The investigation of factors related to suicide attempts in Southeastern Turkey

Characteristics of Single vs. Multiple Suicide Attempters Among Adult Population: A Systematic Review and Meta-Analysis

PURPOSE OF REVIEW

We aimed to examine the factors that differentiate single and multiple suicide attempters in adult population. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to conduct this review and meta-analysis. The review protocol was registered in PROSPERO. We carried out a systematic literature search in three databases to identify original studies that explored the differences between single and multiple suicide attempters among adult population.

RECENT FINDINGS

There might be meaningful differences between those individuals that attempt suicide once in their lifespan and those who make multiple attempts in terms of sociodemographic and clinical characteristics. There are no previous meta-analysis addressing this topic in the adult population. A total of 75 studies were included in the review and 69 were included in the meta-analysis. Multiple attempters were more likely to present certain disorders such as mood and psychotic disorders, as well as personality or substance use disorders. Higher suicide ideation and suicide intent scores also characterized this group. Childhood trauma experiences, stressful life events, and higher rates of hopelessness were statistically significant in multiple attempters. Identifying the factors predicting multiple suicide attempts helps to delineate a high-risk suicidal profile that should be taken into account in the clinical and suicide prevention scenario.

Analyzing two decades of intimate partner femicide-suicides in Türkiye

Intimate partner femicide-suicide (IPF-S) is an understudied subgroup of homicide-suicide deaths. Limited research has been conducted on IPF-Ss in the Eastern Mediterranean region. This study thus aimed to evaluate the characteristics of IPF-Ss that occurred in Türkiye between 2000 and 2019. IPF-Ss (n = 226) were extracted from electronic news stories. Data on victims, perpetrators, their relationships, and incidents of murder and suicide were collected. Descriptive statistics were calculated, and logistic regression analysis, mortality rates, and proportion of IPF-S in femicide calculations were conducted, showing that 13.3% of the femicides (n = 1699) were IPF-Ss. The IPF-Ss increased in 5-year intervals and were the highest during the 2015-2019 period (62.5%). Victims were married in 48.2% of the cases and 56% were aged <35 years, while 51.3% of the perpetrators were married and 52.6% were aged >40 years. In 42.0% of the cases, the perpetrator lived with the victim. Most (79.2%) of the cases took place in urban settlements, and the perpetrators used firearms in 84.1% of femicide cases. Firearm use was the most common method in cases where IPF-S was planned (OR = 2.98), when the IPF-S method was the same (OR = 29.6), and when the perpetrator committed suicide (OR = 7.82). In addition, it was found that firearm ownership is an important risk factor for IPF-S in Türkiye. Therefore, we recommend legislation to restrict firearms, as well as new measures to prevent illegal access to weapons.

Suicide attempts and related factors in patients referred to Gachsaran Hospital, Iran

Background

Suicide is considered as an important, widespread phenomenon in the world, causing numerous deaths annually. This study is going to investigate how suicidal attempts are affected by several demographic and other underlying factors.

Objective

The present study was designed to investigate suicide attempts and its related factors in patients referred to Gachsaran Hospital, Iran.

Materials and methods

This cross-sectional study was conducted on 348 people who had attempted suicide (Please note that 348 was the number of suicidal attempts not the number of suicidal deaths). The data were collected by consent of Shiraz University of Medical Sciences and necessary coordination with the Emergency Management Statistics Center of Shahid Rajaee Hospital in Gachsaran city. The data analysis was performed through the logistic regression test using SPSS software version 19. The significance level was considered 0.05.

Results

A total of 348 individuals with a mean age of 23.9 ± 8.1 had attempted suicide in Gachsaran. Of these, 185 were female (53.2%) and 163 were male (46.8%). The results of multivariate regression showed that, after controlling the effect of probable confounding variables, the following variables had a significant relationship with suicide attempts in the individuals who had attempted to suicide: male gender, unemployment, and love problems.

Conclusion

Considering the high rate of suicide attempts among unemployed male individuals during one year, counseling centers in Gachsaran city should pay special attention to this group of people. Measures such as creating jobs for young people can help prevent this social dilemma.

Psychological autopsy study and risk factors for suicide in Muslim countries

BACKGROUND

Suicide and risk factors have been poorly studied in the Muslim-majority countries that hinder the formulation of prevention strategies and affect suicide prevention eventually.

OBJECTIVES

We aimed at identifying and analyzing the psychological autopsy studies assessing the risk factors for suicide conducted in Muslim-majority countries.

