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What Can Influence Iranian Suicide Attempters to Go Through the Process of Non-Fatal Suicide Act Once Again? A Preliminary Report

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Abstract

The thrust of this study was to examine some of the psycho-social risk factors for the recurrence of non-fatal suicide attempt in a sample of 1121 inmates admitted between April 2012 to June 2013 at the toxicology emergency ward, Noor Medical Centre, Isfahan, Iran. Out of the total participants, 240 of them reported history of suicide attempt and assumed the status of case group. The remaining 881 patients were admitted first their attempt and constituted the control group. Cases were compared to the controls with respect to select demographic features (i.e. age, sex, education, occupation, marital status, type of residence, and locale), current suicide attempt method, family history of suicide and drug abuse, history of psychiatric disorder, physical ailment and physical disability, substance abuse and alcohol use, psychiatric diagnosis, and recent life hassles (i.e. interpersonal, occupational, financial, medical, and home affairs). We used a structured interview schedule to interview the participants. Psychiatric diagnosis was based on the DSM-IV criteria. Data were computer analyzed using SPSS.21 and administering statistical analysis including Chi Square, t-student, and logistic regression. Demographic risk factors for recurrence of suicide attempts at the univariate level included occupational status [Crud odds Ratio (COR) = 0.53] and type of residence (COR = 1.40). Medical and psychiatric risk factors at the univariate level included substance abuse (COR = 1.97), physical ailment (COR = 1.76), alcohol use (COR = 1.84), psychiatric disorder (COR = 3.69), and history of suicide in the family of origin (COR = 1.86). Recent life hassles risk factors at the univariate level included financial constraints (COR = 1.46) and medical emergencies (COR = 3.48). A multivariate logistic regression model identified five variables (i.e. substance abuse, alcohol use, psychiatric illness, suicide in family, and medical emergencies) that were statistically associated with an increased risk for recurrence of nonfatal suicide attempt. The model predicted chances of repeating suicide attempt correctly 79 % of the time. These observations indicate that people who report to the toxicology emergency ward for nonfatal suicide not only need immediate relief but also careful psychiatric and social assessments which subsequently may lead to psychiatric admission and comprehensive community interventions.

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References

  • Allebeck, P., & Allgulander, C. (1990). Suicide among young men: psychiatric illness, deviant behavior and substance absue. Acta Psychiatrica Scandinavica, 81, 565–570.

    Article  CAS  PubMed  Google Scholar 

  • Allgulander, C., Allebeck, P., Przybeck, T. R., & Rice, J. P. (1992). Risk of suicide by psychiatric diagnosis in Stockholm County. A longitudinal study of 80,970 psychiatric inpatients. European Archives of Psychiatry and Clinical Neuroscience, 241, 323–326.

    Article  CAS  PubMed  Google Scholar 

  • Andrews, J. A., & Lewinsohn, P. M. (1992). Suicidal attempts among older adolescents: Prevalence and co-occurrence with psychiatric disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 655–662.

    Article  CAS  PubMed  Google Scholar 

  • Bagalman, E. (2013). Suicide Prevention Efforts of the Veterans Health Administration. CRS Report R42340. Retrieved from: http://www.crs.gov.

  • Bakken, K., & Vaglum, P. (2007). Predictors of suicide attempters in substance-dependent patients: A six-year prospective follow-up. Clinical Practice and Epidemiology in Mental Health. doi:10.1186/1745-0179-3-20.

  • Barker, E., Snider. A. M., Mc Phedrans, S., & De Leo, D. (2013). Suicide research: Selected findings (Vol. 19). Australian Institute for Suicide Research. Australia: Australian Academic Press.

  • Bernal, M., Haro, J. M., Bernert, S., Brugha, T., de Graaf, R., Bruffaerts, R., et al. (2007). Risk factors for suicidality in Europe: Results from the ESEMED study. Journal of Affective Disorders, 101, 27–34.

    Article  CAS  PubMed  Google Scholar 

  • Borowsky, I. W., Ireland, M., & Resnick, M. D. (2001). Adolescent suicide attempts: Risk and protectors. Pediatrics, 107, 485–493.

    Article  CAS  PubMed  Google Scholar 

  • Brent, D. A., Perper, J. A., Moritz, G., Liotus, L., Schweers, J., Balach, L., & Roth, C. (1994). Familial risk factors for adolescent suicide: A case-control study. Acta Psychiatrica Scandinavica, 89, 52–58.

