Parasuicide: a Singapore perspective

Maladaptive Personality Traits of Inpatients with Self-Harm Behavior and Its Association with Suicide Intent Severity

Introduction: Inpatients with self-harm behavior utilize a high proportion of health care resources, and determining their suicide risk may be challenging. This study examines how maladaptive personality traits in people who self-harm are associated with suicide intent severity. Methods: This was a 5-month cross-sectional study. The International Personality Disorders Examination (IPDE) ICD-10 questionnaire, Beck's Suicide Intent Scale (SIS), and the Depression Anxiety Stress Scale (DASS) 21 were administered. Sociodemographic and clinical data were recorded with STATA version 10.1 for statistical analyses. Results: Thirty-seven out of 40 (92.50%) inpatients participated in this study. About two-thirds (n = 24, 64.86%) were first-time self-harmers, with self-poisoning (n = 33, 89.19%) being the most common method. About two-thirds (n = 24, 64.86%) had low to moderate suicide intent. The most common diagnosis was adjustment disorder (n = 21, 56.76%). Around one-third had at least severe ratings for depressive, anxiety, and stress symptoms. All screened positive for at least one class of maladaptive personality traits, with the majority (n = 33, 89.19%) having more than one class of maladaptive personality traits. The three most prevalent classes of maladaptive personality traits were anankastic (n = 28, 75.68%), schizoid (n = 25, 67.57%), and paranoid (n = 23, 62.16%). Only dissocial traits were positively correlated with suicide intent severity (regression coefficient = 1.37, p = .017) following adjustment for the most important confounder, DASS 21. Discussion: Maladaptive personality traits were common in inpatients with self-harm behavior, with dissocial traits being positively correlated with suicide intent severity. This finding may inform suicide prevention strategies for patients who self-harm.

Thematic Analysis of Medical Notes Offers Preliminary Insight into Precipitants for Asian Suicide Attempters: An Exploratory Study

One important dynamic risk factor for suicide assessment includes suicide precipitant. This exploratory study used a qualitative paradigm to look into the themes surrounding precipitants for suicide attempts in Singapore. Medical records related to suicide attempters who were admitted to the emergency department of a large teaching hospital in Singapore over a three year period were subjected to analysis. A total of 666 cases were examined (69.2% females; 63.8% Chinese, 15% Malays, 15.8% Indians), ages ranged from 10 years old to 85 years old (Mean = 29.7, Standard Deviation = 16.1). The thematic analysis process that was applied to the textual data elicited key concepts labelled as Relationship issues, Financial strain, Socio-legal-academic—environmental stress, and Physical and mental illness and pain. Interpreted with other recent local research on suicide attempters in Singapore, the findings have implications for informing suicide interventions.

Suicide Precipitants Differ Across the Lifespan but Are Not Significant in Predicting Medically Severe Attempts

An important risk factor for suicide assessment is the suicide precipitant. This study explores suicide attempt precipitants across the lifespan. Three years of medical records related to suicide attempters who were admitted to the emergency department of a large teaching hospital in Singapore were subjected to analysis. These cases were divided into three age groups: Adolescence, Early Adulthood, and Middle Adulthood. A total of 540 cases were examined (70.9% females; 63.7% Chinese, 13.7% Malays, 15.9% Indians), whose ages ranged from 12 to 62. There were eight cases above the age of 65 years which were excluded from the analysis. Significant differences were found in precipitants for suicide attempts across the lifespan. Middle adults had relatively fewer relationship problems, and adolescents had comparatively fewer financial and medical problems. The models to predict medically severe attempts across the age groups using suicide precipitants were not significant. The findings were discussed in regards to implications in suicide assessment and primary prevention in Singapore, as well as limitations and recommendations for future research.

What predicts medical lethality of suicide attempts in Asian youths?

This study explores youth suicide attempts in Singapore using multiple databases of comprehensive archival records. Three years of medical records related to suicide attempters (N=666) who were admitted to the emergency department of a large teaching hospital in Singapore were subjected to retrospective analysis. Compared to other age groups, a peak in suicide attempts (n=207) was observed in youths aged between 15 and 24 years old (76.3% females; 23.7% males, mean age=19.30, SD=2.89). The model using recognized risk and protective factors was significant in predicting medical lethality, and correctly classified 62.8% of high lethality cases. Only resolution of precipitant made a unique statistical significant contribution. Analysis was separately conducted for males and females. Implications of the findings are discussed.

Factors associated with adult poisoning in Northern Malaysia: a case-control study

Data on adult risk factors associated with drug or chemical poisonings in Malaysia are scarce. The objective of the study was to identify possible risk factors associated with adult admissions to the Penang General Hospital (PGH) due to chemical poisoning and/or drug overdose. The present study was a case-control study, conducted over 18 weeks. One hundred acutely poisoned adult patients admitted to PGH during the period from September 2003 to February 2004 were considered as cases. Two hundred patients admitted to the same medical wards for other illnesses, during the same period, were matched for age and gender with the poisoned cases and thus selected as controls. McNemar test and binary logistic were used for univariate analysis and logistic regression analysis for multivariate analyses. The odds ratio (OR) and its 95% confidence interval (95% CI) were calculated for each predictor variable. Positive histories of psychiatric illness and previous poisoning, problems in boy/girl friend relationships, family problems, marital problems, Indian ethnicity, Chinese ethnicity, living in rented houses and living in a household with less than five people were significant risk factors associated with adult admissions due to poisoning.

