Hanging deaths in Dammam, Kingdom of Saudi Arabia

Suicidal thoughts and behaviors in the Kingdom of Saudi Arabia

OBJECTIVE

Suicidal thoughts and behaviors (STB) constitute an escalating public health concern globally. Despite the growing burden of suicidal ideation, plan, and attempts, national information on the trends of STB is lacking in the Kingdom of Saudi Arabia (KSA). Therefore, we aim to report on the prevalence, correlates, and treatment-seeking behaviors associated with STB in the country using nationally representative information from The Saudi National Mental Health Survey (SNMHS).

METHODS

The SNMHS is a national household survey of Saudi citizens aged 15-65 (n = 4004). The adapted Composite International Diagnostic Interview (CIDI) 3.0 was administered to produce lifetime and 12-month prevalence and treatment estimates of STB in the KSA. Associated correlates were calculated using cross tabulations and logistic regressions.

RESULTS

Suicidal ideation, plan, and attempt had respective lifetime prevalence rates of 4.90 %, 1.78 %, and 1.46 %; 12-month prevalence rates of 1.82 %, 0.89 %, and 0.63 %. Significant correlates of STB include younger age, female gender, low education, urban rearing, and singe marital status. STB were also significantly associated with the presence of prior mental disorders, childhood adversities, and low treatment-seeking.

CONCLUSIONS

High unmet need and significant sociocultural and psychological risk factors have been identified in association with STB in the KSA. Given the community-based nature of the SNMHS and the limited national data on STB in the Middle East and North Africa region, our findings can extend to inform the necessary healthcare policies, treatment plans, and prevention strategies needed to alleviate the burdens of STB in the region.

A Retrospective Study of Epidemiological Correlations of Food, Drug and Chemical Poisoning in Al-Baha, Western Saudi Arabia

Poisoning is a common and severe problem worldwide. Due to significant growth in the agricultural, chemical, and pharmaceutical industries over the past few decades, poisoning risks have increased with the use of food, chemicals, and medicines everywhere in the world, especially in Saudi Arabia. Advanced information on acute poisoning patterns is critical for the effective management of poisoning events. This study aimed to examine the characteristics of patients with various patterns of acute poisoning, caused by food, drugs, and chemicals, that were reported to the Department of Toxicology and Poison Center at King Fahad Hospital and the Poison Center in Al-Baha Province, Saudi Arabia. The study also examined the relationship between demographic characteristics, including age, toxin type, and geographical distribution, and poisonings in Baha Province. This retrospective cross-sectional analysis included 622 poisoning cases. The data were collected from 2019 to 2022 and it was found that out of 622 instances, 159 had food poisoning, with more men than females sick (53.5% male and 46.5% female), 377 had drug poisoning (54.1% males and 45.9% females), and 86 had chemical poisoning (74.4% males and 25.6% females). This study found that the most prevalent agents implicated in acute poisoning were medicines, particularly analgesics and antipsychotic drugs. Food poisoning was the second most common acute poisoning, affecting largely males followed by female patients. Finally, chemical poisoning involved acute poisoning, with most cases involving methanol and household items including the strongest bleaches (chlorines) (Clorox^®, Oakland, CA, USA). Insecticides and pesticides were also secondary sources of chemical poisoning. Additional research revealed that the incidence of food, chemical, and drug poisoning was highest in children aged 1-15 years (food poisoning, n = 105, 66%; drug poisoning, n = 120, 31.8%); patients aged 11-20 years had the highest incidence of chemical poisoning (n = 41, 47.7%). Most poisoning incidents among youngsters are caused by easy access to drugs at home. Implementing strategies to enhance public awareness and limit children's access to drugs would contribute considerably to decreasing the community's burden of this problem. The findings of this study suggest that Al-Baha should improve its education regarding the rational and safe use of drugs and chemicals.

