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Tharani A, Farooq S, Lakhdir MPA, Talib U, Khan MM. Characteristics and patterns of individuals who have self-harmed: a retrospective descriptive study from Karachi, Pakistan. BMC Psychiatry 2022; 22:367. [PMID: 35641917 PMCID: PMC9158237 DOI: 10.1186/s12888-022-04018-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 05/26/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Self-Harm (SH) is a major global public health problem under-researched in Pakistan due to religious and legal implications. This study aims to identify the characteristics and patterns among patients with SH and factors associated with the intent to die. METHOD This retrospective descriptive study where SH cases presented to private tertiary care teaching hospital in Karachi, Pakistan, from January 2013 to December 2017 were extracted from HIMS records. Details related to demography, history, associated factors, access to methods used, and intent to die were collected on a structured proforma and analysed using STATA version 14. RESULTS: A total of 350 cases were analysed. More than half of the reported cases were in the age group 20-39 years. Though only one-fourth of the SH cases had a past psychiatric history, it was found to be significantly (P-value < 0.05) associated with intent to die. Notably, 81% of the cases do not have a history of SH. Drug overdose (61.6%) and insecticides (36.6%) were the two most common methods used. Depression was identified in nearly half of the cases. The most common reason for attempting SH was inter-personal relationship issues (54.3%). CONCLUSION This paper provides recent data on the characteristics and patterns associated with the intent to die of individuals who have self-harmed. In most cases of SH, past psychiatric history was not evident. Current psychiatric diagnosis and young adults were favoured in this study. The data from this study has limited representation for all demographic representation of SH cases from Pakistan as being from a single private hospital. There is a need for further research on SH in Pakistan.
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Affiliation(s)
- Ambreen Tharani
- grid.7147.50000 0001 0633 6224School of Nursing and Midwifery, Aga Khan University, Second Floor, Stadium Road, P.O Box 3500, Karachi, Pakistan
| | - Salima Farooq
- School of Nursing and Midwifery, Aga Khan University, Second Floor, Stadium Road, P.O Box 3500, Karachi, Pakistan.
| | - Maryam Pyar Ali Lakhdir
- grid.7147.50000 0001 0633 6224Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Uroosa Talib
- Karwan-E-Hayat, Psychiatric Care and Rehabilitation Center, Karachi, Pakistan
| | - Murad Moosa Khan
- grid.7147.50000 0001 0633 6224Department of Psychiatry, Aga Khan University, Karachi, Pakistan
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Zheng Y, Zhang H, Fan Q. Discordance between family report and clinical assessment of suicide attempts: a prospective study from the emergency department. Gen Psychiatr 2022; 34:e100576. [PMID: 34970640 PMCID: PMC8666883 DOI: 10.1136/gpsych-2021-100576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background Developing accurate identification methods for individuals with suicide attempts and providing them with follow-up care and supports can be a vital component of all comprehensive suicide prevention strategies. However, because of the difficulties concerning one’s intentions behind injurious behaviour, identifying suicide attempts is a challenge for families and clinicians. Aims The aim of this study was to investigate the differences between family report and clinical assessment for suicide attempts in the emergency department (ED). Methods A total of 148 patients with suspected suicide attempts (SSAs) and 148 family caregivers in the ED were enrolled. The suicide risk module of the Chinese version of the MINI International Neuropsychiatric Interview and the self-report measure were used to assess those with SSA’s suicidal behaviours. The Family Adaptability and Cohesion Evaluation Scales and semi-structured interviews were used to investigate the characteristics of suicide risk and demographics of patients with SSA, as well as the rate and influencing factors of omitted suicide attempts reported by family caregivers. Results The underreporting rate for family reported suicide attempts in the ED was 69.0%. The suicide attempts group indicated lower mean scores on perceptions of family resources, adaptability and cohesion. Patients' suicide risk rating (OR=0.152, 95% CI: 0.037 to 0.620, p=0.009), adult-children relationship (OR=5.037, 95% CI: 1.478 to 17.167, p=0.010) and caregiver’s age (OR=0.279, 95% CI: 0.103 to 0.757, p=0.012) might be associated with underreporting by families. If patients committed suicide attempts through a falling injury or medication overdose, their families may have misreported the suicide attempt. Conclusions The discordance of suicide attempt records between family report and clinical assessment reveals the limitations of family self-reports when identifying suicide attempts. Interviews and observations, together with information from certain diagnoses, should be combined to accurately identify suicide attempters in the ED.
