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

Sociodemographic Characteristics and Clinical Profile of Suicide Attempters Attending the Emergency Department at a Tertiary Care Hospital in Oman: A Retrospective Study

OBJECTIVE

This study examined the sociodemographic and clinical characteristics of individuals who attended the emergency department of a tertiary care center in Muscat, Oman following a suicide attempt.

METHODS

A retrospective study (N=154) was conducted between January 2015 and June 2018. Information that was collected included sociodemographic variables (age, nationality, sex, marital status, and occupation), risk (medical comorbidities, psychiatric history, substance misuse, alcohol misuse, and previous history of suicide attempts), and precipitating factors, as well as the chosen methods for the suicide attempts.

RESULTS

In all, 83.1% of the sample were Omanis, and women constituted 69.5%. The mean age of the sample was 27 years; 30% were students, 42% were unemployed, and 40.9% had a history of psychiatric disorders. Family conflict, suffering from chronic illness, and having social problems were the most common precipitating factors for the suicide attempt. The most common method used in the suicide attempt was drug overdose (48.1%), mainly involving paracetamol (acetaminophen) (40%). Significant gender differences emerged in precipitating factors, history of substance misuse, and methods of suicide.

CONCLUSIONS

The data from this study are consistent with international trends that suggest that women and younger age groups are the most vulnerable to suicide attempts. Although in its infancy, the type of research presented here could lay the groundwork for preventive interventions and programs.

Characterization of suicide attempts and self-harm by adolescents and adults notified in Santa Catarina, Brazil, 2014-2018

OBJECTIVE

To characterize adolescent and adult suicide attempts and self-harm reported in Santa Catarina, Brazil, from 2014 to 2018.

METHODS

This was a cross-sectional descriptive study with data from the Notifiable Health Conditions Information System. The sociodemographic, clinical and type of self-inflicted violence characteristics among adolescents and adults were compared.

RESULTS

Among the 8,859 notifications analyzed, suicide attempts predominated in relation to self-mutilation; self-inflected violence was more frequent in females, those of white skin color and with mental disorders; it occurred more at home, in both age groups. Among adolescents, repeated self-mutilation (83.3%) stood out, while among adults, repeated suicide attempts (50.6%) and suspected alcohol use (18.3%) at the time of violence stood out.

CONCLUSION

We identified high prevalence of attempted suicide among adolescents and adults; the characteristics of violence were similar between the age groups analyzed.

Socio-Demographic and Clinical Characteristics of Psychiatric Patients Who Have Committed Suicide: Analysis of Bulgarian Regional Suicidal Registry for 10 Years

Introduction: Suicide is a major public health problem but factors determining suicide risk are still unclear. Studies in this field in Bulgaria are limited, especially on a regional level. Methods: By a cross-sectional design, we accessed the medical records of all psychiatric patients committed suicide over a 10-year period (2009-2018) in one major administrative region of Bulgaria. A statistical analysis was performed of the association between age of suicide as an indirect yet measurable expression of the underlying suicidal diathesis and a number of socio-demographic and clinical characteristics. Results: Seventy-seven of 281 suicides (28%) had psychiatric records. Most common diagnoses were mood disorders (44%), followed by schizophrenia (27%), anxiety disorders (10%), substance use disorders (9%) and organic conditions (8%). Male gender, single/divorced marital status, early illness onset, co-occurring substance misuse and lower educational attainment (for patients aged below 70) were significantly associated with earlier age of suicide whereas past suicide attempts and psychiatric hospitalizations, comorbid somatic conditions and unemployment showed insignificant association. Substantial proportion of patients (60%) had contacted psychiatric service in the year preceding suicide, with nearly half of these encounters being within 30 days of the accident. Conclusion: Severe mental disorders are major suicide risk factor with additional contribution of certain socio-demographic and illness-related characteristics. Monitoring for suicidality must be constant in chronic psychiatric patients. Registration of suicide cases in Bulgaria needs improvement in terms of information concerning mental health. More studies with larger samples and longitudinal design are needed to further elucidate distal and proximal suicide risk factors.

