Overdose among youth in Bahrain: psycho-social characteristics, contact with helping agencies and problems

Do suicide attempts occur more frequently in the spring too? A systematic review and rhythmic analysis

BACKGROUND

Seasonal variations in suicides have been reported worldwide, however, there may be a different seasonal pattern in suicide attempts. The aim of this study was to perform a systematic review on seasonality of suicide attempts considering potential interfering variables, and a statistical analysis for seasonality with the collected data.

METHOD

Observational epidemiological studies about seasonality in suicide attempts were searched in PubMed, Web of Science, LILACS and Cochrane Library databases with terms attempted suicide, attempt and season. Monthly or seasonal data available were evaluated by rhythmic analysis softwares.

RESULTS

Twenty-nine articles from 16 different countries were included in the final review. It was observed different patterns of seasonality, however, suicide attempts in spring and summer were the most frequent seasons reported. Eight studies indicated differences in sex and three in the method used for suicide attempts. Three articles did not find a seasonal pattern in suicide attempts. Cosinor analysis identified an overall pattern of seasonal variation with a suggested peak in spring, considering articles individually or grouped and independent of sex and method used. A restricted analysis with self-poisoning in hospital samples demonstrated the same profile.

LIMITATIONS

Grouping diverse populations and potential analytical bias due to lack of information are the main limitations.

CONCLUSIONS

The identification of a seasonal profile suggests the influence of an important environmental modulator that can reverberate to suicide prevention strategies. Further studies controlling interfering variables and investigating the biological substrate for this phenomenon would be helpful to confirm our conclusion.

Characteristics and determinants of adult patients with acute poisoning attending the accident and emergency department of a teaching hospital in Qatar

Data about etiologic and demographic characteristics of acute poisoning in adults in Qatar are lacking. This prospective observational study was undertaken to analyze characteristics and possible determinants of acute poisoning in adults in Qatar. During 2010, 18,073 patients attended the emergency department of Hamad General Hospital, a teaching hospital in Qatar. Out of them, 599 (3.3%) patients were diagnosed as “poisoning case” with either chemical or pharmaceutical substances. The prevalence rate of poisoning incidence was 35.3/100,000 population. Seven patients died, corresponding with a case-fatality rate of 0.39/1000. The majority were male (65%) and the mean age was 34 years. The poisons involved were mainly chemicals (61.6%) and pharmaceuticals (38.4%). Female, mainly single, suffered more intentional poisoning compared to male. Of the patients aged 60 years and above (7.2%), the majority (95.3%) suffered unintentional poisoning with pharmaceuticals; 56% with warfarin, 12% with digoxin and 7% with insulin. Multivariate analysis shows that female gender, single status, younger than 35 years of age, being poisoned by pharmaceutical products, and the need for hospitalization are significant determinants for acute intentional poisoning after adjusting all other possible covariates. The findings of this study can be used to establish awareness and prophylactic campaigns in Qatar.

The impact of environmental temperature on lithium serum levels

OBJECTIVES

Three studies have reported a seasonal variation in lithium serum levels, with higher levels during summer. Our objective was to investigate the impact of actual environmental temperature on lithium serum levels.

METHODS

A retrospective study was conducted using available records of lithium serum levels for the period between January 1995 and July 2004, obtained from three large teaching hospitals in The Netherlands. Lithium serum levels were linked to season and average daily temperature data obtained from the Royal Netherlands Meteorological Institute. An analysis was performed on all lithium serum levels not accounting for the intra-individual dependency of lithium serum levels. The association between season, temperature and both absolute lithium serum level and the frequency of potentially toxic serum levels was investigated. A mixed model analysis, accounting for intra-individual dependency of lithium serum levels, was performed.

RESULTS

A total of 41,102 lithium serum levels (3,054 patients) were included. A significant difference in mean lithium serum levels across seasons (p < 0.001) and temperature categories (p = 0.001) was found, peaking in summer [0.761 mmol/L, +/- standard error of the mean (SEM) 0.002] and at temperatures of 15-20 degrees C [0.762 mmol/L (+/- SEM 0.005)], and at a minimum in winter [0.748 mmol/L (+/- SEM 0.002)] and at <0 degrees C [0.741 mmol/L (+/- SEM 0.005)]. The relative frequency of potentially toxic serum levels significantly differed between seasons (p = 0.023, highest in winter), but not between temperature categories (p = 0.481). A significant positive association for intra-individual lithium serum level and season (p < 0.001) and temperature (p < 0.001) was established.