Epidemiology of Suicide by Hanging in Fars Province, Iran (2011-2019): A Population-based Cross-sectional Study

OBJECTIVES

Hanging is a common method of attempted suicide. This study investigated the epidemiological profile of attempted and completed suicides by hanging in southern Iran.

METHODS

This cross-sectional study was performed on 1167 suicide attempts by hanging between 2011 and 2019. All data related to suicide attempts by hanging were collected from the Fars Suicide Surveillance System. The trends in suicide cases and the mean age of attempted and completed suicides were plotted. The chi-square test was used to identify suicide-related factors. Crude rates of incidence, mortality, and standardized fatality during the study period were calculated. Finally, logistic regression was used to identify the predictors of death in individuals who attempted suicide.

RESULTS

The mean age of those who attempted suicide was 33.21±16.82 years; the majority were male (80.5%). The rate of attempted and completed suicide by hanging were 3.50 and 2.79 per 100 000 people, respectively. The case-fatality rate was calculated as 79.34%. The results of our study indicated an increasing trend in suicide attempts by hanging. The likelihood of death was 2.28 times higher in individuals with a previous history of suicide attempts and 1.85 times higher in those with a psychological disorder.

CONCLUSIONS

The findings of this study suggest an increasing trend in attempted and completed suicide by hanging, especially among individuals with a history of suicide attempts and psychological disorders. It is necessary to take action to reduce the rate of suicide attempts and identify the underlying causes of suicide attempts by hanging.

Gender differences in completed suicidal hangings from 2013 to 2018 in Muğla, Turkey

BACKGROUND

Hanging is the most preferred among suicide methods. Although methods vary based on age groups and social and cultural conditions, many studies have reported it as the most common suicide method in Turkey.

OBJECTIVE

Assess autopsy findings of suicidal hangings according to gender differences.

DESIGN

Retrospective, cross-sectional.

SETTING

Local morgue.

SUBJECTS AND METHODS

The autopsy reports of hanging autopsies between 2013-2018. Data was retrospectively collected from autopsy reports. Sociodemographic features, reasons, suicide notes, the news media, and macroscopic autopsy findings were evaluated. Findings were statistically compared by gender.

MAIN OUTCOME MEASURE

Gender differences in autopsy findings.

SAMPLE SIZE AND CHARACTERISTICS

175 autopsy reports of suicide by hanging.

RESULTS

Among 2534 autopsies, 175 (6.9%) cases involved hanging. Most (76%, n=133) were males; the median (interquartile range) age was 42.0 (29.5), the male/female ratio was 3:1. Suicide notes were found in 42 cases; 81 (24%) were from men. The most common reason for suicide was a mental illness (n=51, 29.2%), followed by family problems (n=26, 14.9%), but the cause was unknown in 42 cases (24.0%). More than half of the events were covered in the news media (58.9%). Rope was most commonly used with women preferring a softer material. Men were more frequently single than women. Men were more frequently single and not actively working than women (P=.026 and P≤.001, respectively). The incidence of atypical hanging was higher for males than females (P<.05).

CONCLUSION

The findings showed that there were some statistically significant differences in socioeconomic and mental health factors between men and women in hanging suicide. This study may serve as the basis for more comprehensive studies to investigate the causes of suicide.

LIMITATIONS

Single-center, retrospective.

CONFLICT OF INTEREST

None.

Patterns of suicide in Kuwait from 2014 to 2018

OBJECTIVES

Suicide is a public health problem in many countries around the world and is one of the top ten causes of death internationally. We performed a retrospective study from 2014 to 2018 to study the patterns of suicide in Kuwait.

STUDY DESIGN

After reviewing files from the General department of Criminal Evidence, we collected a total of 297 in our study period that were signed out as suicide fatalities.

METHODS

The relationship between demographic factors (e.g. age, sex, residential area) and suicides were studied using various statistical methodologies.

