospective study, when a patient with PD was first identified, individuals at risk of PD but not yet at onset were matched among patients of the same age and sex as the identified patient with PD.…”

AASLD Practice Guidance: Palliative care and symptom‐based management in decompensated cirrhosis

“…[25,109,113,[270][271][272][273] A recent report found that patients with new cirrhosis diagnoses were at increased risk of suicide, highlighting the importance of identifying and treating mental health symptoms in this population. [274] Mental health symptoms can have organic causes (e.g., vitamin deficiency) and can mimic encephalopathy and dementia, such that a high index of suspicion is required to distinguish mental health symptoms from other related disorders.…”