title: Acute Coronary Syndrome and Suicide: A Case-Referent Study.
abstract: The high prevalence of acute coronary syndrome (ACS) represents a significant burden on healthcare resources. A robust association exists between depression and increased morbidity and mortality after ACS. This study examined the relationship between suicide and ACS after adjusting for depression and other comorbidities.
  
  
  
  In this case-referent study conducted in Taiwan, the cases were people aged 35 years or older who died from suicide between 2000 and 2012 and 4 live referents, each matched by age, sex, and area of residence. The covariates adjusted for in the analysis were sociodemographic characteristics, physical comorbidities, and psychiatric disorders. We identified 41 050 persons who committed suicide and 164 200 referents. In the case and referent groups, 1027 (2.5%) and 2412 (1.5%) patients had ACS, respectively. After potential confounders were adjusted, ACS was significantly associated with increased odds of suicide (aOR=1.15, 95% confidence interval [CI]=1.05-1.26). The odds of suicide were highest during the initial 6 months post-ACS diagnosis (OR=3.05, 95% CI=2.55-3.65) and remained high for at least 4 years after ACS diagnosis.
  
  
  
  ACS patients are at an increased risk of suicide compared with otherwise healthy people. The risk of suicide is particularly high in the 6 months after ACS diagnosis. Our results suggest that we need to identify efficacious methods to recognize those at risk for suicide and to develop effective interventions to prevent such deaths.
authors.affiliation: Biomedical Engineering Program, Graduate Institute of Applied Science and Technology, Taipei, Taiwan.|E-Da Hospital, Kaohsiung, 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: School of Medicine, Tzu Chi University, Hualien, Taiwan.|Division of Cardiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
authors.forename: Ji-Hung
authors.initials: JH
authors.lastname: Wang
authors.affiliation: Department of Psychiatry, Mackay Memorial Hospital, 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 jungchenchang@ntu.edu.tw mybai@mail.ntust.edu.tw.|Adjunct Appointment to the National Defense Medical Center, Taipei, Taiwan (ROC).
authors.forename: Meng-Yi
authors.initials: MY
authors.lastname: Bai
authors.affiliation: School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan jungchenchang@ntu.edu.tw mybai@mail.ntust.edu.tw.
authors.forename: Jung-Chen
authors.initials: JC
authors.lastname: Chang
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000523:psychology*; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology
keywords: acute coronary syndrome; acute myocardial infarction; suicide