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Affiliation(s)
- Yue Zheng
- East China University of Science and Technology, Shanghai, China.,Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyin Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Fan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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Relationship of the high proportion of suicidal acts involving ingestion of pesticides to the low male-to-female ratio of suicide rates in China. Epidemiol Psychiatr Sci 2020; 29:e114. [PMID: 32299524 PMCID: PMC7214533 DOI: 10.1017/s2045796020000244] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIMS The 2014 World Health Organization report on global suicide identified large differences in the male-to-female ratio of suicide rates between countries: most high-income countries (HICs) report ratios of 3:1 or higher while many low- and middle-income countries (LMICs) - including China and India - report ratios of less than 1.5:1. Most authors suggest that gender-based social-cultural factors lead to higher rates of suicidal behaviour among women in LMICs and, thus, to relatively high female suicide rates. We aim to test an alternative hypothesis: differences in the method and case-fatality of suicidal behaviour - not differences in the rates of suicidal behaviour - are the main determinants of higher female suicide rates in LMICs. METHODS A prospective registry of suicide attempts treated in all 14 general hospitals in a rural county in China was established and data from the registry were integrated with population and mortality data from the same county from 2009 to 2014. RESULTS There were 160 suicides and 1010 medically-treated suicidal attempts in the county; 84% of female suicides and 58% of male suicides ingested pesticides while 73% of female attempted suicides and 72% of male attempted suicides ingested pesticides. The suicide rate (per 100 000 person-years of exposure) was 8.4 in females and 9.1 in males (M:F ratio = 1.08:1) while the incidence of 'serious suicidal acts' (i.e. those that result in death or received treatment in a hospital) was 81.5 in females and 47.7 in males (M:F ratio = 0.59:1). The case-fatality of serious suicidal acts was higher in males than in females (19 v. 10%), increased with age, was highest for violent methods (92%), intermediate for pesticide ingestion (13%) and lowest for other methods (5%). CONCLUSIONS The incidence of medically serious suicidal behaviour among females in rural China was similar to that reported in HICs, but the case-fatality was much higher, primarily because most suicidal acts involved the ingestion of pesticides, which had a higher case-fatality than methods commonly used by women in HICs. These findings do not support sociological explanations for the relatively high female suicide rate in China but, rather, suggest that gender-specific method choice and the case-fatality of different methods are more important determinants of the demographic profile of suicide rates. Further research that involves ongoing monitoring of the changing incidence, demographic profile and case-fatality of different suicidal methods in urban and rural parts of both LMICs and HICs is needed to confirm this hypothesis.
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Tong Y, Yin Y, Liu NH. Differences between medically treated and untreated non-fatal self-harm reported by hotline callers in China. PeerJ 2019; 7:e7868. [PMID: 31637129 PMCID: PMC6800983 DOI: 10.7717/peerj.7868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/11/2019] [Indexed: 12/15/2022] Open
Abstract
Background Many self-harmers do not present in hospitals due to the self-harm. It is still unclear on the differences between medically treated and untreated self-harm in China. This study described the differences of the two groups of self-harmers using the largest psychological aid hotline data. Methods The present observational study recruited 3,403 hotline callers who reported episodes of self-harm before the call. In routine assessment, information about the most recent episode of self-harm was collected, including the method of self-harm, the wish to die, goals of the self-harm, and any medical treatment (irrespective of psychological services) in the hospital. The callers were divided into two groups: those who received hospital-based medical treatment due to the most recent self-harm (treated self-harm callers) and those who did not (untreated self-harm callers). Results In the most recent episode of self-harm, 65% (n = 2,217) of callers were untreated and 55% (1,226/2,217) of the untreated self-harm callers reported a wish to die. A total of 67% of the callers reported that their main goal of self-harm was to relieve suffering. The most common self-harm methods were using instruments (knife or rope) and overdosing on medicines. Compared with treated self-harm callers, the untreated self-harm callers were less likely to have a wish to die (OR = 0.57), engage in self-harm outside the home (OR = 0.71 and 0.78), and attribute their self-harm to romantic relationship problems (OR = 0.76); however, they were more likely to use instruments, to jump, or to choose other methods (OR = 3.73, 3.83, and 7.71, respectively). Conclusions Among hotline callers, many episodes of self-harm did not receive medical treatment, despite over half reporting a wish to die. Characteristics of self-harm behaviors were different between treated and untreated self-harm callers. Our findings suggest that more strategies should improve access to hospital-based medical treatment and coverage for post-intervention for self-harmers who are not presented in hospitals.