    Article  CAS  PubMed  Google Scholar 

  • Caces, F. E., & Harford, T. (1998). Time series analysis of alcohol consumption and suicide mortality in the United States, 1934–1987. Journal of Studies on Alcohol, 59, 455–461.

    Article  CAS  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (2010). Web-based injury statistics query and reporting system (WISQARS) [online]. Cited October 19, 2012. www.cdc.gov/injury/wisqars/index.

  • Christiansen, E., & Jensen, B. F. (2007). Risk of repetition of suicide attempt, suicide or all deaths after an episode of attempted suicide: a register-based survival analysis. Australian and New Zealand Journal of Psychiatry, 41, 257–265.

    Article  PubMed  Google Scholar 

  • Conner, K. R., Cox, C., Duberstein, P. R., Tian, L., Nisbel, P. A., & Conwell, Y. (2001). Violence, alcohol, and completed suicide: A case-control study. American Journal of Psychiatry, 158, 1705–1710.

    Article  Google Scholar 

  • Conner, K. R., & Duberstein, P. R. (2004). Predisposing and precipitating factors for suicide among alcoholics: Empirical review and conceptual integration. Alcoholism, Clinical and Experimental Research, 28, 6S–17S.

    Article  PubMed  Google Scholar 

  • Cornelus, J. R., Clark, D. B., Salloum, I. M., Bukstein, O. G., & Kelly, T. M. (2004). Interventions in suicidal alcoholics. Alcoholism Clinical and Experimental, 28, 89S–96S.

    Article  Google Scholar 

  • Crombine, I. K. (1990). Can changes in the unemployment rates explain the recent changes in suicide rates in developed countries? International Journal of Epidemiology, 19, 412–416.

    Article  Google Scholar 

  • Crosby, A. E., Han, B., Ortega, L. A. G., Parks, S., & Patel, N. (2012). Surveillance for violent deaths—National Violent Death reporting System, 16 States, 2009. MMWR Surveillance Summary 61:1–43. http://www.cdcgov/mmwr/preview/mmwrhtml.

  • Daraker, S., & Ross, J. (2001). The relationship between suicide and heroin overdose among methadone maintenance patients in Sydney, Australia. Addiction, 96, 1442–1453.

    Google Scholar 

  • Dieserud, G., Roysamb, E., Braverman, M. T., Dalgard, O. S., & Ekeberg, E. (2003). Predicting repetition of suicide attempt: a prospective study of 50 suicide attempters. Archives of Suicide Research, 7, 1–15.

    Article  Google Scholar 

  • Donker, T., Calear, Grant G. B., van Spijker, B., Fenton, K., Hehir, K. K., Cuijpers, P., & Christensen, H. (2013). Suicide prevention in schizophrenia spectrum disorders and psychosis: A systematic review. BMC Psychology, 3, 1–6.

    Google Scholar 

  • First, M. B., Gibbon, M., Spitzer, R. L., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-IR Axis I disorders (Research Version). Biometrics Research Department, New York Psychiatric Institute, New York. www.SCID4.org.

  • Flensborg-Madsen, T., Knop, J., Mortensen, E. L., Becker, U., Sher, L., & Grønbæk, M. (2009). Alcohol use disorders increase the risk of completed suicide—Irrespective of other psychiatric disorders. A longitudinal cohort study. Psychiatry Research, 167, 123–130.

    Article  PubMed  Google Scholar 

  • Foster, T., Gillespie, K., McClelland, R., & Patterson, C. (1999). Risk factor for suicide independence of DSM-III-R axis I disorder: Case-control psychological autopsy study in Northern Ireland. The British Journal of Psychiatry, 2, 175–179.

    Article  Google Scholar 

  • Ghafarian Shirazi, H. R., Hosseini, M., Zoladl, M., Malekzadeh, M., Momeninejad, M., Noorian, K., & Mansorian, M. A. (2012). Suicide in the Islamic Republic of Iran: An integrated analyses from 1981 to 2007. EMHJ, 18(6), 607–613.

    Google Scholar 

  • Ghaleiha, A., Afzali, S., Bazyar, F., Khorsan, F., & Torbian, S. (2012). Characteristics of hospitalized patients following suicide attempt in Hamadan. Oman Medical Journal, 27(4), 304–309.