RESULTS

The majority of the 297 samples were in the age range of 19-35 years (180; 60.6%) and 36-65 years (107; 36%). Males constituted the majority of cases (241; 81.1%). The sample consisted of 20 different nationalities. More than half of the 297 samples were Indian (179; 60.2%), whereas Kuwaitis were a minority (22; 7.4%). Hanging was the preferred method of suicide in our study population (269; 90.6%). The governorate of Ahmadi had the highest death toll (89; 30%), followed by Farwaniyah (77; 25.9%) and Jahra (64; 21.5%).

CONCLUSION

The government of the State of Kuwait needs to target the group that has the largest number of fatalities by increasing education and awareness of employers and employees to the danger of this condition and the driving factors that lead people to it.

Mental Health Status of Expatriate Nurses in Northcentral Saudi Arabia

Mental health status may vary by nationality among expatriate workers; no conclusive data is available in Saudi Arabia. We invited expatriate nurses employed in governmental hospitals in Al-Qassim, Saudi Arabia to fill out an electronic survey that contained questions on demography (including nationality), lifestyle, job, depression, anxiety, and stress (assessed with DASS-21 scale). We categorized each outcome into normal, mild to moderate, and severe, and used adjusted multinomial logistic regressions for analyses. Nurses (n = 999) were from India (54.1%), the Philippines/Indonesia (37.0%), Pakistan (4.9%) and Arab countries (4.0%). Indian nurses were three times (OR = 2.93; 95% CI 1.84, 4.67), Pakistani nurses were 2.5 times (OR = 2.54; 95% CI 1.07, 6.00), and Arab nurses were five times (OR = 5.65; 95% CI 2.40-13.31) more likely to suffer from severe depression compared to Filipino/Indonesian nurses (reference group). Results were similar for stress. Depression and stress varied significantly by nationality among expatriate nurses.

Health and well-being of male international migrants and non-migrants in Bangladesh: A cross-sectional follow-up study

BACKGROUND

Temporary labor migration is an increasingly important mode of migration that generates substantial remittance flows, but raises important concerns for migrant well-being. The migration and health literature has seen a growing call for longitudinal, binational surveys that compare migrants to relevant non-migrant counterfactual groups in the sending country, in order to answer the basic question "Is migration good for health?" This study compares the health of male international migrants, internal migrants, and non-migrants using a unique representative panel survey of the Matlab subdistrict of Bangladesh.

METHODS AND FINDINGS

A cohort of 5,072 respondents born 1958-1992 were interviewed in 1996-1997, and reinterviewed in 2012-2014. Extensive migrant follow-up yielded a 92% reinterview rate. We explored health and income outcomes for respondents who at the time of the follow-up interview were current international migrants (n = 790), returned international migrants (n = 209), internal migrants (n = 1,260), and non-migrants (n = 2,037). Compared to non-migrants, current international migrants were younger (mean 32.9 years versus 35.8 years), had more schooling (7.6 years versus 5.8 years), and were more likely to have an international migrant father (9.7% versus 4.0%) or brother (49.1% versus 30.3%). We estimated multivariate ordinary least squares and logistic regression models controlling for a wide range of control variables measured as far back as 1982. Results show that current international migrants had substantially better health status on factors that likely relate to self-selection such as grip strength and self-rated health. Current international migrants had no excess risk of injury in the past 12 months compared to non-migrants (adjusted mean risk = 6.0% versus 9.3%, p = 0.084). Compared to non-migrants, current international migrants had roughly twice the risk of overweight/obesity (adjusted mean risk = 51.7% versus 23.3%, p < 0.001), obesity (6.9% versus 3.4%, p = 0.012), and stage 1 or higher hypertension (13.0% versus 7.0%, p = 0.014). Compared to internal migrants, current international migrants had significantly higher levels of overweight/obesity (adjusted mean risk = 51.7% versus 37.7%, p < 0.001). Current international migrants showed above average levels of depressive symptoms on a 12-item standardized short-form Center for Epidemiologic Studies Depression Scale (+0.220 SD, 95% CI 0.098-0.342), significantly higher than internal migrants (-0.028 SD, 95% CI -0.111, 0.055; p < 0.001). Depressive symptoms differed significantly from those reported by non-migrants when restricting to items on negative emotions (international migrant score = 0.254 SD, non-migrant score = 0.056 SD, p = 0.004). Key limitations include the descriptive nature of the analysis, the use of both in-person and phone survey data for international migrants, the long recall period for occupational and mental health risk measures, and the coverage of a single out-migration area of origin.

