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Particularly, an increased risk of SA caused by the enhancement effects of depression on COPD was noted in patients aged less than 50 years. Conclusion SA and SDO risks are extremely high in Taiwanese COPD patients with depression. Our findings suggest that clinicians should be aware that for COPD patients with comorbid depression, prescribing a large amount of medications may be associated with SA risk through SDO. Copyright © 2020 Lin, Harnod, Lin and Kao.Background Oxford Mental Illness and Suicide tool (OxMIS) is a brief, scalable