Reasons for Living and Coping with Suicidal Ideation among Adolescents in Malaysia

Introduction

The rate of suicide ideation everywhere continues to increase, and adolescents are therefore at risk of displaying suicidal behaviour. This study examined the protective role of the reasons for living and coping strategies in reducing suicidal ideation among young adolescents in Malaysia.

Methods

A cross-sectional survey was conducted among 176 adolescents aged between 13 and 19 years of age with the majority being Malay and Muslim. The Brief Reasons for Living for Adolescents (BRFL-A), Jalowiec Coping Scale and Suicide Ideation Scale were employed.

Results

The results showed that the reasons for living and palliative coping strategy correlated negatively with suicide ideation; although, further analysis using multiple regression revealed that family alliance and optimistic and palliative coping strategies were found to be significant reasons for living that protect adolescents from suicidal thoughts. Also, those adolescents who used emotive and evasive coping strategies had higher suicidal ideation.

Conclusion

Cultural and social values continue to play an important role in protecting adolescents in Malaysia from suicidal behaviour.

The impact of migration and culture on suicide attempts of children and adolescents living in Istanbul

BACKGROUND

Suicidal attempts are steadily increasing in societies with rapid urbanisation and dramatic social changes in places like Istanbul. Stress related to internal migration may increase suicidal behaviour.

AIM

We investigated the impact of internal migration and culture on suicide attempts among youth in Istanbul.

METHODS

We retrospectively analysed the records of 210 children and adolescents, aged 6-18 years, who presented at the Emergency Outpatient Clinic of the Department of Pediatrics at Cerrahpaşa Medical School in Istanbul because of suicide attempts between January 2008 and December 2010.

RESULTS

The majority of patients (78.95%, N = 165) had a background of internal migration, mostly (65%, N = 136) originating from regions with large cultural differences compared with that of Istanbul. Noticeably, more migrants than non-migrants (18.8% vs. 6.8%) and more patients originating from regions with large cultural differences chose high-risk methods for suicide attempts (20.7% vs. 8.1%).

CONCLUSION

Internal migration can be considered a serious risk factor for suicidal behaviour. Furthermore, the degree of cultural differences between the area of origin and the new environment can be of vital importance. Healthcare measures should, therefore, focus on internal migration as a risk factor for youth suicidal behaviour and provide assistance for appropriate resettlement and integration in countries with increased mobility.

Cost-Effectiveness Analysis of Aripiprazole Augmentation Treatment of Patients with Major Depressive Disorder Compared to Olanzapine and Quetiapine Augmentation in Turkey: A Microsimulation Approach

OBJECTIVES

Major depressive disorder (MDD) is a chronic illness associated with a major burden on quality of life (QOL) and health care resources. Aripiprazole augmentation to antidepressant treatment was recently approved for patients with MDD responding insufficiently to antidepressant treatment in Turkey. The objective was to estimate the cost-effectiveness of aripiprazole augmentation in this indication compared with olanzapine and quetiapine augmentation from a payer perspective.

METHODS

A lifetime economic model was built simulating transitions of patients with MDD between major depressive episodes (MDEs) and remission. During MDEs, patients were treated with adjunctive aripiprazole, quetiapine, or olanzapine. Patients who did not respond switched to subsequent treatment lines. Comparative effectiveness between adjunctive aripiprazole, quetiapine, and olanzapine was estimated by using an indirect comparison. Resource utilization and costs were obtained from Turkish studies.

RESULTS

Over a lifetime horizon, patients treated with aripiprazole spent less time in MDEs than did patients treated with quetiapine (-11 weeks) and olanzapine (-7 weeks). On average, patients treated with aripiprazole showed improvement in QOL compared with patients treated with quetiapine (+0.054 quality-adjusted life-years [QALYs]) and olanzapine (+0.039 QALYs) combined with cost saving of 593 Turkish lira (TL) versus quetiapine and 485 TL versus olanzapine. The probability that adjunctive aripiprazole would be cost-effective among the three strategies ranged between 74% and 75% for willingness-to-pay values between 0 TL and 100,000 TL per QALY gained.

