Carol Choo

What predicts medical lethality of suicide attempts in Asian youths

This study explores youth suicide attempts in Singapore using multiple databases of comprehensive archival records. Three years of medical records related to suicide attempters (N=666) who were admitted to the emergency department of a large teaching hospital in Singapore were subjected to retrospective analysis. Compared to other age groups, a peak in suicide attempts (n=207) was observed in youths aged between 15 and 24 years old (76.3% females; 23.7% males, mean age=19.30, SD=2.89). The model using recognized risk and protective factors was significant in predicting medical lethality, and correctly classified 62.8% of high lethality cases. Only resolution of precipitant made a unique statistical significant contribution. Analysis was separately conducted for males and females. Implications of the findings are discussed.

Does ethnicity matter in risk and protective factors for suicide attempts and suicide lethality

This study explored ethnic differences in risk and protective factors for suicide attempts, for the major ethnic groups in Singapore, and ethnic differences in prediction of lethality. Three years of medical records related to suicide attempters (N = 666) who were admitted to the emergency department of a large teaching hospital in Singapore were subjected to analysis. Of the sample, 69.2% were female, 30.8% male; 63.8% Chinese, 15.8% Indian, and 15.0% Malay. Indians were over-represented in this sample, as compared with the ethnic distribution in the general population. Ages ranged from 10 to 85 years old (M = 29.7, SD = 16.1). Ethnic differences were found in risk and protective factors, and perceived lethality of suicide attempts. All available variables were subjected to regression analyses for Chinese, Indian and Malay attempters to arrive at parsimonious models for prediction of perceived lethality. The findings were discussed in regards to implications in assessment of suicide risk and primary prevention for the multiethnic society in Singapore.

Effect of Cardiac Rehabilitation on Quality of Life, Depression and Anxiety in Asian Patients

This study explored the effect of cardiac rehabilitation on quality of life, depression, and anxiety in Asian patients in Singapore. Out of the 194 patients who were recruited into the study, 139 patients (71.6%) completed both the pre- and post-cardiac rehabilitation questionnaires. Their ages ranged from 28 to 80 (M = 56.66, SD = 8.88), and 103 patients (74.1%) were males and 21 patients (15.1%) were females. As hypothesized, there was a statistically significant difference between the pre- and post-cardiac rehabilitation scores on the combined dependent variables, F (4, 135) = 34.84, p < 0.001; Wilks’ Lambda = 0.49; partial eta squared = 0.51. An inspection of the mean scores indicated that patients reported higher levels of physical and mental quality of life and lower levels of depression post-cardiac rehabilitation. The findings were discussed in regards to implications in cardiac rehabilitation in Singapore.

Prediction of lethality in suicide attempts: gender matters

This study explores gender differences in lethality of suicide attempts. Three years of medical records related to suicide attempters (N = 666) were subjected to analysis. Of the sample, 69.2% were female, 30.8% male; 63.8% Chinese, 15.8% Indian, and 15.0 % Malay. Ages ranged from 10 to 85 years old (M = 29.7, SD = 16.1). More males than females made attempts with high perceived lethality (χ2 = 12.10, p < .0001) and high medical lethality (χ2 = 10.59, p < .0001). Available variables were subjected to regression analyses. The regression models predicted more than 60% of high medical lethality suicide attempts and more than 80% of high perceived lethality attempts. Suicide intent and opportunity for rescue were significant predictors for both measures of lethality. Gender differences were examined. Findings were discussed in regard to implications in suicide assessments and interventions.

Prediction of quality of life in Asian patients with schizophrenia: a cross-sectional pilot study

Background There has been a shift in mental health services from an emphasis on treatment focused on reducing symptoms to a more holistic approach involving quality of life (QOL) and overall well-being. Many psychosocial variables are associated with QOL but a parsimonious framework is needed to deepen our understanding about the contribution of psychosocial factors in influencing the QOL of Asian patients with schizophrenia in Singapore. The study aimed to address the current gap in literature by analysis of QOL using available predictors in Asian patients with schizophrenia in Singapore. Methods 43 Singaporean patients diagnosed with schizophrenia were recruited at a large teaching hospital in Singapore from January to May 2010 and were invited to complete questionnaires. Of the sample, 65.1% were females, ages ranged from 18 to 65 (M = 44.60, SD = 12.19). Available variables were subjected to regression analysis. Findings The data were analyzed using SPSS Version 23 with the alpha level set at 0.05. The final model with five predictors was significant in predicting QOL. Positive Re-appraisal, Social Support, Avoidant Coping, Duration of Hospitalization, and Education accounted for 47.2% of the variance (Adjusted R2 = 40.0%) in QOL, F (5, 37) = 6.60, p < 0.001. Those with post-secondary or higher education had higher QOL than those with secondary or lower education. Duration of hospitalization negatively predicted QOL. Conclusion The findings were discussed in regards to clinical implications for informing interventions to enhance QOL in patients with schizophrenia.