Gene-level genome-wide association analysis of suicide attempt, a preliminary study in a psychiatric Mexican population

Background

Evidence suggests that liability for suicide behavior is heritable; additionally, suicide has been partly related to other psychiatric disorders. Nevertheless, most of the information reported so far address Caucasian and Asian individuals. Hence, our aim was to conduct a gene‐level association study in Mexican psychiatric individuals diagnosed with suicide attempt.

Methods

We recruited 192 individuals from two clinical centers in Mexico. All participants were born in Mexico and had Mexican parents and grandparents. Direct genotyping was performed using the commercial platform Infinium PsychArray BeadChip. A p‐value lower than 1e‐05 was considered as gene‐level significant and a p‐value lower than 1e‐04 was considered as gene‐level nominal significant.

Results

Our analyses showed that SCARA5 was associated to suicide intent at a gene‐level with statistical significance (p‐value = 1.12e‐6). Other genes were nominally associated with suicide attempt: GHSR (p‐value = 0.0004), RGS10 (p‐value = 5.13e‐5), and STK33 (p‐value = 3.62e‐5). Regarding gene variant analyses, the SNPs with a statistical association (p > .05) were rs561361616, rs1537577, rs11198999 for RGS10, and rs11041981, rs11041993, rs11041994, rs11041995, rs11041997, rs10840083, rs10769918 for STK33. For these genes, previous studies have associated SCARA5 with depression, GHSR with alcohol dependence and depression, and RGS10 with schizophrenia and depression. To date, STK33 has not been associated with any psychiatric disorder.

Conclusion

Our outcomes revealed that SCARA5, GHSR, RGS10 and STK33 could be considered as risk biomarkers for suicide attempt behavior in our Mexican psychiatric sample. We recommend to perform larger scale analyses to have conclusive results.

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.

Suicide ideation and behavior in Mexico: Encodat 2016

OBJECTIVE

To provide updated information regarding the 12-month prevalence and associated sociodemographic factors for suicide ideation and behavior (plan and attempts) to substantiate preventive programs in Mexico.

MATERIALS AND METHODS

Cross-sectional nationally representative survey, conducted during 2016 (n=56 877) among those 12-65 years old living in rural, urban and metropolitan dwellings.

RESULTS

The prevalence of suicide ideation in the last 12-months was 2.3%, 0.8% of the sample reported a plan and 0.7% reported a suicide attempt. All three outcomes were about two times more common among females and suicide plan and attempt were less common among the elderly (50-65 years old). Suicide attempts were more common in urban than in rural areas. The state of Tabasco showed an increased prevalence of ideation, plan and attempts when compared to national average rates.

CONCLUSIONS

Public health measures to diminish and treat suicidal behavior are urgently needed all over the country.

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.

Demographic and Clinical Characteristics of Completed Suicides in Mexico City 2014-2015

Objective: To analyze sex differences in demographic and clinical characteristics of individuals who died by suicide in Mexico City. Method: Statistical analysis of residents of Mexico City whose cause of death was suicide, during two years period from January 2014 to December 2015, with a coroner's report. Suicide mortality rates were calculated by age, sex, and location within the city. The Chi-squared test was used to assess statistical differences. Results: From January 2014 to December 2015, 990 residents of Mexico City died by suicide (men: 78.28%, women: 21.72%). Among males, the highest mortality rates were among the groups of 20-24 and 75-79 years old, whereas in women, the group with the highest mortality rate was 15 to 19 years old. 74% of the sample used hanging as suicide method. However, men had higher rates of a positive result in the toxicology test (40%) (p < 0.05). There was no concordance between male and female suicide by city jurisdictions. Conclusion: Our results provide evidence that the characteristics of Mexico City's residents who committed suicide had significant sex-related differences, including where they used to live. Understanding the contributory factors associated with completed suicide is essential for the development of effective preventive strategies.