CONCLUSIONS

This is the first lifetime health-economic model in Turkey that takes patient heterogeneity into account when assessing QOL and costs of different adjunctive strategies in MDD. The results indicate that adjunctive treatment with aripiprazole provides health benefits at lower costs in patients with MDD when compared with quetiapine and olanzapine augmentation.

University students' suicidal thoughts and influencing factors

This research was planned as a descriptive study for the purpose of examining the suicidal thoughts of first-year university students and the factors that might affect them. The research was conducted with the participation of first-year students (class of 1992) at Ege University between January 2003 and October 2004. The research data were collected on a form prepared by the researcher to determine the university students' socio-demographic characteristics and their suicidal thoughts, the trait anger, expression of anger inventory and the brief symptom inventory. It was determined that 2.4% of the students had suicidal thoughts, and 11.2% of the students had previously attempted suicide. The risk factors of the students' suicidal thoughts were determined to be issues of gender, school problems, family relationships, anger expression, somatization, hostility, psychotic symptoms, phobic anxiety, anxiety disorder and interpersonal sensitivity.

Konya’da 2000-2005 Yılları Arasında Gerçekleşen İntihar Orijinli Ölüm Olgularının Retrospektif Değerlendirilmesi

İntihar; tüm yaş, ırk ve sınıftaki insanları etkileyen, ölüm nedeni olarak erişkin ve adolesan yaş grubunda daha sık karşımıza çıkan adli bir olaydır. Bu çalışmada, Konya ilinde intihara bağlı ölüm olgularının sosyodemografik özelliklerinin ve adli tıp açısından öneminin belirlenmesi, elde edilen verilerin literatür bilgileri ışığında değerlendirilmesi amaçlanmıştır. Konya Adli Tıp Şube Müdürlüğü’nce 01.01.2000 ve 31.12.2005 tarihleri arasında ölü muayene ve otopsisi yapılan 2698 olgu içinden orijini intihar olarak bildirilen 220 (%8.2) olgu, retrospektif şekilde değerlendirildi. Bu olgular; yaş, cinsiyet, kullanılan intihar yöntemi, aylara ve günlere göre dağılımı, tanısı konmuş psikiyatrik bir hastalık ve daha önceden intihar girişimi mevcut olup olmadığı yönünden incelendi. 220 intihara bağlı ölüm olgusundan 157’si (%71.4) erkek, 63’ü (%29.6) kadın idi. Olgularımızın yaşları 10 ile 94 arasında değişmekte olup, ortalama yaş 38.7 + 18.7 bulundu. İntiharlara bağlı ölüm, 54 (%24.5) olgu ile en sık 20-29 yaş grubunda meydana gelmişti. Olguların kullandığı intihar yöntemi değerlendirildiğinde, 105 (%47.8) olguda ası ilk sırada olup, bunu 51 (%23.2) olgu ile ateşli silah yaralanmaları (30 Av Silah Mermi Çekirdeği (ASMÇ), 21 Av Tüfeği Saçma Taneleri (ATST)), 39 (%17.7) olgu ile zehirlenmeler, 15 (%6.8) olgu ile yüksekten atlamalar izlemekteydi. Çocuk ve gençlerimize okullardaki psikolojik danışma ve rehberlik servisinin aktif ve etkili olarak hizmet vermesinin, daha önceden intihar girişimi öyküsü bulunan, başta depresyon olmak üzere psikiyatrik rahatsızlığı olan ve intihar eğilimi bulunan bireylerin ülkemiz çapında örgün, kolay erişilebilir psikolojik danışma hizmetlerinden yararlanmasmm sağlanmasının, intihar girişim oranmda ve intihara bağlı ölümlerin sayısında azalma sağlayacağını düşünmekteyiz.Anahtar kelimeler: İntihar, adli tıp, ölüm.