Gender-specific differences among patients treated for suicide attempts in the emergency departments of four general hospitals in Shenyang, China

Internet addiction and suicidal behavior among vocational high school students in Hunan Province, China: A moderated mediation model

Background

Vocational education is an important part of high school education in China. However, there is little research on high school students' mental health. This study aimed to investigate the prevalence of suicidal behavior (SB) among this population and the mediating role of insomnia, depression, anxiety, and stress in the relationship between Internet addiction (IA) and SB using a structural equation model.

Methods

A cross-sectional questionnaire survey was conducted among several vocational high school students in Hunan Province, and 7,968 valid questionnaires were obtained. General demographic data and data from the Dual-Mode Self-Control Scale, Athens Insomnia Scale, Depression Anxiety Stress scale-21, and Revised Chen Internet Addiction Scale were collected. A structural equation model was used to explore the different pathways from IA to SB.

Results

Among the participants, 37.7, 15.7, and 21.8% reported suicidal ideation, plans, and attempts, respectively. The structural equation model confirmed that IA was indirectly related to SB and was mediated by insomnia and/or depression, anxiety, and stress.

Limitations

First, we only recruited students from vocational schools in Hunan Province, therefore, the sample may not represent the entire population of vocational students in China. Second, self-report scales were used in this study, and clinical diagnosis required professional interviews. Third, since this study had a cross-sectional design, the causal relationship between the variables could not be determined.

Conclusions

The prevalence of SB among vocational high school students in China was significantly high. The prevention of SB related to IA can be attributed to the improvement of insomnia and emotional problems.

Characteristics and Risk Factors for Suicide in People with Schizophrenia in Comparison to Those without Schizophrenia

BACKGROUND

Little research has been conducted that compares suicide cases with and without schizophrenia. The aim of the present study was to identify demographic, personal, social, relational, and psychological characteristics among suicides identified posthumously with schizophrenia compared to those without.

METHODS

The DSM-IV was used to independently assess the presence of schizophrenia among suicide cases by two psychiatrists. Data on risk factors was collected through a psychological autopsy method, which included structured interviews of two informants for each suicide case (a family member and a close friend). Interview questions included demographic characteristics, suicide risk factors, the Beck Hopelessness Scale, Dickman's Impulsivity Inventory, the Spielberger State-Trait Anxiety Inventory, the Hamilton Depression Scale and the Duke Social Support Inventory.

RESULTS

The prevalence of schizophrenia was 9.69% among suicide cases in this sample. The schizophrenia suicide group was more likely to be female, older, in poorer physical health, suffer from chronic disease, suffer other psychological disorders, and have a family history of psychological disorders compared to those not diagnosed schizophrenia. Other important risk factors included more frequent past suicide attempts, increased levels of depression and anxiety, lower levels of impulsivity, lower help seeking from friends, and lower social interaction social support.

CONCLUSIONS

There is a notable link between schizophrenia and suicide in China. Identification of social, personal, relational, and psychological risk factors could beneficially guide attempts to improve future preventive measures against suicide among those with schizophrenia in China.

Gender difference in suicidal ideation and related factors among rural elderly: a cross-sectional study in Shandong, China

BACKGROUND

Suicide is a global public health problem which has significant negative influence on individuals, families and the society. The aim of this study is to investigate the prevalence of suicidal ideation and related factors among elderly people in rural China, and further examine the gender differences of suicidal ideation.

METHODS

Data were collected from the 2017 Survey of the Shandong Elderly Family Health Service, which was conducted by Shandong University. A total of 5514 elderly aged 60 and above from rural Shandong were included in this study. Binary logistic regression model was performed to examine the gender difference towards suicidal ideation, and to identify the influencing factors of suicidal ideation by gender among elderly.

RESULTS

7.7% rural elderly reported suicidal ideation in the past 12 months in Shandong, China. The prevalence of suicidal ideation among females was significantly higher than that among males (P < 0.001). Education level, debts, stress of daily life, loneliness and psychological distress were significantly related to suicidal ideation in both males and females. Besides, negative life events and life satisfaction were found to be significantly associated with suicidal ideation in females but not in males.

CONCLUSIONS

There was a significant gender difference towards suicidal ideation among rural elderly in Shandong, China. So, gender difference should be considered when medical practitioners and public health workers seek to prevent and manage suicidal ideation among rural elderly, which will be important to develop strategies for coping with risk factors for suicidal ideation among males and females. In other words, more attention should be paid to females who had encountered negative life event or with lower life satisfaction.