METHODS

We did a search to trace all the available psychological autopsy studies in the Muslim countries with the search term "psychological autopsy study in Muslim countries." We also checked the available bibliographies to identify the psychological autopsy studies in the Muslim countries so that all the possible studies could be included.

RESULTS

Out of the Muslim countries, only eight psychological autopsy studies were identified in five countries (Bangladesh [1], Indonesia [1], Iran [1], Pakistan [2], and Turkey [3]). Six studies adopted a case-control study design, and all were carried out in urban settings. The prevalence of psychiatric disorders among case-control studies varied from 52.8% in Turkey to 96% in Pakistan. Psychiatric illness, self-harm, and stressful life events were the commonly replicated risk factors for suicide across studies.

CONCLUSIONS

Psychological autopsy studies have been conducted only in five Muslim countries revealing that the risk factor for suicide is certainly under-researched in the incumbent countries. This review identified a similar list of risk factors for suicide, namely, psychiatric disorder, past non-fatal attempts, and adverse life events compared to the Western countries even though the rate varies.

Attempted suicide and suicide of young Turkish women in Europe and Turkey: A systematic literature review of characteristics and precipitating factors

BACKGROUND

The increased risk of suicidal behaviour among Turkish women living in Europe and Turkey is a serious public health problem. This study compares and synthesises the empirical evidence of demographic, social, psychological and interpersonal characteristics and precipitating factors in the suicides and attempted suicides of Turkish women in Europe and Turkey.

METHODS

We systematically searched eight databases (PsycINFO, PubMed, Med Line, Web of Science, Smart Cat, Safety Lit, BASE and Ulakbim), using search terms in English, Turkish, German and Dutch, as well as the reference lists of the retrieved papers. We extracted data on countries/regions, population characteristics, sample characteristics, recruitment, method of data collection, type of suicidal behaviour (suicide or attempted suicide) and precipitating factors and characteristics. The results were qualitatively synthesised.

RESULTS

We retrieved nine studies on attempted suicide in Europe (from Germany, Switzerland and the Netherlands), 17 studies on attempted suicide in Turkey and 10 studies on suicide in Turkey (36 in total). Overall, we found similar precipitating factors and characteristics of attempted suicide and suicide in Turkey and Europe, including socio-demographic factors (young age and not being enrolled in the labour market), poverty and, to some extent, mental illness. Moreover, conflicts with family or spouses and violence against women, including so-called honour violence, were particularly common for women living in or originating from traditional areas in Turkey.

CONCLUSION

The framework of intersectionality is relevant to understanding our results, because structural inequalities in gender roles, gender role expectations as well as power imbalances among socio-economic classes collectively impact the suicidal behaviour of Turkish women. Moreover, the importance of violence against women points to the cultural continuity of the patriarchal and oppressive structures of Europe and Turkey. Suicide prevention efforts should address cultural attitudes underlying violence against women and girls through community education programmes, cultural and gender-sensitive care provision and jurisdiction.

Association of emotional and behavioral problems with single and multiple suicide attempts among Chinese adolescents: Modulated by academic performance

BACKGROUND

There were differences in the characteristics and prevalence rates between individuals with a history of one suicide attempt and those with multiple suicide attempts. This large-scale study was conducted to test, among Chinese adolescents, the associations of emotional and behavioral problems with single and multiple suicide attempts and whether these associations vary with adolescents' academic performance.

METHODS

Data were drawn from the 2019 School-based Chinese Adolescents Health Survey (n = 20,702). Information about emotional and behavioral problems, suicide attempts, suicidal ideation, academic performance, and sleep duration was gathered. Multinomial logistic regression models using Firth penalized likelihood approach and appropriate sampling weights were performed.

RESULTS

Compared with no suicide attempt, peer problems, emotional problems, conduct problems, and hyperactivity were associated with an elevated risk of both a single suicide attempt and multiple suicide attempts, respectively (P < 0.05); the magnitudes of these associations in multiple suicide attempters were higher than those in single suicide attempters. Further stratification analyses by academic performance showed a greater association of the four difficulties with multiple suicide attempts in adolescents reporting poor academic performance than in those with good or average academic performance.

LIMITATIONS

The school-based study sample only included students, and causal inference could not be delineated due to the cross-sectional design.

CONCLUSIONS

Emotional and behavioral problems are associated with an elevated risk of single and multiple suicide attempts with differences between multiple suicide attempters and single suicide attempters. Adolescent academic performance plays a modulating role in these associations for multiple suicide attempts.