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Affiliation(s)
- Yongsheng Tong
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China.,WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China.,Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Yi Yin
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China.,WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China.,Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Nancy H Liu
- Department of Psychology, University of California, Berkeley, Berkely, CA, USA
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Ho CSH, Ong YL, Tan GHJ, Yeo SN, Ho RCM. Profile differences between overdose and non-overdose suicide attempts in a multi-ethnic Asian society. BMC Psychiatry 2016; 16:379. [PMID: 27821108 PMCID: PMC5100276 DOI: 10.1186/s12888-016-1105-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 11/01/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study explores differences in characteristics of overdose (OD) and non-overdose (NOD) suicide attempts in Singapore. METHODS Four hundred eighty-five medical records of people who attempted suicide were extracted from a local general hospital patient database and classified into OD and NOD groups. Differences in socio-demographic factors, suicide characteristics and hospital admission types between both groups were examined. RESULTS Indians were more likely than the Chinese and Malays to employ OD method in their attempts. More suicide attempts in the OD group than NOD group were self-reported. The most likely place for suicide attempts for both groups was at home, though more NOD suicide attempts were in public areas as compared to the OD group. Analgesics were the most used substance in the OD group. Those who attempted suicide using OD had a higher number of psychiatric ward admissions than the NOD group. Risk and protective factors varied between both groups. CONCLUSION Differences in socio-demographics, suicide characteristics and admission characteristics between OD and NOD groups were observed. Recommendations for suicide prevention in the community are discussed. Further studies on the mediators and moderators of these trends and characteristics of suicide attempts are necessary to ensure maximal efficacy of prevention and management.
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Affiliation(s)
- Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Lower Kent Ridge Road, Singapore, 119 228, Singapore.
| | - Y L Ong
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Lower Kent Ridge Road, Singapore, 119 228, Singapore
| | - Gabriel H J Tan
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Lower Kent Ridge Road, Singapore, 119 228, Singapore
| | - S N Yeo
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Lower Kent Ridge Road, Singapore, 119 228, Singapore
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Zeppegno P, Gramaglia C, Castello LM, Bert F, Gualano MR, Ressico F, Coppola I, Avanzi GC, Siliquini R, Torre E. Suicide attempts and emergency room psychiatric consultation. BMC Psychiatry 2015; 15:13. [PMID: 25652192 PMCID: PMC4327969 DOI: 10.1186/s12888-015-0392-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 01/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicidal behaviours are major public health concerns worldwide. They are associated with risk factors that vary with age and gender, occur in combination, and may change over time. The aim of our study was to investigate how frequently patients visiting a hospital emergency room (ER) require a psychiatric consultation for attempted suicide, and to outline the characteristics of this population. METHODS Determinants of emergency room visits for psychiatric reasons were studied prospectively from 2008 to 2011 at the "Maggiore" Hospital in Novara. RESULTS 280 out of 1888 patients requiring psychiatric consultation were referred to the ER because of suicide attempt. Suicide attempters were more often female. The rate of suicide attempters among Italian people was 14.2%, compared to 19.5% in foreigners. Subjects living with parents or own family and those having a permanent job had a higher frequency of suicide attempt. Suicide attempts were more frequent among patients with a history of psychiatric disorders; nonetheless, suicide attempts were more common among those who had not previously been hospitalized in a psychiatric ward or were not under the care of a psychiatrist. The multivariate analysis found that female gender was a risk factor for suicide attempt, while being in the colder months of the year and, surprisingly, unemployment were protective factors. CONCLUSIONS A better understanding of patients referring to the ER due to attempted suicide may allow the identification of at-risk subjects and the implementation of targeted treatment approaches.