Psychiatric morbidity and suicidal behaviour in low- and middle-income countries: A systematic review and meta-analysis

BACKGROUND

Psychiatric disorders are reported to be present in 80% to 90% of suicide deaths in high-income countries (HIC), but this association is less clear in low- and middle-income countries (LMIC). There has been no previous systematic review of this issue in LMIC. The current study aims to estimate the prevalence of psychiatric morbidity in individuals with suicidal behaviour in LMIC.

METHODS AND FINDINGS

PubMed, PsycINFO, and EMBASE searches were conducted to identify quantitative research papers (any language) between 1990 and 2018 from LMIC that reported on the prevalence of psychiatric morbidity in suicidal behaviour. We used meta-analytic techniques to generate pooled estimates for any psychiatric disorder and specific diagnosis based on International classification of disease (ICD-10) criteria. A total of 112 studies (154 papers) from 26 LMIC (India: 25%, China: 15%, and other LMIC: 60%) were identified, including 18 non-English articles. They included 30,030 individuals with nonfatal suicidal behaviour and 4,996 individuals who had died by suicide. Of the 15 studies (5 LMIC) that scored highly on our quality assessment, prevalence estimates for psychiatric disorders ranged between 30% and 80% in suicide deaths and between 3% and 86% in those who engaged in nonfatal suicidal behaviour. There was substantial heterogeneity between study estimates. Fifty-eight percent (95% CI 46%-71%) of those who died by suicide and 45% (95% CI 30%-61%) of those who engaged in nonfatal suicidal behaviour had a psychiatric disorder. The most prevalent disorder in both fatal and nonfatal suicidal behaviour was mood disorder (25% and 21%, respectively). Schizophrenia and related disorders were identified in 8% (4%-12%) of those who died by suicide and 7% (3%-11%) of those who engaged in nonfatal suicidal behaviour. In nonfatal suicidal behaviour, anxiety disorders, and substance misuse were identified in 19% (1%-36%) and 11% (7%-16%) of individuals, respectively. This systematic review was limited by the low number of high-quality studies and restricting our searches to databases that mainly indexed English language journals.

CONCLUSIONS

Our findings suggest a possible lower prevalence of psychiatric disorders in suicidal behaviour in LMIC. We found very few high-quality studies and high levels of heterogeneity in pooled estimates of psychiatric disorder, which could reflect differing study methods or real differences. There is a clear need for more robust evidence in order for LMIC to strike the right balance between community-based and mental health focussed interventions.

Epidemiology of Suicidal Behavior in Malaga (Spain): An Approach From the Prehospital Emergency Service

Objective: This study aims to analyse the number and characteristics of calls made to the Málaga Prehospital Emergency Service (PES) for suicidal behavior based on sociodemographic, temporal, and health care variables. Method: This is a retrospective, descriptive study that records all calls made to the PES due to suicidal behavior (suicide attempts and completed suicides) in 2014. Sociodemographic variables (age, sex, and health district), variables related to the calls (time-slot, degree of sunlight, type of day, month, season of the year, prioritization, and number of resources mobilized) were extracted from these calls. The number of cases and percentages were presented for the qualitative variables. The rates per 100,000 were calculated by sex and health district and presented with the corresponding 95% confidence interval (CI). Results: Of the total valid calls to PES (n = 181,824), 1,728 calls were made due to suicidal behavior (0.9%). The mean age was 43.21 (±18) years, 57.4% were women, and the rate was 112.1 per 100,000 inhabitants. The calls due to suicidal behavior were in the younger-middle age segment, in the time-slot between 16 and 23 h and during daylight hours, on bank holidays, in spring and summer in comparison with winter, and with a peak of calls in August. The majority of these calls were classified as undelayable emergencies and mobilized one health resource. Conclusions: Prehospital emergency services are the first contact to the sanitary services of persons or families with suicide attempts. This information should be a priority to offer a complete overview of the suicide behavior.