Psychiatric morbidity and suicidal behaviour in low- and middle-income countries: A systematic review and meta-analysis

BACKGROUND

Psychiatric disorders are reported to be present in 80% to 90% of suicide deaths in high-income countries (HIC), but this association is less clear in low- and middle-income countries (LMIC). There has been no previous systematic review of this issue in LMIC. The current study aims to estimate the prevalence of psychiatric morbidity in individuals with suicidal behaviour in LMIC.

METHODS AND FINDINGS

PubMed, PsycINFO, and EMBASE searches were conducted to identify quantitative research papers (any language) between 1990 and 2018 from LMIC that reported on the prevalence of psychiatric morbidity in suicidal behaviour. We used meta-analytic techniques to generate pooled estimates for any psychiatric disorder and specific diagnosis based on International classification of disease (ICD-10) criteria. A total of 112 studies (154 papers) from 26 LMIC (India: 25%, China: 15%, and other LMIC: 60%) were identified, including 18 non-English articles. They included 30,030 individuals with nonfatal suicidal behaviour and 4,996 individuals who had died by suicide. Of the 15 studies (5 LMIC) that scored highly on our quality assessment, prevalence estimates for psychiatric disorders ranged between 30% and 80% in suicide deaths and between 3% and 86% in those who engaged in nonfatal suicidal behaviour. There was substantial heterogeneity between study estimates. Fifty-eight percent (95% CI 46%-71%) of those who died by suicide and 45% (95% CI 30%-61%) of those who engaged in nonfatal suicidal behaviour had a psychiatric disorder. The most prevalent disorder in both fatal and nonfatal suicidal behaviour was mood disorder (25% and 21%, respectively). Schizophrenia and related disorders were identified in 8% (4%-12%) of those who died by suicide and 7% (3%-11%) of those who engaged in nonfatal suicidal behaviour. In nonfatal suicidal behaviour, anxiety disorders, and substance misuse were identified in 19% (1%-36%) and 11% (7%-16%) of individuals, respectively. This systematic review was limited by the low number of high-quality studies and restricting our searches to databases that mainly indexed English language journals.

CONCLUSIONS

Our findings suggest a possible lower prevalence of psychiatric disorders in suicidal behaviour in LMIC. We found very few high-quality studies and high levels of heterogeneity in pooled estimates of psychiatric disorder, which could reflect differing study methods or real differences. There is a clear need for more robust evidence in order for LMIC to strike the right balance between community-based and mental health focussed interventions.

Characteristics of the schizophrenia suicide attempts in comparison with the suicide attempts with other diagnosed psychiatric disorders: An Egyptian study

BACKGROUND

There has been much literature on schizophrenia, but little is known about the characteristic features of suicide attempts with schizophrenia in comparison with the suicide attempts with other diagnosed psychiatric disorders.

AIMS

The objective of this study was to clarify the specific characteristics and risk factors among suicide attempters with schizophrenia that differentiate them from other psychiatric disorders.

METHODS

Thirty-three suicide attempters diagnosed with schizophrenia and 87 suicide attempters with other psychiatric disorders were included. Suicide attempts seriousness were appraised by the Beck's Suicide Intent Scale (BSIS). Standardized scales were applied: Suicide Probability Scale (SPS) and Barratt Impulsiveness Scale, Version 11 (BIS-11). The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and The Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) based on the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) was applied to assess the psychiatric status of individuals. Demographic and clinical characteristics, method of suicide and suicide probability scores and impulsivity were compared among both groups (schizophrenia group and other psychiatric disorders group).

RESULTS

In total, 27.5% of suicide attempts suffered from schizophrenia. The current study found that having more past history of medical diseases, longer duration of illness, using more violent suicidal methods, and having less significant suicidal ideations were the significant factors that differentiated schizophrenia suicide attempts from those diagnosed with other psychiatric disorders. The schizophrenia group did not show more impulsivity or hostility than other psychiatric disorders group.

CONCLUSION

These results indicated that each group shows its unique characteristics. They give us new perspectives to prevent suicides in schizophrenia according to their different characteristics.

Association between problematic Internet use, sleep disturbance, and suicidal behavior in Chinese adolescents

BACKGROUND AND AIMS

This large-scale study aimed to test (a) associations of problematic Internet use (PIU) and sleep disturbance with suicidal ideation and suicide attempts among Chinese adolescents and (b) whether sleep disturbance mediates the association between PIU and suicidal behavior.

METHODS

Data were drawn from the 2017 National School-based Chinese Adolescents Health Survey. A total of 20,895 students' questionnaires were qualified for analysis. The Young's Internet Addiction Test was used to assess PIU, and level of sleep disturbance was measured by the Pittsburgh Sleep Quality Index. Multilevel logistic regression models and path models were utilized in analyses.

