Parasuicide during Ramadan in Jordan

Effect of Ramadan intermittent fasting on inflammatory markers, disease severity, depression, and quality of life in patients with inflammatory bowel diseases: A prospective cohort study

Background

Intermittent fasting (IF) during the month of Ramadan is part of the religious rituals of Muslims. The effect of intermittent fasting on disease activity in inflammatory bowel diseases (IBD) is still unknown. This is the first study to assess the effect of IF during Ramadan on inflammatory markers in patients diagnosed with IBD. The effects on clinical disease activity, quality of life, and levels of depression were also assessed.

Methods

Patients diagnosed with ulcerative colitis (UC) or Crohn’s disease (CD) who intended to observe Ramadan fasting were recruited. The following were assessed immediately before and at the end of Ramadan: Serum CRP and stool calprotectin, partial Mayo score, Harvey Bradshaw index (HBI), Simple IBD questionnaire (SIBDQ), and Hamilton depression scale questionnaire.

Results

80 patients diagnosed with IBD were recruited (60 UC, 20 CD). Serum CRP and stool calprotectin did not show a significant change before vs after fasting (median CRP 0.53 vs 0.50, P value = 0.27, Calprotectin 163 vs 218 respectively, P value = 0.62). The partial Mayo score showed a significant rise after fasting (median 1 before vs 1 after fasting, mean: 1.79 vs 2.33 respectively, P value = 0.02). Harvey-Bradshaw index did not show a significant change after fasting (median 4 vs 5, P value = 0.4). Multiple linear regression revealed that older age and a higher baseline calprotectin were associated with a higher change in Mayo score after fasting (P value = 0.02 and P value = 0.01, respectively). No significant change was detected in SIBDQ or Hamilton depression scale scores.

Conclusions

In patients diagnosed with UC, IF during Ramadan was associated with worsening of clinical parameters, the effect was more pronounced in older patients and those with higher baseline calprotectin levels. However, IF during Ramadan was not associated with an adverse effect on objective inflammatory markers (CRP and calprotectin).

Who is afraid of Christmas? The effect of Christmas and Easter holidays on psychiatric hospitalizations and emergencies-Systematic review and single center experience from 2012 to 2021

BACKGROUND

Major holidays such as Christmas and New Year's Eve are regular occasions for get-togethers in families and other social groups. Socially, these days are often loaded with memories and expectations but also involve the potential for interpersonal tension and conflicts and disappointments. In addition, loneliness might also be most intense during these days. All these factors might lead to the expectation of increased mental distress and subsequently increased help-seeking in psychiatric contexts resulting in emergency psychiatric contacts, psychiatric hospitalizations, and even suicidal behavior. But is there evidence for increased psychiatric emergencies and hospitalizations around the days of Christmas?

METHODS

The existing evidence is systematically reviewed here (studies in PubMed in English investigating annual and Christmas-related variations in suicide (attempts), psychiatric emergencies and hospitalizations, last search date (13.07.2022) and complemented by an analysis of acute admissions at the University Psychiatry Clinics Basel, Switzerland, around Christmas and Easter holidays compared to the other days of the year. Easter was chosen as a comparison holiday.

RESULTS

In 25 reviewed studies, Christmas holidays were not associated with increased utilization of emergency psychiatric services. In contrast, hospitalizations were lower on Christmas and other holidays than the rest of the year. Analyzing the annual variation of 26,088 hospitalizations in our center between 2012 and 2021 revealed the same pattern.

CONCLUSION

The assumption of increased utilization of psychiatric emergency services on Christmas and other major holidays is not confirmed by multiple studies around the globe in various socio-cultural and medical settings. The study is registered in the international prospective register for systematic reviews (PROSPERO; 351057).

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier 351057.

A systematic review on the effect of Ramadan on mental health: minor effects and no harm in general, but increased risk of relapse in schizophrenia and bipolar disorder

Objectives

Globally, Moslems are the second largest religious group. During the month of Ramadan from dawn to sundown, healthy Moslems are required to refrain from eating, drinking, smoking, sexual activity and harmful behaviour towards others and themselves. Thus Ramadan may change individual physical states and social interactions. Both might affect mental health within society. Consequently, this systematic review looks at the various effects of Ramadan on mental health.

Methods

A literature search on Ramadan and mental health initially identified 294 papers. We finally selected all 22 relevant papers covering Ramadan and mental health from which study data were extracted.