Mobile Phone Apps for Behavioral Interventions for At-Risk Drinkers in Australia: Literature Review

Background The mobile technology era has ushered in the use of mobile phone apps for behavioral intervention for at-risk drinkers. Objective Our objective was to review recent research relevant to mobile phone apps that can be used for behavioral intervention for at-risk drinkers in Australia. Methods The inclusion criteria for this review were articles published in peer-reviewed journals from 2001 to 2017 with use of the search terms “smartphone application,” “alcohol,” “substance,” “behavioural intervention,” “electronic health,” and “mobile health.” Results In total, we identified 103 abstracts, screened 90 articles, and assessed 50 full-text articles that fit the inclusion criteria for eligibility. We included 19 articles in this review. Conclusions This review highlighted the paucity of evidence-based and empirically validated research into effective mobile phone apps that can be used for behavioral interventions with at-risk drinkers in Australia.

Suicide Precipitants Differ Across the Lifespan but Are Not Significant in Predicting Medically Severe Attempts

An important risk factor for suicide assessment is the suicide precipitant. This study explores suicide attempt precipitants across the lifespan. Three years of medical records related to suicide attempters who were admitted to the emergency department of a large teaching hospital in Singapore were subjected to analysis. These cases were divided into three age groups: Adolescence, Early Adulthood, and Middle Adulthood. A total of 540 cases were examined (70.9% females; 63.7% Chinese, 13.7% Malays, 15.9% Indians), whose ages ranged from 12 to 62. There were eight cases above the age of 65 years which were excluded from the analysis. Significant differences were found in precipitants for suicide attempts across the lifespan. Middle adults had relatively fewer relationship problems, and adolescents had comparatively fewer financial and medical problems. The models to predict medically severe attempts across the age groups using suicide precipitants were not significant. The findings were discussed in regards to implications in suicide assessment and primary prevention in Singapore, as well as limitations and recommendations for future research.

Adapting Cognitive Behavioral Therapy for Children and Adolescents with Complex Symptoms of Neurodevelopmental Disorders and Conduct Disorders

Cognitive behavioral therapy (CBT) describes a group of psychotherapeutic techniques in which psychological distress and maladaptive behaviors are treated by changing cognitions and behaviors. Literature provides support for CBT as an effective intervention for children and adolescents, however, there is limited literature on how CBT can be adapted for children and adolescents with Neurodevelopmental Disorders and Conduct Disorders. This paper reviews relevant literature, and comments on how CBT can be adapted for children and adolescents with complex symptoms of Neurodevelopmental Disorders and Conduct Disorders, with a discussion of practical applications.

Smartphone Apps for Mindfulness Interventions for Suicidality in Asian Youths: Literature Review

Background The advent of mobile technology has ushered in an era in which smartphone apps can be used as interventions for suicidality. Objective We aimed to review recent research that is relevant to smartphone apps that can be used for mindfulness interventions for suicidality in Asian youths. Methods The inclusion criteria for this review were: papers published in peer-reviewed journals from 2007 to 2017 with usage of search terms (namely “smartphone application” and “mindfulness”) and screened by an experienced Asian clinician to be of clinical utility for mindfulness interventions for suicidality with Asian youths. Results The initial search of databases yielded 375 results. Fourteen full text papers that fit the inclusion criteria were assessed for eligibility and 10 papers were included in the current review. Conclusions This review highlighted the paucity of evidence-based and empirically validated research into effective smartphone apps that can be used for mindfulness interventions for suicidality with Asian youths.

Thematic Analysis of Medical Notes Offers Preliminary Insight into Precipitants for Asian Suicide Attempters: An Exploratory Study

One important dynamic risk factor for suicide assessment includes suicide precipitant. This exploratory study used a qualitative paradigm to look into the themes surrounding precipitants for suicide attempts in Singapore. Medical records related to suicide attempters who were admitted to the emergency department of a large teaching hospital in Singapore over a three year period were subjected to analysis. A total of 666 cases were examined (69.2% females; 63.8% Chinese, 15% Malays, 15.8% Indians), ages ranged from 10 years old to 85 years old (Mean = 29.7, Standard Deviation = 16.1). The thematic analysis process that was applied to the textual data elicited key concepts labelled as Relationship issues, Financial strain, Socio-legal-academic—environmental stress, and Physical and mental illness and pain. Interpreted with other recent local research on suicide attempters in Singapore, the findings have implications for informing suicide interventions.