Gender differences of suicides in children and adolescents: Analysis of 167 suicides in a Mexican population from 2003 to 2013

Suicide is the second cause of death in youth population. The aim of the present study was to analyze demographic characteristics and suicide methods used, as well as to identify gender differences among Mexican children and adolescents (aged 10-17 years) that committed suicide. Between January 2003 and December 2013, 167 suicides of children and adolescents between 10 and 17 years of age were documented by the Secretary of Health of the state of Tabasco, Mexico. All sociodemographic characteristics were compared according to gender. Our sample included 67.7% males and 32.3% females (male to female 2.1:1). The predominant marital status was single (89.6%) and hanging (93.7%) was the principal method of suicide used. Both female and male adolescents were predominantly students (50%); however, female adolescents were more frequently married (17%) and were housewives (26.4%). Our results identified that hanging is the principal suicide method used by children and adolescents in Mexican population; we also detected main gender differences in terms of poisoning/drug toxicity as the method used, occupation and marital status. These results should be taken into consideration when designing suicide prevention programs due to the differences found by gender.

The growth of suicide ideation, plan and attempt among young adults in the Mexico City metropolitan area

AIMS

Low and middle income countries share a heavy burden of suicide with about three in every four suicides occurring in these countries. Mexico has witnessed a growing trend in suicide deaths; if this trend is not simply a reflection of better reporting of suicide on death certificates, then this increase should logically be accompanied by an increasing trend in suicide ideation, plan and attempts, but we lack information on the trends for suicide ideation, plan and attempt for this period. We therefore aim to report changes for suicidal behaviour for the period 2001-2013 in the Mexico City Metropolitan Area.

METHOD

Using two cross-sectional surveys conducted in Mexico in 2001 and 2013, we report the lifetime and 12-month prevalence of suicide ideation, plan and attempt and changes in treatment for these problems among respondents aged 19-26 living in the Mexico City Metropolitan Area 12 years apart. To estimate the changes in prevalence for each outcome, we used generalised linear models to calculate prevalence ratios (PR; the prevalence rate in the exposed (year 2013) divided by the prevalence rate in the unexposed (year 2001-2002), adjusting for sociodemographic variables.

RESULTS

While increases in the prevalence are noted everywhere, statistical comparisons only found differences for lifetime ideation (PR = 3.1; 95% CI = 1.7-5.8) and a borderline difference for suicide attempt (PR = 2.2; 95% CI = 1.0-4.9). No attempt within the last 12-months was reported in 2001, but the prevalence in 2013 reached 1.5% (18 cases). While PRs for 12-month prevalence were all above the null, none reached statistically significant differences. During this 12-year period, the distribution of mental disorders and the use of services for mental disorders among suicide ideators, planners and attempters did not change in any noticeable way.

CONCLUSIONS

The limitations of our data are the small number of participants in the 2001 survey, the low follow-up rate for the survey in 2013 and that while representative from one city it does not represent the whole country. These findings suggest that suicide ideation and attempt may have increased during this 12-year period in the Mexico City metropolitan area, but this increase did not lead to more use of mental health care services. This information, coupled with the long-term trend of increasing suicide death rates in the country, draw a worrisome and neglected scenario for our youth in this region. Urgent measures, following the recent WHO guidelines for suicide prevention, must not be postponed.

Risk-factor differences for nonsuicidal self-injury and suicide attempts in Mexican psychiatric patients

BACKGROUND

The present study compared sociodemographic characteristics, comorbidities with substance use, and impulsivity features in three groups of psychiatric patients - suicide attempters, nonsuicidal self-injury, and nonsuicidal without self-injury - to determine the predictive factors for nonsuicidal self-injury or suicide behavior.

PATIENTS AND METHODS

Demographic features and self-reported substance use were assessed in 384 Mexican psychiatric patients. Impulsivity features were evaluated using the Plutchik Impulsivity Scale. Comparison analyses between groups were performed and a logistic regression model used to determine the factors associated with nonsuicidal with self-injury behavior and suicidal behavior.

RESULTS

Different predictive factors were observed for nonsuicidal self-injury and suicidal behavior. Females were more likely to present nonsuicidal self-injury behaviors (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.18-0.93; P=0.03). For suicide attempters, the factors associated were younger age (OR 0.89, 95% CI 0.85-0.93; P<0.001), less than 6 years of schooling (OR 0.2, 95% CI 0.06-0.6; P=0.004), and higher impulsivity traits, such as self-control (OR 1.19, 95% CI 1.03-1.36; P=0.01), planning of future actions (OR 0.79, 95% CI 0.66-0.95; P=0.01), and physiological behavior (OR 1.34, 95% CI 1.01-1.78; P=0.03).