A comparison of non-fatal self-poisoning among males and females, in Sri Lanka

BACKGROUND

In the recent past Sri Lanka has had a high rate of attempted suicide by pesticide ingestion, among both males and females. Recent evidence suggests that these trends in self-poisoning may be changing, with increasing medicinal overdoses and changing gender ratios. In the past, attempted suicide in Sri Lanka has been described as impulsive acts, but research regarding aspects such as suicidal intent is limited, and there has been no comparison between genders. The objective of this study was to describe gender differences in non-fatal self-poisoning in Sri Lanka with respect to substances ingested, triggers, stressors, suicidal intent and psychiatric morbidity.

METHODS

Persons admitted to Teaching Hospital Peradeniya, Sri Lanka, for medical management of non-fatal self-poisoning over a consecutive 14-month period were eligible for the study. Participants were interviewed within one week of admission, with regard to demographic details, poison type ingested, triggers, psychiatric morbidity and suicidal intent. 949 participants were included in the study, of whom 44.2% were males, with a median age of 22 years.

RESULTS

Males were significantly more likely to ingest agrochemicals, whereas females were more likely to overdose on pharmaceutical drugs. Interpersonal conflict was a common trigger associated with non-fatal self-poisoning for both males and females. Alcohol use disorders and high suicidal intent were significantly more likely in males. There was no difference in rates of depression between the genders. Multiple regression for both genders separately showed that the presence of depression and higher levels of hopelessness was the strongest predictor of suicidal intent, for both genders.

CONCLUSIONS

Patterns of non-fatal self-poisoning in Sri Lanka appear to be changing to resemble Western patterns, with females having a greater rate of self-poisoning and more medicinal overdoses than males. Alcohol use disorder is a gender specific risk factor associated with non-fatal self-poisoning among males, indicating a need for specific intervention. However there are also many common risk factors that are common to both genders, particularly associations with interpersonal conflict as an acute trigger, and psychiatric morbidity such as depression and hopelessness being related to increased suicidal intent.

From pesticides to medicinal drugs: time series analyses of methods of self-harm in Sri Lanka

OBJECTIVE

To explore if recent changes in methods of self-harm in Sri Lanka could explain the decline in the incidence of suicide.

METHODS

Time series analyses of suicide rates and hospitalization due to different types of poisoning were carried out.

FINDINGS

Between 1996 and 2008 the annual incidence of hospital admission resulting from poisoning by medicinal or biological substances increased exponentially, from 48.2 to 115.4 admissions per 100,000 population. Over the same period, annual admissions resulting from poisoning with pesticides decreased from 105.1 to 88.9 per 100,000. The annual incidence of suicide decreased exponentially, from a peak of 47.0 per 100,000 in 1995 to 19.6 per 100,000 in 2009. Poisoning accounted for 37.4 suicides per 100,000 population in 1995 but only 11.2 suicides per 100,000 in 2009. The case fatality rate for pesticide poisoning decreased linearly, from 11.0 deaths per 100 cases admitted to hospital in 1997 to 5.1 per 100 in 2008.

CONCLUSION

Since the mid 1990s, a trend away from the misuse of pesticides (despite no reduction in pesticide availability) and towards increased use of medicinal and other substances has been seen in Sri Lanka among those seeking self-harm. These trends and a reduction in mortality among those suffering pesticide poisoning have resulted in an overall reduction in the national incidence of accomplished suicide.

Self-harm

The term self-harm is commonly used to describe a wide range of behaviours and intentions including attempted hanging, impulsive self-poisoning, and superficial cutting in response to intolerable tension. As with suicide, rates of self-harm vary greatly between countries. 5-9% of adolescents in western countries report having self-harmed within the previous year. Risk factors include socioeconomic disadvantage, and psychiatric illness--particularly depression, substance abuse, and anxiety disorders. Cultural aspects of some societies may protect against suicide and self-harm and explain some of the international variation in rates of these events. Risk of repetition of self-harm and of later suicide is high. More than 5% of people who have been seen at a hospital after self-harm will have committed suicide within 9 years. Assessment after self-harm includes careful consideration of the patient's intent and beliefs about the lethality of the method used. Strong suicidal intent, high lethality, precautions against being discovered, and psychiatric illness are indicators of high suicide risk. Management after self-harm includes forming a trusting relationship with the patient, jointly identifying problems, ensuring support is available in a crisis, and treating psychiatric illness vigorously. Family and friends may also provide support. Large-scale studies of treatments for specific subgroups of people who self-harm might help to identify more effective treatments than are currently available. Although risk factors for self-harm are well established, aspects that protect people from engaging in self-harm need to be further explored.