CONCLUSIONS

In this study, we observed that international migrants had comparable or lower injury and mortality risks compared to respondents remaining in Bangladesh, due in part to the high risks present in Bangladesh. International migrants also showed higher levels of self-rated health and physical strength, reflective of positive self-selection into migration. They had substantially higher risks of overweight/obesity, hypertension, and depression. Negative health impacts may reflect the effects of both harsh migration conditions and assimilation into host population conditions. Our results suggest the need for bilateral cooperation to improve the health of guest workers.

Suicides by hanging and its association with meteorological conditions in São Paulo

The main goal of this study was to evaluate the association between daily cases of hanging suicides and meteorological conditions in São Paulo, Brazil. We considered a retrospective observational study based on the analysis of all necroscopic medical-expert reports available in digital form from the central unit of the Instituto Médico Legal (Medical Legal Institute) of São Paulo between July 1, 2006 and June 31, 2007. The meteorological variables were combined via Principal Components Analysis. In order to explain their association with the frequency of suicides, Poisson regression models were employed. The analysis suggests that hotter and brighter days are associated with higher incidence of hanging suicides.

Hanging Deaths: A Retrospective Study Regarding 260 Cases

Hanging is a form of asphyxia caused by external pressure on the upper airways deriving from a band tightened by the gravitational weight of the body. During a 33-year period from 1983 to 2015, there were 260 hanging deaths examined at the Brescia Institute of Forensic Medicine (Northern Italy), which represented approximately 40% of all the asphyxial deaths recorded during this period. Almost all of the cases were represented by suicidal events, 1 case was a homicide event and there also was a case of sexual asphyxia. Eighty-two percent of the victims were men; 18% were women. There was an increasing tendency in the ages between 20 and 60 years, and the highest number of cases was observed in the 41- to 50-year age group (23% of the cases). The most common place chosen by the victim was the home setting followed by isolated outdoor places. The most common ligature material was a rope. The pathological findings were evaluated in all cases.

Depression among migrant workers in Al-Qassim, Saudi Arabia

BACKGROUND

Mental disorders are common among migrant workers. There is no data on depression in Saudi Arabia among them; although, they are a third of the population.

OBJECTIVE

To determine the prevalence of depression and to assess its relationship with duration of stay and living condition in a sample of migrant workers.

METHODS

A cross-sectional survey of 400 migrant workers was conducted in Al-Qassim region of Saudi Arabia. Exposure and covariate factors were assessed with a standardized questionnaire, depression with the CES-D (Center for Epidemiological Studies on Depression) scale, and physical indices (e.g. weight, height, and blood pressure) with a general examination. Logistic regression was used to identify significant correlates of depression.

RESULTS

Depression prevalence was 20%; it did not vary by duration of stay or living condition but by age, stress, and self-reported health. In the multivariate model, those who reported 'moderate' or 'high' levels of stress were 1.7 (95% CI: 0.9, 3.1) and 3.9 (95% CI: 1.7, 9.1) times more likely to have depression (reference ='low' level), respectively. Similarly, those who rated their health either 'good' or 'fair to very poor' were 3.4 (95% CI: 1.9, 6.1) and 4.8 (95% CI: 2.3, 10.1) times more likely to have depression (reference ='excellent/very good'), respectively.

LIMITATIONS

The data were collected from one company and pertained to only male participants, and the study design could not establish temporal sequence between the exposure and outcome variables.