Results

Relevant papers focussed on the general population and healthy volunteers, on subjects practising sports, on subjects with severe physical disorders, on subjects at risk of eating disorders and on subjects with mental health disorders. The effects of Ramadan on mental well-being were mixed. Positive and negative effects were usually minor, except in subjects with schizophrenia and metabolic syndrome, and in subjects with bipolar disorder who suffered a substantial increase of relapses.

Conclusion

Ramadan fasting is safe in most conditions and disorders, but caution is required in subjects with schizophrenia and bipolar disorder. The research on mental health and Ramadan would profit from larger studies with more representative samples to help understand the intra-individual and social factors that affect the mental health and well-being in patients and in society. The scientific potential of such studies may have been overlooked in the psychiatric community.

Impact of religious feast days on youth suicide attempts in Istanbul, Turkey

BACKGROUND

Suicidal behaviour is related to psychosocial and biological factors. Although suicide is strictly forbidden by the Islamic faith, there are non-confirmed observations of increased suicidality on religious feast days. The objective of the present study was to find out if suicide attempts of youths living in Istanbul increase on religious feast days compared to ordinary and non-religious holidays.

METHODS

We retrospectively analyzed all suicide attempts (N = 2,232) of young people up to 25 years of age seeking support at various hospitals in Istanbul in 2010. The main hypothesis was that the number of suicide attempts would increase during religious feast days.

RESULTS

The number of suicide attempts was higher on religious feast days and non-religious holidays except for New Year's Day and International Labour Day than the daily average number of the actual months. Like on ordinary days, more female than male youth (84.9% vs. 15.1%) attempted suicide on feast days.

CONCLUSION

We speculate that changes of the daily rhythm and increased family interaction on feast days and non-religious holidays could lead to unexpected confrontations and disputes instead of the expected positive family climate. This "Broken-Promise Effect" and changes of the daily rhythm could contribute to the observed increased suicidal behaviour.

The timing of deliberate self harm behaviour

Objectives: To critically review the scientific literature relating to the timing of deliberate self harm behaviour and completed suicide.

Method: A literature search of the Medline and CINAHL databases from 1970-2002 was performed, using deliberate self harm, overdose, self poisoning, suicide, parasuicide, and time, timing, day, week, month and season as key words. Relevant secondary references were retrieved and hand searching of important journals was done.

Results: The time of day of non-fatal self harm shows a marked diurnal variation, with an evening peak that is related to non-violent episodes, concomitant alcohol use, and a younger age. It is not conclusively linked to the degree of suicidal intent or particular psychiatric diagnoses. Completed suicides more commonly occur earlier in the day, at the beginning of the week and during springtime, but show no overall increase during many national events and holidays.

Conclusions: Circadian biological mechanisms involving the serotonin-melatonin axis, Cortisol secretion and sleep abnormalities appear to be implicated. Psychosocial explanations for these epidemiological findings include alcohol use, a sense of personal isolation and the ‘broken promise’ effect.

Does Ramadan fasting affect sleep?

Experimental fasting has been shown to alter the sleep-wakefulness pattern in various species. As fasting during Ramadan is distinct from experimental fasting, the physiological and behavioural changes occurring during Ramadan fasting may differ from those occurring during experimental fasting. There has been increased interest in recent years in sleep changes and daytime sleepiness during Ramadan. Moreover, many of those who fast during Ramadan associate this fasting with increased daytime sleepiness and decreased performance. This raises the question of whether Ramadan fasting affects sleep. In this review, we discuss the findings of research conducted to assess changes in sleep pattern, chronobiology, circadian rhythms, daytime sleepiness and function and sleep architecture during the month of Ramadan. Where applicable, these findings are compared with those obtained during experimental fasting.

Suicide and islam

Much of the research on suicidal behavior in Muslim countries has been simple descriptive studies of samples of completed and attempted suicides. Despite this, and despite the possible under-reporting of suicidal behavior in countries where such behavior is illegal, suicide rates do appear to be lower in Muslims than in those of other religions, even in countries which have populations belonging to several religious groups. Rates of attempted suicide, on the other hand, do not appear to be lower in Muslims as compared to non-Muslims. Research into this topic has been quite poor, failing to take into account the ethnic background and the Islamic sect to which the suicidal subjects belonged. Reasons for the low rate of completed suicide in Muslims are reviewed, including differences in values and socio-economic status.