CONCLUSIONS

Season and environmental temperature have a statistically significant but therapeutically irrelevant effect on lithium serum levels.

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.

Pattern and risk factors for intentional drug overdose in Saudi Arabia

BACKGROUND

Attempted suicide by intentional drug overdose is an understudied subject in Saudi Arabia. Saudi Arabia is an Islamic country where suicide or attempted suicide is strictly prohibited. Despite the strong religious and constitutional sanctions against suicide, cases of intentional drug overdose occasionally occur. Our study represents the first attempt to better understand and characterize this sensitive topic.

METHODS

Using a retrospective chart review of patients aged 12 years and over with a diagnosis of intentional drug overdose between 1997 and 1999, we studied the demographic characteristics, the risk factors, the most commonly used drugs, and the resulting morbidities and mortalities of study subjects.

RESULTS

Most of the patients were young (mean age 22 years, SD 4.6, range 15 to 40 years), and most were Saudi nationals (n = 76; 96%). Eighty percent of the patients were women. The occurrence of intentional drug overdose peaked during the month of September (that is, 20% of total cases). Previous suicide attempts, family conflicts, and psychiatric disorders represented significant risk factors. Single-agent overdose occurred in 30% of the patients, and most of the drugs used were prescribed medications (53%). Acetaminophen represented the most common drug (30%). While some patients required prolonged hospital stay or admission to the intensive care unit, no mortalities occurred.

CONCLUSIONS

Intentional drug overdose is a relatively uncommon reason for hospital admission in Saudi Arabia. This study identifies certain risk factors relevant to the Saudi community and raises awareness about intentional drug overdose.

Risk factors associated with overdose among Bahraini youth

The aim of this study was to identify the risk factors of overdose among Bahraini youth (15-24 years). These factors included psychiatric disorders, family pathology, and psychosocial stress. All suicide attempters in the country during an 18-month period (N= 100) were identified prospectively. One hospital-matched control was selected for each case. Both cases and controls underwent a semistructured personal interview in the two state general hospitals. A matched pair analysis was done, as well as computation of McNemar's continuity corrected chi-square test, odds ratio, and the 95% confidence interval of the odds ratio. The overdose attempter was more likely than the control to be unemployed, a member of a non-intact family, having a mother whose education was high school or above, not having a friend, involved in a boy/girlfriend relationship, and a cigarette smoker. More students among attempters had failed an examination in the past year than matched controls. Father's education, social class, death of father, recent row with a friend, use of drugs and alcohol, relationship with teachers, recent mobility, financial difficulties, and legal problems were similar in both groups. Stresses generated from living in a non-intact family, interpersonal relationships mainly with the opposite sex, unemployment, and school performance came out as the main risk factors. The association of previously identified risk factors such as depression, aggressive behavior, and use of drug and alcohol was low among attempters. While the results of this study are consistent with the present view that suicidal behaviors are multifactorial in origin, the magnitude and effect of each factor are culturally determined.

Suicidal Behavior in Patients with Adjustment Disorders

Summary: This retrospective study characterizes the suicidal behavior in 119 patients with Axis I adjustment disorders as assessed by psychiatrists at the University of Virginia Hospital. Results indicated that 72 patients (60.5%) had documented suicide attempts in the past, 96% had been suicidal during their admission to the hospital, and 50% had attempted suicide before their hospitalization. The most commonly used method of suicide attempts was overdosing. Of the sample group with suicide attempts in the past, 67% had Axis II diagnoses of borderline personality disorder and antisocial personality disorder. Adjustment disorder diagnosis in patients with the suicide attempts was associated with a high level of suicidality at admission, involuntary hospitalization and substance-abuse disorders. Axis II diagnoses in patients with adjustment disorders constituted risk factors for further suicidal behavior. Additional future prospective studies with reliability checks on diagnosis of adjustment disorders and suicidal behavior are needed.