CONCLUSION

Depression is considerably high in this population; a large-scale and nationally representative survey is needed to validate the findings.

Road Traffic Injury as a Major Public Health Issue in the Kingdom of Saudi Arabia: A Review

Injury was the largest single cause of disability-adjusted life years and death in the Kingdom of Saudi Arabia in 2013. The vast majority of injury-related fatalities are deaths caused by road traffic. Measures to control this serious public health issue, which has significant consequences for both Saudi families and the Saudi economy as a whole, have been underway for years but with little success. Most attempts at intervening revolve around attempts for enforcing stricter traffic laws and by installing automated traffic monitoring systems that will catch law breakers on camera and issue tickets and fines. While there has been much research on various factors that play a role in the high rate of road traffic injury in The Kingdom (e.g., driver behavior, animal collisions, disobeying traffic and pedestrian signals, environmental elements), virtually no attention has been given to examining why Saudi drivers behave the way that they do. This review provides a thorough account of the present situation in Saudi Arabia and discusses how health behavior theory can be used to gain a better understanding of driver behavior.

Evaluating the temporal trend of completed suicides referred to the Iranian Forensic Medicine Organization during 2006-2010

OBJECTIVE

The objective of the present study was to determine the temporal trend of the rate of completed suicides in Iran during 2006-2010.

MATERIAL AND METHODS

Data on completed suicides were collected from the national suicide registry of the Iranian Forensic Medicine Organization. The rates were calculated for males and females for each year of the study period, from which the temporal trends were determined. Statistical analyses were conducted using SPSS software, using chi-squared and analysis of variance (ANOVA) tests.

RESULTS

The overall rate of suicide was 4.7/100,000, with a male/female ratio of 2.4. The mean age of suicide was 31.9 years, which was significantly higher in males. Hanging was the most common method, followed by poisoning and self-immolation. During the study period, the rate of drug poisoning almost doubled, while that of firearms halved. The rates of hanging and self-immolation also increased in the last years of the study period.

CONCLUSION

According to the results of this study, it can be concluded that Iran has had a constant rate of completed suicides over the past decade. Our study also indicated the need for future nationwide studies on the risk factors of suicidal behavior and on different suicide methods in the entire Iranian population.

The pattern of suicide in the western Kingdom of Saudi Arabia: a retrospective study from 2008 to 2012

Suicide represents the dramatic end of human life mostly in young age. In a 5-year retrospective study in Jeddah in the western Kingdom of Saudi Arabia, 200 successful suicidal attempts demonstrated that hanging was the most common method of suicide with 72% of the cases, and males represented 77% of the total loses. Most fatalities were of the age range from 20s to 40s. Saudi cases constituted 18.5% of the death cases representing the second most common nationality of successful suicidal attempt in Jeddah after Indians who represented 23% of the entire study. Saudi fatalities were induced by hanging in 56% of the all Saudi deaths in contrast to about 83% in the Indian fatalities.

Patterns of suicide in Kuwait: a retrospective descriptive study from 2003-2009

Background

Prior to the invasion of Kuwait by Iraq in 1990, suicides were almost unheard of in Kuwait. However, there has been a notable increase in the referrals of suicide cases to the forensic authorities since then. A review of suicide cases was performed to investigate the demographics of this phenomenon and the suicide modalities used and to uncover issues that can be addressed by the region's government.

Methods

The sole source of data was the general department of criminal evidence (GDCE), where cases are referred by police authorities and by hospital investigators from the entire country. All cases signed out by forensic investigators as “suicide” during the time period 2003–2009 were retrieved. A full review of the data from the case files was made. This included demographic data, scene examination, radiographic investigations, autopsies with histo-pathological examination findings and toxicological screening results in each case.

Results

A total of 347 cases were retrieved and studied. Hanging was found to be the most common suicide modality used by subjects (60 %). Non-citizens constituted 87 % of cases, and no significant difference was found between married and single subjects or between Muslims and non-Muslims. Regions that were more populated with an expatriate labour force had the highest suicide prevalence.