Attempted suicide in Hanoi, Vietnam

BACKGROUND

Attempted suicide is a key predictor of suicide, which is among the dominant causes of young people's deaths worldwide. Very little is known about the characteristics of suicide attempters in Asia, especially in Vietnam.

METHODS

Medical records of 509 patients (515 attempted-suicide events) admitted to Bach Mai General Hospital in Hanoi, Vietnam from 1 January 1999 to 30 April 2001 were analysed according to the criteria of the WHO Multicentre Study of Attempted Suicide.

RESULTS

The suicide attempters' mean age was 28.3+/-12.9 years. Nearly half (48.7%) were aged 15-24. The female-to-male ratio of patients living in urban areas (2.1:1) was higher than in rural areas (1.2:1). In urban areas, students (32 %) and homeworkers (28%) and, in rural areas, farmers (56 %) and students (17%) were the salient occupational categories. Acute life stressors were the main causes (73.8%) of suicide attempts. Only in some 6% of cases had a psychiatric illness been diagnosed before the suicide attempts. As a means of attempting suicide, intoxication with analgesics and antipyretics (e. g. paracetamol) with low medical lethality scores was a frequent method among the urban patients, the majority of whom (81%) consequently stayed in hospital less than 24 h. Pesticide and rat poison, more commonly (57.2%) used by attempters in rural areas, had higher medical lethality scores and also necessitated more prolonged hospital treatment.

CONCLUSIONS

Some suicide-preventive strategies used in the West for young people may be applicable in Vietnam. Reducing access to pesticides and rat poison is comparable to western efforts to make paracetamol or firearms less freely available. Skills in resolving family and other conflicts can be taught in schools according to WHO's suicide-prevention resources for teachers.

Physiological and chronobiological changes during Ramadan intermittent fasting

BACKGROUND AND AIMS

During the month of Ramadan, Moslems refrain from drinking and eating between sunrise and sunset. This review aimed to analyze the effects of Ramadan fasting on physiological and behavioral variables in healthy subjects.

METHODS

Articles included in this paper were taken from Medline, three international congresses on health and Ramadan, and in several cases from local journals.

RESULTS

Ramadan fasting did not dramatically affect the metabolism of lipids, carbohydrates and proteins, or the daily mean of hormonal serum levels. An increase in serum urea and uric acid was frequently reported and this could be attributed to dehydration during this month. Some changes, such as the increase of HDL and apoprotein A1, and the decrease in LDL, could be beneficial for the cardiovascular system. However, the chronobiological studies have shown that Ramadan fasting affects the circadian distribution of body temperature, cortisol, melatonin and glycemia. The amplitude of most of these rhythms decreased and the acrophase shifted. Nocturnal sleep, daytime alertness and psychomotor performance were decreased.

CONCLUSION

The major changes during Ramadan fasting are chronobiological and behavioral. They could be responsible for the high incidence of road traffic accidents and the reduction of working hours during the month of Ramadan.

RAMADAN FASTING – EFFECT ON HEALTHY MUSLIMS

The purpose of this review was to ascertain the effects on healthy Muslims of fasting during Ramadan. We found some changes such as weight loss, evidence of dehydration, increase in serum uric acid, and nonpharmacological improvement in lipid parameters. We also observed changes in daily lifestyles and mental-health status. Thus, observance of the Ramadan fasting has both positive and adverse effects on healthy individuals. The adverse effects, however, are unlikely to persist after Ramadan or to lead to other complications. Healthy individuals can observe Ramadan without anxiety about their health.

Deliberate self-poisoning in Oman

OBJECTIVE

To describe the demographics, precipitating factors, substances and methods used for deliberate self-harm in Oman.

METHODS

Data were extracted from the Accident and Emergency (A & E) records of patients treated at the A & E units in Muscat from 1993 to 1998. Data were obtained form the history, and clinical findings resulting form deliberate self-harm.

RESULTS

During the 5-year study period, 123 persons presented to various hospitals in the Muscat area with injuries that resulted form deliberate self-harm. Most of these cases were women, students and unemployed. There was a high incidence of family, marital and psychiatric or social problems. The methods of self-harm were most often analgesics (such as paracetamol) and non-pharmaceutical chemicals.

CONCLUSIONS

The rate of self-injurious behaviour is low in Oman, compared with other countries, including other Islamic countries. The data illustrate a rising rate and a tendency to ingest toxic doses of analgesics or non-pharmaceutical chemicals.