Population attributable fractions of clinical and social risk factors for suicide in Bangladesh: Finding from a case-control psychological autopsy study

Psychiatric disorder and life-event in self harm: A cross-sectional study among clinical population in Bangladesh

Background

Mental illness is an important risk factor for self-harm behavior. However, the association between self-harm behavior and psychiatric disorders has been poorly studied in Bangladesh.

Aims

To determine the prevalence of psychiatric disorders and life-events among patients with a self harm behavior.

Methods

This cross-sectional study was conducted between March 2022 and November 2023. We collected data from 100 patients with self harms from two tertiary care hospital of Dhaka by semi-structured interviews.

Results

Of the 100 cases, 72 were females, 63 % came from semi-urban background. Hanging was the commonest method (31 %) followed cutting and piercing instrument (22 %), and ingestion of Benzodiazepines (20 %). Among the cases, 71 % had at least one psychiatric disorder (Axis I 49 % and Axis II 35 %). In case of life events, 52 % had life-events within immediate 48 h, 15 % in the last one month and 17 % in the last year. Family conflict (30 %) was the commonest risk factor and increased argument with resident family members (38 %) was the commonest life event.

Conclusions

This study revealed a similar proportion of psychiatric disorders revealed in previous studies among suicide attempts. It also unveiled life events in suicide attempts indicating a potential role of life events in suicide attempts in Bangladesh. However, a prudential interpretation is warranted while considering the study results as it was conducted among clinical samples.

Advancing early detection of suicide? A national study examining socio-demographic factors, antecedent stressors and long-term history of self-harm

BACKGROUND

A range of factors including mental disorders, adverse events and history of self-harm are associated with suicide risk. Further examination is needed of the characteristics of suicides which occur without established risk factors, using national surveillance systems.

METHODS

Data on all suicides in Ireland from 2015 to 2017 were drawn from the Irish Probable Suicide Deaths Study (IPSDS). Variables examined included socio-demographics, psychiatric history and precipitant stressors. Suicide data were linked with data on prior self-harm from the National Self-Harm Registry Ireland (NSHRI). Latent Class Analysis (LCA) was used to identify sub-groups of suicide cases.

RESULTS

Of the 1809 individuals who died by suicide, 401 (22.2 %) had a history of hospital-treated self-harm. Four distinct profiles of suicides were identified. One group was marked by high levels of prior self-harm and mental health conditions. Two of the groups included few individuals with a history of self-harm but had notably high levels of mental health conditions. These two groups had relatively high levels of reported chronic pain or illness but differed in terms of socio-demographics. The final group, predominantly male, had markedly low levels of mental health conditions or self-harm but high levels of personal stressors and substance use.

LIMITATIONS

The use of coronial data may be limited by bias in the collecting of information from the deceased's family members.

CONCLUSIONS

A sub-group of suicide cases exists without any psychiatric or self-harm history but with salient occupational or health-related proximal stressors. Suicide prevention interventions should include occupational settings and should promote mental health literacy.

Characteristics of deaths by suicide in postmortem studies in Brazil: A systematic review and meta-analysis

INTRODUCTION

Suicide is one of the leading causes of death, with a trend for its increase in Brazil in past decades. This study aimed to review the characteristics of suicides in Brazilian postmortem studies.

METHODS

Studies investigating suicide deaths in Brazil, and based on autopsy or psychological autopsy were included. Proportions were pooled across studies with the use of random and fixed effects models.

RESULTS

6777 references were retrieved from six databases (searches up to January, 2023), and 45 studies included. In autopsy studies (k = 37, n = 16,231), substance use at toxicological analysis was found in 36.42% of cases (95% CI: 30.05-43.32), previous suicide attempts in 23.92% (95% CI: 6.73-57.78). In psychological autopsy studies (k = 8, n = 139), previous suicide attempts were reported in 28.09% (95% CI: 19.74-38.28), psychiatric conditions/symptoms in 90.67% (95% CI: 67.79-97.82), family history of suicidality in 21.33% (95% CI: 13.5-32.03). Most suicide deaths were reported in males and took place at the victim's home, hanging was the most frequent suicide method. Included studies presented significant limitations in quality assessment.

CONCLUSION

Future studies should present more robust methodology, including bigger samples, the use of controls, and validated methodology.

Suicide in Bangla Movie and Drama: A Content Analysis

We aimed to assess how suicidality has been depicted in Bangla movies and dramas. We conducted a search on YouTube by using search terms to identify movies and dramas with suicidal scripts. The search was performed between February and May 2022 resulting in 71 items consisting of 35 Bangla movies and 36 Bangla dramas. We scrutinized the contents of movies and dramas against our pre-designed instrument and we assessed their quality against World Health Organization guidelines. Among the 71 suicidal behaviors, 46.5% were suicides, 72% of the suicidal behavior was noted in young adults, 63.9% were unmarried, and 69% attempts were found in prominent characters. Hanging was found as the most prominent method (25.4%) and premarital and extramarital affairs and sexual harassment were the most prominent risk factors (60.6%). The potentially harmful characteristics were present in almost all events whereas potentially helpful contents were mentioned very minimally.

Psychosocial and psychiatric factors preceding death by suicide: A case-control psychological autopsy study involving multiple data sources

BACKGROUND

A range of factors including mental disorders and adverse life events can increase the risk of suicide. The objectives of this study were to examine psychosocial and psychiatric factors and service engagement among suicide decedents compared with living controls.

METHODS

A case-control study using multiple sources was conducted. Information on 132 consecutive cases of suicide was drawn from coronial files, and interviews were carried out with 35 family informants and 53 living controls. GPs completed questionnaires for 60 suicide cases and 27 controls.

RESULTS

The majority (83.3%) of suicide decedents had contacted a GP in the year prior to death, while 23.3% had 10 or more consultations during the year prior to death. Half of suicide decedents had a history of self-harm. Suicide cases were significantly more likely than controls to have a psychiatric diagnosis (60% vs. 18.5%) and a depressive illness (36.7% vs. 14.8%). Over one-quarter of suicide decedents had been treated as a psychiatric inpatient.

DISCUSSION

Primary care providers should be supported to deliver multidisciplinary interventions to engage, assess, and treat patients at risk of suicide, targeting those who present very frequently, those with a history of self-harm or substance misuse, and those with psychological presentations.