title: Suicide and chronic kidney disease: a case-control study.
abstract: BACKGROUND
  The association of chronic kidney disease (CKD) and dialysis with suicide is not well established. The objectives of this study were to assess the association of suicide with CKD and dialysis and investigate whether differences exist between dialysis modalities or the durations of dialysis.
  
  
  METHODS
  Data were obtained from the Taiwan National Health Insurance Research Database. A total of 51 642 patients who died from suicide between 2000 and 2012 and 206 568 living control patients matched by age, gender and residency area were examined. Known risk factors included sociodemographic characteristics, physical comorbidities and psychiatric disorders, which were controlled for as covariates in the analysis. The crude odds ratios (ORs) and adjusted ORs (aORs) for various risk factors were obtained using conditional logistic regression.
  
  
  RESULTS
  After potential confounders were controlled for, CKD was significantly associated with an increased risk of suicide [aOR = 1.25, 95% confidence interval (CI) = 1.17-1.34]. End-stage renal disease patients on haemodialysis (HD) had an increased risk of suicide compared with controls (aOR = 3.35, 95% CI = 3.02-3.72). Moreover, patients who initially underwent dialysis within 0-3 months had a significantly increased risk of suicide (aOR = 20.26, 95% CI = 15.99-25.67).
  
  
  CONCLUSIONS
  CKD and HD are positively associated with suicide. Suicide is preventable; therefore, assessing mental and physical disorders is essential and recommended to all physicians, particularly those treating patients in the early phase of HD.
authors.affiliation: Biomedical Engineering Program, Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei, Taiwan.
authors.forename: Chao-Han
authors.initials: CH
authors.lastname: Liu
authors.affiliation: Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan.|School of Pharmacy, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Ming-Kung
authors.initials: MK
authors.lastname: Yeh
authors.affiliation: Department of Business Administration, Taipei City University of Science and Technology, Taipei, Taiwan.
authors.forename: Shu-Chuan
authors.initials: SC
authors.lastname: Weng
authors.affiliation: Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan.
authors.forename: Meng-Yi
authors.initials: MY
authors.lastname: Bai
authors.affiliation: School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Jung-Chen
authors.initials: JC
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D006435:Renal Dialysis / Q000523:psychology*; D051436:Renal Insufficiency, Chronic / Q000523:psychology*; D012307:Risk Factors; D013405:Suicide / Q000523:psychology / Q000639:trends*; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: CKD; dialysis; haemodialysis; suicide