CONCLUSION

Our results show that in a Mexican population, impulsivity features are predictors for suicide attempts, but not for self-injury. Other factors related to sociocultural background and individual features (such as personality) may be involved in this behavioral distinction, and should be studied in future research aimed at better understanding of both self-harmful behaviors.

Differences by gender in completed suicides in a Mexican population: A psychological autopsy study

OBJECTIVE

Using the method of psychological autopsy, we identified differences by gender in socio-demographic aspects, signs and symptoms, and suicide characteristics in a population of the state of Tabasco. Mexico.

METHODS

Between the years 2007-2014, 182 psychological autopsies were documented by the Secretary of Health of the State of Tabasco, Mexico. A structured questionnaire was used to obtain information on socio-demographic aspects and suicide characteristics.

RESULTS

The sample was mainly formed by males (78%). 84% of the sample used hanging as suicide method. However, in comparison with the male group, females were older on the average (p = 0.002); they were mostly housewives (37.5%) and had more years of schooling (p = 0.004). Other significant differences predominantly present in the male group were: the use of alcohol at the time of suicide (52.1%), job retirement, and increases in apathy (50.7%) and aggressiveness (36.6%) (p < 0.05).

CONCLUSION

Our results suggest that there are differences by gender between subjects with completed suicide. Factors such as alcohol consumption, job retirement, aggressiveness and isolation/social apathy certainly render men more vulnerable to suicide in the Mexican population.

Poisonings with Suicidal Intent Aged 0-21 Years Reported to Poison Centers 2003-12

Introduction

Few studies explore the clinical features of youth suicide by poisoning. The use of both social and clinical features of self-poisoning with suicidal intent could be helpful in enhancing existing and creating new prevention strategies. We sought to characterize self-poisonings with suicide intent in ages 0 to 21 years reported to three regional poison control centers from 2003–2012.

Methods

This study was a blinded retrospective review of intentional self-poisonings by those age 21 or younger captured by the Poison Information Control Network. Age, sex, substance(s) used, medical outcome, management site, clinical effects, and therapies were described using counts and percentages and analyzed using chi-square tests. We analyzed the medical outcome ranging from no effect to death using the Wilcoxon rank-sum test. Serious medical outcome was defined as death or major outcome.

Results

We analyzed a total of 29,737 cases. The majority were females (20,945;70.5%), of whom 274 (1.3%) were pregnant. Most cases were 15–18 year olds (15,520;52.2%). Many experienced no effects (9,068;30.5%) or minor medical outcomes (8,612;29%). Males had more serious medical outcomes (p<0.0001), but females were more likely to be admitted to a critical care unit (p<0.0001). There were 17 deaths (0.06%), most in males (10;p=0.008). Of the 52 substances reported in the death cases, 12 (23.1%) were analgesics. In eight (47.1%) of the deaths, over two substances were used. Overall, drowsiness/lethargy (7,097;19.3%) and single-dose charcoal (8,815;16.3%) were frequently reported. Nearly 20% were admitted to critical care units (5,727;19.3%) and 28.7% went to psychiatric facilities (8,523). Of those admitted to hospitals (8,203), nearly 70% (5,727) required critical care units. Almost half <10 years old were evaluated and released (43;47.2%). Of the 114 reported substances for this population, 22.8% involved psychotropic medications, 15.8% analgesics, and 14% Attention Deficit-Hyperactive Disorder (ADHD) medications. Analgesics (13,539;33.6%) were the most common medication category used by all age groups. Typically only one substance (20,549;69.1%) was used.

Conclusion

Undiagnosed ADHD may be a potential underlying cause for self-harming behaviors in the very young. Gender-specific suicide prevention strategies may be more effective at identifying those at risk than traditional measures alone. Further study into admitting practices by emergency physicians is needed to understand the difference in critical care admission rates based on gender. Once identified to be at-risk for suicidal behavior, access to analgesics and psychotropics should be monitored by care-givers especially in those between the ages of 15–18.