Parasuicides in a general hospital psychiatric unit: their demographic and clinical characteristics

Suicide attempters in a general hospital unit in India: their socio-demographic and clinical profile--emphasis on cross-cultural aspects

The number of suicide attempts in developing countries has been increasing progressively, as in the West. It is important to note that much of the data on suicidal behaviour is based on information obtained from developed Western societies. All such data need to be evaluated within their specific cultural context as well as cross-culturally. The present study explored the various socio-demographic, clinical characteristics of suicide attempters in a general hospital unit in India. There were certain findings that contrasted markedly with those observed in the West. Male suicides tended to predominate here, as in many Indian studies. None of them were living alone, separated or deserted by their partner. Some suicide attempters continued to live with their extended family. There was virtually no alcohol consumption by female suicide attempters. The commonest agents used were organophosphates and other household poisons. Several cross-cultural variations in the suicidal act emerged compared to the West. The 'suicide potential' in the Indian culture is discussed.

The epidemiology of parasuicide in Edmonton

The objective of this study was to examine some of the characteristics of parasuicides in Edmonton and to calculate rates of parasuicide. The method involved examining all records of parasuicides attending the University of Alberta Hospitals for a six month period (20% of all parasuicides in Edmonton are treated at the University of Alberta Hospitals). The results indicated that 58% of 275 subjects were single. The most frequent method (88.6%) of parasuicide was overdose. The peak age group was 25 to 29 years of age. The age range was 12 to 80 years (six percent < 15 years), mean age 30.2. The female to male ratio (cases) was 1.6:1; 30.2% were admitted; 46.5% received psychiatric emergency consultation; 41% had made a previous parasuicide. Calculated rates of parasuicide in Edmonton were at 448/100,000/year for those 15 years and older (men 357, women 534). The overall rate is higher than that found in any centre in the WHO/EURO investigation. The conclusion is that parasuicide presents a significant public health problem, and a cost burden on the health care system.

Attempted suicide in Hong Kong

In 1986, psychiatrists saw a total of 307 attempted suicide cases presented to a regional general hospital in Hong Kong, whether admitted or not. Compared with suicide attempts in Hong Kong in 1954 and those in Western countries, suicide attempts in Hong Kong in 1986 were significantly more likely to be precipitated by interpersonal conflicts, and significantly less likely to be precipitated by economic stress. Compared with the methods of attempted suicide in Hong Kong in 1986, those in Hong Kong in 1954 were significantly more likely to be fatal, while those in Western countries are significantly more likely to be ingestion of hyponotics and sedatives. Suicide attempters in Hong Kong are significantly more likely to be diagnosed as schizophrenics or paranoid psychotics than those in Western countries.

Attempted suicide in those with personality disorders. A comparison of depressed and unsocialized suicide attempters

From a sample of 499 patients admitted to hospitals for suicide attempts, a subsample of 182 suicide attempters who described histories of illicit activities or who were diagnosed with DSM-II anti-social, drug or alcohol personality disorders were compared with another sample of 109 suicide attempters diagnosed as having depressive disorders. The former group of unsocialized attempters obtained similar depression inventory scores as the diagnosed depressive attempters. However, the index attempts of the unsocialized group were made with less suicidal intent than those of the diagnosed depressive patients, and they made more prior suicide attempts than the diagnosed depressive patients.

Depression and attempted suicide: a comparative study

The Levine-Pilowsky depression questionnaire was used to compare the qualitative and quantitative characteristics of depression in 176 patients admitted to a general hospital following a suicide attempt and 65 psychiatric inpatients with a diagnosis of major affective disorder. The study showed that despite significant age and sex differences there was a striking similarity between the groups on all measures of depression. Diagnostic and therapeutic implications of these findings are discussed, and further research directions are suggested.

Hopelessness and low-intent in parasuicide

Parasuicide is usually associated with low suicidal intent and research data show that rising rates remain a challenging clinical and research problem. Hopelessness, a core characteristic of depression, appears to be the link between depression and suicidal behavior in high-risk patients. Previous research in this regard focused largely on hopelessness as a correlate of suicide, attempted suicide, serious suicidal intent, and as a predictor of eventual suicide among serious suicidal ideators in the absence of a recent suicide attempt. The present study was designed to investigate the relationship between hopelessness and low suicidal intent in a cohort of 337 hospitalized adult parasuicide patients referred to a general hospital psychiatric unit. Within 24-48 hours after admission, all patients, once alert, underwent an individual detailed clinical interview and one of three assessments, viz., they were rated on the Beck Hopelessness Scale, The Zung Self-Rating Depression Scale or, DSM III criteria for depression. Results support the positive relationship between hopelessness and suicidal behavior in low-intent patients, previously demonstrated in high-intent patients. The need to also address hopelessness in low-intent patients as part of an effective therapeutic intervention strategy is discussed.