    Article  PubMed  PubMed Central  Google Scholar 

  • Goldsmith, S. K., Pellmar, T. C., Kleiman, A. M., & Bunney, W. E. (Eds.). (2002). Reducing suicide: A national imperative. Washington, DC: National Academy Press.

    Google Scholar 

  • Gould, M. S., Fisher, P., Parides, M., Flory, M., & Shaffer, D. (1996). Psychosocial risk factors of child and adolescent completed suicide. Archives of General Psychiatry, 53, 1155–1162.

    Article  CAS  PubMed  Google Scholar 

  • Harris, E. C., & Barraclough, B. (1997). Suicide as an outcome for mental disorders. A meta-analysis. The British Journal of Psychiatry, 170, 205–228.

    Article  CAS  PubMed  Google Scholar 

  • Hawon, K. C., Comabella, C., Haw, C., & Saunder, K. (2013). Risk factors for suicide in individuals with depression: A systematic review. Journal of Affective Disorders, 147(1–3), 17–28. doi:10.1016/j.jad.2013.01.004. (Epub 2013 Feb 12).

    Article  Google Scholar 

  • Hawton, K., Sutton, L., Haw, C., Sinclair, J., & Deeks, J. J. (2005). Schizophrenia and suicide: Systematic review of risk factors. The British Journal of Psychiatry, 187, 9–20.

    Article  PubMed  Google Scholar 

  • Illgen, M. A., Harris, A. H., Moos, R. H., & Tiet, Q. Q. (2007). Predictors of a suicide attempt one year after entry into substance use disorder treatment. Alcoholism Clinical and Experimental, 31, 635–642.

    Google Scholar 

  • Janghorbani, M., & Sharirad, G. H. R. (2005). Completed and attempted suicide in Ilam, Iran (1995–2002): Incidence and associated factors. Archives of Iranian Medicine, 5(2), 119–126.

    Google Scholar 

  • Johansson, S. E., & Sundquist, J. (1997). Unemployment is an important risk factor for suicide in contemporary Sweden: An 11-year follow-up study of a cross-sectional sample of 37,789 people. Public Health, 111, 41–45.

    Article  CAS  PubMed  Google Scholar 

  • Johnson, F. W., Gruenewald, P. J., & Remer, L. G. (2009). Suicide and alcohol; Do outlets play a role? Alcoholism, Clinical and Experimental Research, 33(12), 2124–2133.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kahyee, H., & Taylor, M. (2010). Suicide and schizophrenia: A systematic review of rates and risk factors. J Psychopharmacol., 24(4_supplement), 81–90.

    Google Scholar 

  • Kaikhavani, S., Sayemiri, K., & Asadollahi, K. (2010). Study of process and causes related to suicide in Ilam province during 1992–2005. Research Journal of Medical Sciences, 4(3), 217–221.

    Article  Google Scholar 

  • Kanwar, A., Malik, S., Sim, L. A., Felstein, D., Wang, Z., & Marad, M. H. (2013). The association between anxiety disorders and suicidal behaviors: A systematic review and meta-analysis. Depression and Anxiety, 30(10), 917–929. doi:10.1002/da.22074. (Epub 2013 Feb 13).

    PubMed  Google Scholar 

  • Kessler, R. C., Borges, G., & Walters, E. E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry, 56(7), 617–626.

    Article  CAS  PubMed  Google Scholar 

  • King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osom, D., Popelynk, D. A., & Nazareth, I. (2008). Systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry, 8, 70. doi:10.1186/1471-244X-8-70.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kleiman, E., & Liu, R. T. (2013). Social support as a protective factor in suicide: Findings from two naturally representative samples. Journal of Affective Disorders, 150, 540–545.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kposowa, A. (2001). Unemployment and suicide: A cohort analysis of social factors predicting suicide in the US National Mortality Study. Psychological Medicine, 31, 127–138.

    Article  CAS  PubMed  Google Scholar 

  • Kuo, W. H., Gallo, J. J., & Tien, A. Y. (2001). Incidence of suicide ideation and attempts in adults: The 13-year follow-up of a community sample in Baltimore, Maryland. Psychological Medicine, 31, 1181–1191.

    Article  CAS  PubMed  Google Scholar 

  • Lamis, D. A., & Malone, P. S. (2013). Alcohol use and suicidal behaviors among adults: A synthesis and theoretical model. Suicidology Online, 3, 4–23.