Mental disorders and suicide attempt in rural China

The prevalence of various mental disorders and their age and gender specific characteristics among suicide attempters remains unclear in rural China. This study using 1:1 paired case-control design included 409 suicide attempters and 409 paired controls matched on age, gender and place of residence. Mental disorders were assessed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders. The prevalence of mental disorders was 32.3% for suicide attempters and 4.9% for paired controls. Mental disorder constituted a significant risk factor for suicide attempt with an adjusted odds ratio of 7.16 (95%CI: 3.65-14.04). The prevalence of mental disorders was higher among male than female suicide attempters. Major depressive disorder was most common in female suicide attempters while alcohol use disorder was most common in the males. The prevalence of mental disorders seemed to increase with age. Suicide attempters of higher ages were more prone to have mood disorders, especially a major depression. Suicide attempters with mental disorders differed from those without mental disorders on a number of socio-economic characteristics and suicidal behavior features. These insights should be taken into account in strategies and efforts to improve mental health care and ultimately to reduce suicidal behavior among residents in rural China.

Personality traits and suicide attempts with and without psychiatric disorders: analysis of impulsivity and neuroticism

BACKGROUND

There is a critical need for empirical data concerning the association of personality traits and attempted suicide with and without psychiatric disorders in mainland China. The objective of the present study is to provide such data by determining the prevalence of psychiatric disorders and analyzing the levels of impulsivity and neuroticism among people who have attempted suicide, and to examine the association between these personality traits and suicide attempt in people with or without psychiatric disorders.

METHODS

We administered self-reported tests and clinical interviews to 196 people who have attempted suicide who were admitted to a hospital emergency room or our psychiatric settings after a suicide attempt.

RESULTS

One hundred and fifty-six subjects (79.6%) met the criteria for Axis I disorders and eleven (6.6%) met the criteria Axis II personality disorders. Those who have attempted suicide who did not have psychiatric disorders exhibited a greater degree of background characteristics (e.g., high lethality, more interpersonal conflicts and more alcohol use), lower levels of suicidality (suicide risk, depressive symptoms) and differences of personality traits (e.g., more impulsive and less neuroticism) as compared to those who do have psychiatric disorders. Profile differences existed even after control for the stressful life event.

CONCLUSION

Our findings suggest that some personality traits differ between people who have attempted suicide depending on whether or not they have psychiatric disorders. Based on these findings, investigating the impact of personality traits on suicidal behavior in therapeutic settings would provide critical data to improve patient treatment and outcomes.

Suicide attempters examined in a Parisian Emergency Department: Contrasting characteristics associated with multiple suicide attempts or with the motive to die

Among patients examined after a suicide attempt in a Parisian emergency department, we aimed to compare individual characteristics of i) first time and multiple suicide attempters, ii) attempters whose principal motive was "to die" and attempters who had any other motive. Information regarding sociodemographics, clinical characteristics, prior mental health care and outgoing referral was collected in 168 suicide attempters using a standardized form. Associations of these variables with suicide attempt repetition (yes or no) and with the motive underlying the attempt (to die or not) were examined using descriptive statistics and multivariable logistic regression models. Multiple attempters were more likely to have no occupation and to report previous mental health care: mental health follow-up, psychiatric medication or psychiatric hospitalization. The motive to die was not associated with the risk of multiple suicide attempts but related to past suicidal ideation and to some specific precipitating factors, including psychiatric disorder. Patients who intended to die were also more likely to be referred to inpatient than to outpatient psychiatric care. Multiple attempters and attempters who desire to die might represent two distinct high-risk groups regarding clinical characteristics and care pathways. They would probably not benefit from the same intervention strategies.

Gender differences among medically serious suicide attempters aged 15-54 years in rural China

China is one of few countries which reported higher female suicide rates in the worldwide. However, little is known about the gender differences among Chinese rural suicide attempters. This study aims to analyze the gender differences among medically serious suicide attempters aged 15-54 years in rural China. Subjects were 791 medically serious suicide attempters and 791 controls aged 15-54 years in rural China. Socio-demographic, psychological and some critical variables were assessed in the interview. The results showed that all of the factors (education years, family suicide history, negative life events, social support, impulsivity and mental disorder) associated with male suicide attempters also could be found for females. Physical disease, mental disorder and pesticide ingestion played more roles on male suicide attempters. Ever married, peasant, religious belief, and less social support played more roles on female suicide attempters. Compared with male suicide attempters, female ones are mainly influenced by social factors. A gender-specific approach should be emphasized in suicide prevention.

Prevalence and influence factors of suicidal ideation among females and males in Northwestern urban China: a population-based epidemiological study

Background

Suicide is an urgent public health challenge for China. This study aims to examine the prevalence, influence factors, and gender differences of suicidal ideation among general population in Northwestern Urban China.