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Affiliation(s)
- Patrizia Zeppegno
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, via Gnifetti, 8, 28100 Novara, Italy
| | - Carla Gramaglia
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, via Gnifetti, 8, 28100 Novara, Italy
| | - Luigi Mario Castello
- Emergency Medicine, Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy
| | - Fabrizio Bert
- Department of Public Health and Paediatric Sciences, Università degli Studi di Torino, via Santena 5/bis, 10126 Torino, Italy
| | - Maria Rosaria Gualano
- Department of Public Health and Paediatric Sciences, Università degli Studi di Torino, via Santena 5/bis, 10126 Torino, Italy
| | - Francesca Ressico
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, via Gnifetti, 8, 28100 Novara, Italy
| | - Isabella Coppola
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, via Gnifetti, 8, 28100 Novara, Italy
| | - Gian Carlo Avanzi
- Emergency Medicine, Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy
| | - Roberta Siliquini
- Department of Public Health and Paediatric Sciences, Università degli Studi di Torino, via Santena 5/bis, 10126 Torino, Italy
| | - Eugenio Torre
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, via Gnifetti, 8, 28100 Novara, Italy
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Kavalci G, Ethemoglu FB, Batuman A, Kumral D, Emre C, Surgit M, Akdikan A, Kavalci C. Epidemiological and cost analysis of self-poisoning cases in ankara, Turkey. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e10856. [PMID: 25763203 PMCID: PMC4329943 DOI: 10.5812/ircmj.10856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 11/22/2013] [Accepted: 10/01/2014] [Indexed: 11/23/2022]
Abstract
Background: Poisoning is a global public health problem. Self-poisoning has potentially serious consequences. Follow-up studies have found that 3-10% of self-harm patients eventually succeed. Objectives: This study was designed to investigate the epidemiological, clinical and economical aspects of deliberate self-poisoning patients admitted to Yenimahalle State Hospital Intensive Care Unit. Patients and Methods: The study was carried out retrospectively in Ankara Yenimahalle State Hospital. It included Seventy-one patients over 16 years of age who were admitted to the hospital due to poisoning during 2012. Exposed poisons were classified into one of three categories; pharmaceuticals, pesticides, and alcohols. Cost account was based on the medical invoices at patient discharge. Data were compared using Student’s T test and chi-square test. A P value of less than 0.05 was considered significant. Results: The female/male ratio was 2.55. The mean age of the 71 poisoned patients was 28.92 ± 11.51 years. Most of the poisoning agents were pharmaceuticals (68 cases). Among the pharmaceuticals, antidepressants were involved most often, followed by analgesics. There was no statistically significant difference between pharmaceutical agents in terms of hospital cost (P > 0.05). The mean length of hospital stay was 6.4 ± 4.3 days. There was a statistically significant difference between the lengths of stay of patients in terms of hospital cost (P < 0.05). Conclusions: The patient cost increased as the length of stay increased due to the policy of bundle pricing.
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Affiliation(s)
- Gulsum Kavalci
- Department of Anesthesiology and Reanimation, Yenimahalle State Hospital, Ankara, Turkey
- Corresponding Author: Gulsum Kavalci, Department of Anesthesiology and Reanimation, Yenimahalle State Hospital, Ankara, Turkey. Tel: +90-3125085026, Fax: +90-3123125346, E-mail:
| | - Filiz Banu Ethemoglu
- Department of Anesthesiology and Reanimation, Yenimahalle State Hospital, Ankara, Turkey
| | - Asli Batuman
- Department of Anesthesiology and Reanimation, Yenimahalle State Hospital, Ankara, Turkey
| | - Dilber Kumral
- Department of Anesthesiology and Reanimation, Yenimahalle State Hospital, Ankara, Turkey
| | - Cengizhan Emre
- Department of Anesthesiology and Reanimation, Yenimahalle State Hospital, Ankara, Turkey
| | - Meltem Surgit
- Department of Anesthesiology and Reanimation, Yenimahalle State Hospital, Ankara, Turkey
| | - Alev Akdikan
- Department of Anesthesiology and Reanimation, Yenimahalle State Hospital, Ankara, Turkey
| | - Cemil Kavalci
- Department of Medicine Emergency, University of Baskent, Ankara, Turkey
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