    Google Scholar 

  • Leslie, M. E., Baker, R., Burns, J., Clark, D., & Kincaid T. (2012). Physical health problems and suicide in Virginia: A report from the Virginia violent death reporting system 2007–2010. http://www.vdh.virginia.gov/medExam/NVDRS.htm.

  • Lewis, G., & Sloggett, A. (1998). Suicide, deprivation, and unemployment: Record linkage study. British Medical Journal, 317, 1283–1286.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Maloney, E., Degenhardt, L., Darke, S., et al. (2007). Suicide behavior and associated risk factors among opioid-dependent individuals: A case-control study. Addiction, 102, 1933–1941.

    Article  PubMed  Google Scholar 

  • Mayberry, D. J., Neale, J., Arentz, A., & Jones-Ellis, J. (2007). The negative event scale: Measuring frequency and intensity of adult hassles. Anxiety Stress Coping, 20(2), 163–176.

    Article  Google Scholar 

  • Moller, H. J. (2003). Suicide, suicidality and suicide prevention in affective disorders. Acta Psychiatrica Scandinavica, 418, 73–80.

    Article  PubMed  Google Scholar 

  • Murphy, G. E., & Wetze, R. D. (1990). The lifetime risk of suicide in alcoholism. Archives of General Psychiatry, 47, 383–392.

    Article  CAS  PubMed  Google Scholar 

  • Murphy, G. E., & Wetzel, R. D. (1982). Family history of suicidal behavior among suicide attempters. The Journal of Nervous and Mental Disease, 170, 86–90.

    Article  CAS  PubMed  Google Scholar 

  • Nazarzadeh, M., Bidel, Z., Ayubi, E., Asadollahi, K., Carsonand, K. V., & Sayehmiri, K. (2013). Determinants of the social factors of suicide in Iran: A systematic review and meta-analysis. BMC Public Health, 13, 4. doi:10.1186/1471-2458-13-4.

    Article  PubMed  PubMed Central  Google Scholar 

  • Nordstrom, P., Samuelsson, M., & Asberg, M. (1995). Survival analysis of suicide risk after attempted suicide. Acta Psychiatrica Scandinavica, 91, 336–340.

    Article  CAS  PubMed  Google Scholar 

  • Norstrom, T., Stickley, A., & Shibuya, K. (2013). The importance of alcoholic beverage type for suicide in Japan: a time-series analysis, 1963–2007. Drug and Alcohol Review, 31, 251–256.

    Article  Google Scholar 

  • Nover, C., & Jackson, S. S. (2013). Primary care-based educational interventions to decrease risk factors for metabolic syndrome for adults with major psychotic and/or affective disorders: A systematic review. Systematic Reviews, 2, 116.

    Article  PubMed  PubMed Central  Google Scholar 

  • O’Connor, E., Gaynes, B., Burda, B. U., Williams, C., & Whitlock, E. P. (2013). Screening for suicide risk in primary care: A systematic evidence review for the US Preventive Services Task Force Evidence Synthesis (No. 13). Agency for Healthcare Research and Quality US, Department of Health and Human Services (AHRQ) Publication.

  • Peltzer, K., & Louw, J. (2013). Prevalence of suicide behavior and associated factors among tuberculosis patients in public primary care in South Africa. Indian Journal of Medical Research, 138, 194–200.

    PubMed  PubMed Central  Google Scholar 

  • Pompili, M., Gonda, X., Serafini, G., Sher, L., Amore, M., & Rihmer, Z. (2013). Epidemiology of suicide in bipolar disorders: A systematic review of the literature. Bipolar Disorders, 15(5), 457–490. doi:10.1111/bdi.12087.

    Article  PubMed  Google Scholar 

  • Qin, P., Agerbo, E., & Mortensen, P. B. (2003). Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: A national register-based study of all suicides in Denmark, 1981–1997. American Journal of Psychiatry, 160, 765–772.

    Article  PubMed  Google Scholar 

  • Qin, P., Mortensen, P. B., Agerbo, E., Westergard-Nielsen, N., & Eriksson, T. (2000). Gender differences in risk factors for suicide in Denmark. The British Journal of Psychiatry, 177, 546–550.

    Article  CAS  PubMed  Google Scholar 

  • Quan, H., Arboleda-Flórez, J., Fick, G. H., Stuart, H. L., & Love, E. J. (2002). Association between physical illness and suicide among the elderly. Social Psychiatry and Psychiatric Epidemiology, 37(4), 190–197. doi:10.1007/s001270200014.