Conclusion

The government of Kuwait needs to investigate the dire conditions in which some expatriates live and to improve their situation. More control over the dispensing of certain medications needs to be enforced. Finally, strict firearm control could help reduce the suicide rates in Kuwait.

Mental health issues among migrant workers in Gulf Cooperation Council countries: literature review and case illustrations

More than 15 million non-nationals are currently living and working in Gulf Cooperation Council (GCC) states. The majority are blue-collar or domestic workers coming from the Indian Subcontinent or South East Asia. They often work under very harsh conditions. There are reports of a high rate of psychosis and suicide among these people but no reliable data are available. To address this issue we conducted a literature search both in English and in Arabic to review the available articles on the psychological well-being of this population. Very few articles were found. We hereby review the available literature and contribute by presenting several brief vignettes to illustrate the various clinical aspects of this at risk population. We also discuss possible reasons for underreporting and underscore the need for more research in this area.

Patterns of suicide in Brunei Darussalam and comparison with neighbouring countries in South East Asia

A retrospective study of suicides in Brunei Darussalam (Brunei) over a 20 year period from 1991-2010 was conducted by analysing the post-mortem examination and external examination reports and other relevant records. The suicide rate in Brunei is very low (1.9 deaths per 100,000 per year). The majority of the victims were expatriates 82(66%) and hanging was the commonest mode of suicide both in expatriate and local population. The study showed that the suicide rate among the Bruneian Malays was the lowest (0.5 deaths per 100,000 per year) among the different nationalities. The study highlights the demographics and socio-economic background of the victims, methods used in committing suicide, suicide rates in different ethnic groups and predisposing factors. The results of this study would be of use for taking preventive measures to minimize the incidence of suicide.

Suicide methods in Asia: implications in suicide prevention

As the largest continent in the World, Asia accounts for about 60% of World suicides. Preventing suicide by restricting access to suicide methods is one of the few evidence-based suicide prevention strategies. However, there has been a lack of systematic exploration of suicide methods in Asian countries. To amend this shortage, the current review examines the leading suicide methods in different Asian countries, their trend, their age- and sex- specific characteristics, and their implications for suicide prevention. In total, 42 articles with leading suicide methods data in 17 Asian countries/regions were retrieved. The epidemiologic characteristics and recent trends of common suicide methods reflect specific socio-cultural, economic, and religious situations in the region. Common suicide methods shift with the introduction of technologies and constructions, and have specific age- or sex-characteristics that may render the restriction of suicide methods not equally effective for all sex and age sub-groups. Charcoal burning, pesticide poisoning, native plant poisoning, self-immolation, and jumping are all prominent examples. In the information society, suicide prevention that focuses on suicide methods must monitor and control the innovation and spread of knowledge and practices of suicide "technologies". It may be more cost-effective to design safety into technologies as a way of suicide prevention while there is no rash of suicides yet by the new technologies. Further research on suicide methods is important for public health approaches to suicide prevention with sensitivity to socio-cultural, economic, and religious factors in different countries.

Blood alcohol levels in suicide by hanging cases in the state of Sao Paulo, Brazil

Suicide is one of the main causes of violent death worldwide, and has become a public health issue. Since alcohol consumption is associated with the increase in the number of suicides and hanging is one of the main methods used worldwide, the present study consists of an epidemiological analysis of BACs in victims of suicide by hanging autopsied in the State of Sao Paulo, Brazil. The objective of the present work was to establish an epidemiological profile and evaluate blood alcohol concentrations in victims of suicide by hanging in the State of São Paulo, Brazil, in the year of 2007. A cross-sectional retrospective study was conducted by collection of secondary data from autopsy reports of victims of hanging. According to the present study, positive results for alcohol were higher in male victims, but the mean BAC was higher in women.