Methods

Data used in this study were derived from the third wave of a cohort study of a randomized community sample with 4291 participants (≥20 years) in 2008 in Lanzhou City and Baiyin City, Gansu Province. Data were collected via face-to-face interview by the trained interviewers. Descriptive analyses, chi-square tests and multivariate logistic regressions were performed by using Stata 12.0, as needed.

Results

The prevalence of 12-month suicidal ideation was 4.29 %, there was no significant difference between males and females [5.04 % vs 3.62 %, Adjusted Odds Ratio (AOR) = 0.83, p = 0.351]. Several risk factors for suicidal ideation were confirmed, including being unmarried (AOR = 1.55, p = 0.030), having depression symptoms (AOR = 2.33, p < 0.001), having other insurance (AOR = 1.83, p = 0.01) or no insurance (AOR = 1.73, p = 0.024). In addition, several influence factors were significantly different in males and females, such as being currently married (unmarried vs married, AOR = 1.84, p = 0.027, for females; no difference for males), feeling hopeless (hopless vs hopeful, AOR = 1.92, p = 0.06, for females; no difference for males), having other insurances (having other insurances vs having basic employee medical insurance, AOR = 1.92, p = 0.044, for males; no difference for females), having debts (having debts vs no debts, AOR = 2.69, p = 0.001, for males; no difference for females), currently smoking (smoking vs nonsmoking, AOR = 3.01, p = 0.019 for females, no difference for males), and currently drinking (drinking vs nondrinking, AOR = 2.01, p = 0.022, for males; no difference for females).

Discussion and conclusion

These findings suggested that comprehensive suicide prevention strategies should be developed or strengthened in order to prevent suicide ideation in China, and the gender-specific differences need to be explored through further researches.

Gender differences in socio-demographic, clinical characteristics and psychiatric diagnosis in/of suicide attempters in a Mexican population

OBJECTIVE

The aim of the present study was to analyse demographic and clinical characteristics, as well as psychiatric diagnoses to identify gender differences in patients with attempted suicide in a Mexican population.

METHODS

Between September 2010 and September 2012, 140 suicide attempts were documented in the Department of Psychiatry at the General Hospital of Comalcalco (Hospital General de Comalcalco in Spanish) in Tabasco, Mexico. Diagnoses were established using the DSM-IV questionnaire in which Axis I and II were considered. The Suicide Intent Scale was also applied.

RESULTS

In our sample, 63.6% were females and 36.4% males. With regard to socio-demographic characteristics, the predominant marital status in males was single, and in females married (χ2=5.93, df=2, p=0.05). In occupation the male group was mainly unemployed and housewife in females (χ2=55.51, df=4, p<0.001). Male subjects were more likely to consume alcohol (χ2=20.40, df=1, p≤0.001), cannabis (χ2=16.62, df=1, p≤0.001) or tobacco. The prevalence of psychiatric diagnosis was significantly different because, the male group was mainly diagnosed with substance-related disorders, whereas female participants showed a prevalence of stress-related disorders (χ2=34.17, gl=4, p=0.0001).

CONCLUSION

Our results provide evidence that the characteristics of suicide attempt are different by gender in the Mexican population. Interventions are necessary for the development of prevention strategies that may lead to a reduction in suicidal behaviour. These preventive activities should consider the occupation for the female group and consumption of alcohol, cannabis or tobacco in the male group.

Gender differences among suicide attempters attending a Crisis Intervention Clinic in South India

BACKGROUND AND OBJECTIVES

Studying gender differences among suicide attempters is important for identifying gender-specific risk factors and for planning management and prevention. Our objective was to delineate gender differences among a well-defined group of suicide attempters.

MATERIALS AND METHODS

This record-based study was conducted among patients presenting to a Crisis Intervention Clinic in a Tertiary Care Hospital in South India. Information was gathered regarding sociodemographic and clinical characteristics. Hopelessness was measured using Beck Hopelessness Scale (BHS), and stress was evaluated using Presumptive Stressful Life Events Scale (PSLES).

RESULTS

The sample comprised of 162 males and 137 females. Males were significantly older and were more likely to be employed as compared to females. Alcohol use was significantly more in males and number of men who attempted suicide under intoxication was significantly higher. Females had a greater proportion of attempts with the use of plant poisons and medication overdose. There was no significant difference between two genders on BHS though differences were noted on types of stresses reported on PSLES.

CONCLUSION

Gender-specific differences were noted with regard to substance use, mode of attempt and types of stressors experienced. Identifying these factors might help us to design targeted interventions to prevent further attempts.