    Article  PubMed  Google Scholar 

  • Ranjbar, A. R., Liaghati, A. R., Ranjbar, A., & Mohabbati, H. (2013). Toxicologic laboratory findings in cases reported with hanging death: A two-year retrospective study in Northeast Iran. Asia Pacific Journal of Medical Toxicology, 293, 92–95.

    Google Scholar 

  • Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L. L., & Goodwin, F. K. (1990). Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA, 264, 2511–2518.

    Article  CAS  PubMed  Google Scholar 

  • Rezaeian, M. (2013). Comparing the statistics of Iranian Ministry of Health with data of Iranian Statistical Center regarding recorded suicidal cases in Iran. Journal of Health System Research, 8(7), 1190–1196.

    Google Scholar 

  • Roy, A. (2009). Characteristics of cocaine-dependent patients who attempted suicide. Archives of Suicide Research, 13, 46–51.

    Article  PubMed  Google Scholar 

  • Sareen, J., Houlahan, T., Cox, B. J., & Asmundson, G. J. (2005). Anxiety disorders associated with suicidal ideation and suicide attempts in the National Comorbidity Survey. Journal of Nervous and Mental Disease, 93, 450–454.

    Article  Google Scholar 

  • Serafini, G., Pompilini, M., Lindquist, D., Dwiverdi, Y., & Girardi, P. (2013). The role of neuropeptides in suicidal behavior: A systematic review. BioMed Research International,. doi:10.1155/2013/687575.

    PubMed  PubMed Central  Google Scholar 

  • Skinner, H. A. (1982). The drug abuse screening test. Addictive behaviors, 7(4), 363–371.

    Article  CAS  PubMed  Google Scholar 

  • Stenager, E. N., & Stenager, E. (2002). Physical illness and suicide behavior. In K. Heeringen & K. van Hawton (Eds.), The international handbook of suicide and attempted suicide. New York: Wiely.

    Google Scholar 

  • Taghaddosinejad, F., Sheikhazadi, A., Behnoush, B., Reshadati, J., & Anar, S. H. S. (2010). A survey of suicide by burning in Tehran, Iran. Acta Medica Iranica, 48(4), 266–272.

    PubMed  Google Scholar 

  • Vijayakumar, L., & Tajakumar, S. (1997). Are risk factors of suicide universal? A case-control study in India. Acta Psychiatrica Scandinavica, 99, 110–407.

    Google Scholar 

  • Whitlock, F. A. (1978). Suicide, cancer and depression. The British Journal of Psychiatry, 132, 269–274.

    Google Scholar 

  • Wichstrom, L. (2000). Predictors of adolescent suicide attempts: A national representative longitudinal study of Norwegian adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 603–610.

    Article  CAS  PubMed  Google Scholar 

  • Wilcox, H. C., Conner, K. R., & Caine, E. D. (2004). Association of alcohol and drug use disorders and completed suicide: An empirical review of cohort studies. Drug and Alcohol Dependence, 76, S1–S19. (Suppl).

    Article  Google Scholar 

  • Wojnar, M., Illgen, M. A., Czyze, E., et al. (2009). Impulsive and non-impulsive suicide attempts in patients treated for alcohol dependence. Journal of Affective Disorders, 115(1–5), 131–139. doi:10.1016/j.jad.2008.09.001.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was funded by the Deputy of Research, Isfahan University of medical Sciences. We thank Dr. Attari, the director of Behavioral Sciences Research Center (BSRC), his deputy director, Dr. Khairabadi, and the research committee of the BSRC for their support. Special thanks are due to Dr. Mahaki, assistant professor of biostatistics for his valuable comments, Miss Masaeli and Miss Khalifesoltan, research associates at the BSRC for smoothening the official procedures. This work would not have been possible without the assistance of the medical and nursing staff of the toxicology emergency ward at Noor Medical Center, Isfahan. Sincere thanks goes to our honorable respondents who patiently shared their bitter experiences with us.

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Toudehskchuie, G.R.G., Fereidoon, M. What Can Influence Iranian Suicide Attempters to Go Through the Process of Non-Fatal Suicide Act Once Again? A Preliminary Report. Community Ment Health J 52, 597–608 (2016). https://doi.org/10.1007/s10597-015-9958-1

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