The Association between Unstable Employment and Suicidal Behavior in Young-Adult Precarious Workers

ObjectivePrecarious workers have increased over the past two decades in South Korea. Employment instability, especially among young adults, is considered a serious social problem. The unstable employment status of precarious workers has negative impacts on their mental health, such as suicidal behavior. This study aims to identify the effect of the unstable employment conditions on the suicidal behavior of precarious workers. MethodsAn online survey was conducted with a panel sample of South Korean adults (n=797) who were precarious workers aged between 25–34 years. We applied Model 6 of SPSS PROCESS MACRO 3.5 to examine the multiple mediation effects of depression and anger in the relationship between employment instability and suicide. ResultsUnstable employment had no direct effect on suicidal behavior. The path of unstable employment to suicidal behavior via depression and anger had a significant indirect effect. However, employment and anger were negatively related. The indirect effect of depression and anger on the relation between unstable employment and suicidal behavior was statistically significant. ConclusionThis study suggests an association between unstable employment and suicidal behavior, mediated by depression and anger. Specifically, a high level of unstable employment status increased depression. In contrast, a low level of unstable employment status increased anger, which ultimately led to an increase in suicidal behavior. These contrasting findings are likely to reflect the heterogeneity of precarious workers. Further longitudinal studies are necessary to identify the causality between precarious employment and suicidal behavior over time.     

Recognition and labeling of delirium symptoms by intensivists: Does it matter?

Objective The approach to acute cognitive dysfunction varies among physicians, including intensivists. Physicians may differ in their labeling of cognitive abnormalities in critically ill patients. We aimed to survey: (a) what Canadian intensive care unit (ICU) physicians identify as “delirium”; (b) choices of non-pharmacological and pharmacological management; and (c) consultation patterns among ICU patients with cognitive abnormalities. Design A mail-in self-administered survey was sent to Canadian intensivists registered with the Canadian Critical Care Society. The survey contained three clinical scenarios which described cognitively abnormal patients with: (a) hepatic encephalopathy; (b) multiple drug overdose; and (c) post-operative aortic aneurysm repair. Symptoms, which included fluctuating level of consciousness, inattention, disorientation, hallucinations, sleep/wake cycle disturbance, and paranoia, all fulfilled DSM-IV criteria for delirium. We asked for diagnoses in short-answer format for each scenario, and offered multiple selections of non-pharmacological and pharmacological therapies and consultation options. Participants All intensivists registered with the Canadian Critical Care Society. Measurements and results One-hundred thirty surveys were returned, for a response rate of 58.3%. When an etiological cognitive dysfunction diagnosis was obvious, 83–85% responded with the medical diagnosis to explain the cognitive abnormalities; only 43–55% used the term “delirium”. In contrast, where an underlying medical problem was lacking, 74% of respondents diagnosed “delirium” (p = 0.002). Non-pharmacological and pharmacological management varied considerably by physician and scenario but independently from whether the term “delirium” was selected. Commonly selected pharmacological agents were antipsychotics and benzodiazepines, followed by narcotics, non-narcotic analgesics, and other sedatives. Whether and when intensivists chose to consult other services varied. Conclusions Canadian intensivists diagnose delirium based upon the presence or absence of an obvious medical etiology. Wide variation exists in approach to management, as well as patterns of consultation. C.Z. Cheung, S.M.H. Alibhai, M. Robinson, G. Tomlinson, D. Chittock, J. Drover, Y. Skrobik, for the Canadian Critical Care Trials Group.