RESULTS

Of the total sample, 2,864 (13.7%) reported having suicidal ideation, and 537 (2.6%) reported having suicide attempts. After adjusting for control variables and sleep disturbance, PIU was associated with an increased risk of suicidal ideation (AOR = 1.04, 95% CI = 1.03-1.04) and suicide attempts (AOR = 1.03, 95% CI = 1.02-1.04). Findings of the path models showed that the standardized indirect effects of PIU on suicidal ideation (standardized β estimate = 0.092, 95% CI = 0.082-0.102) and on suicide attempts (standardized β estimate = 0.082, 95% CI = 0.068-0.096) through sleep disturbance were significant. Conversely, sleep disturbance significantly mediated the association of suicidal behavior on PIU.

DISCUSSION AND CONCLUSIONS

There may be a complex transactional association between PIU, sleep disturbance, and suicidal behavior. The estimates of the mediator role of sleep disturbance provide evidence for the current understanding of the mechanism of the association between PIU and suicidal behavior. Possible concomitant treatment services for PIU, sleep disturbance, and suicidal behavior were recommended.

Associations of Childhood Maltreatment with Single and Multiple Suicide Attempts among Older Chinese Adolescents

OBJECTIVES

To test, among older Chinese adolescents, the associations of childhood maltreatment with single and multiple suicide attempts and whether these associations vary in relation to the presence of sleep disturbance.

STUDY DESIGN

We analyzed data collected from 10th to 12th graders from 7 randomly selected provinces of China in the 2015 School-based Chinese Adolescents Health Survey. There were 83 200 students who were invited to participate, and 75 715 students' questionnaires were completed and qualified for the survey. Adjusted multinomial logistic regression models were conducted to evaluate the associations of childhood maltreatment with suicide attempts.

RESULTS

Compared with no suicide attempts, each type of adjusted childhood maltreatment (physical abuse, emotional abuse, sexual abuse, physical neglect, or emotional neglect) was associated with an increased risk of single and multiple suicide attempts (P < .05). The magnitude of the aORs in multiple suicide attempters was greater than those in single suicide attempters. Moreover, the adjusted interaction effects for a single suicide attempt between each type of childhood maltreatment and sleep disturbance were all statistically significant in the multivariable multinomial logistic regression models (P < .001). However, the adjusted interaction effects for multiple suicide attempts were not significant (P > .05).

CONCLUSIONS

Maltreatment during one's childhood is associated with an increased risk of single and multiple suicide attempts among older Chinese adolescents. Sleep disturbances play a moderating role in these associations for a single suicide attempt.

Comparison of the characteristics of suicide attempters with major depressive disorder and those with no psychiatric diagnosis in emergency departments of general hospitals in China

BACKGROUND

Major depressive disorder (MDD) is a known major risk factor for suicide due to the high suicide mortality. However, studies comparing the characteristics of suicide attempters with major depressive disorder and those with no psychiatric diagnosis in China are very limited. This study examined and compared the sociodemographic and psychological characteristics of suicide attempters with MDD and those with no psychiatric diagnosis in emergency departments of general hospitals to better understand the risk factors for suicide attempts in China.

METHODS

All subjects were enrolled in the study between June 2007 and January 2008. A total of 127 suicide attempters-54 with MDD and 73 with no psychiatric diagnosis-were enrolled. The sociodemographic and clinical characteristics were compared between two groups using the statistical analysis performed using frequency distribution, Student's t test, Chi-square test, and Fisher's exact test and a logistic regression model.

RESULTS

Suicide attempters with MDD were more likely to be more depressive, older, divorced or separated, unemployed, and living alone, and more likely to write a suicide note, have suicide ideation, and be motivated by reducing pain and burden. Suicide attempters with no psychiatric diagnosis were more likely to be younger and more impulsive, have self-rescue, and be motivated by threatening or taking revenge on others. Multivariate logistic regression analysis identified the following independent predictors of suicide attempts in individuals with MDD: a lower score on the quality of life scale, more years of education, and suicide ideation.

CONCLUSIONS

The present study found both similarities and differences in the sociodemographic and clinical characteristics of suicide attempters with MDD and those with no psychiatric diagnosis in the emergency departments of general hospitals in China. These findings will help us to recognize the characteristics of suicide attempters in both groups and develop specific interventions for the two types of suicide attempters to prevent future suicide in China. For example, the suicide attempters with MDD in the emergency departments must be advised to the psychological clinic.