The characteristics of suicide attempters admitted to the main general hospital in Fiji Islands

Objective: To study the characteristics of suicide attempters attending the main general hospital in Fiji Islands. Method: Consecutive suicide attempters were clinically evaluated, and their sociodemographic and clinical characteristics were compared with those of other patients seen in the psychiatric service between January 15, 1999 and January 14, 2000. Results: Thirty-nine suicide attempters were seen, representing 36.8% of all the cases referred to the psychiatric service. The prevalence of attempted suicide in the Greater Suva Area was 34.8 per 100,000. Majority (56.4%) were young (16–25 years), Indians (59%), female (61.5%), students (41%), never married (74.4%) and of Hindi faith (48.7%). The commonly used methods were ingestion of drugs and pesticides. The intention to die was present in 20 (51.3%) of the population. Social problems and/or psychiatric comorbidity were present in over 60% of cases. Suicide attempters were significantly younger, more of single persons (P<.0001), and fewer were in employment (P<.001) than nonsuicidal cases seen. The difference was not significant when the two groups were compared regarding gender, race or religion. Conclusions: Young people attempt suicide in disturbed psychosocial milieu, using available poisoning methods with strong desire to die. Apparently, high proportion of female Indians in this group reflects high rate of service utilization by them. Unemployment is an insignificant predisposing factor.     

Recurrent unipolar mania in a psychiatric hospital setting in the Fiji Islands

This study aimed to determine the rate of unipolar mania and compare its characteristics with those of other bipolar affective disorders in a psychiatric hospital in the Fiji Islands. Fifty-one patients with unipolar mania seen between January 1999 and October 2000, had their diagnosis confirmed using the Schedules for Clinical Assessment in Neuropsychiatry and the International Classification of Diseases, 10th edition. Their demographic and clinical characteristics were compared with those of 31 manic-depressive patients seen during the period under review. Unipolar mania constituted 47.2% of the bipolar affective disorders in this sample. The frequency of episodes, duration of affective illness, mean age at onset, gender distribution, marital status, employment status and race were not significantly different for the unipolar manic and manic-depressive groups (p > 0.05). Family history of major psychiatric morbidity was 9.8% for the unipolar manic patients and 22.6% for the manic-depressive group (p > 0.05). Recurrent unipolar mania may be considered a useful category based on its high rate, although its demographic and clinical characteristics do not clearly distinguish it from manic-depression.     

Suicide and attempted suicide in a general hospital in western Ethiopia

ABSTRACT Suicidal behaviour in western Ethiopia as seen in a general hospital is reported on. The suicide rate is at least 3–11 per 100,000 inhabitants per year (mean 4.5) which is higher than is usually reported from Africa. As many women as men seem to commit suicide and the incidence is highest in the age group 19–24 years and lowest in the oldest group. The incidence seems to be higher in urban areas. Hanging is the most frequent method used by both sexes.     

Attitudes of general hospital emergency room personnel towards attempted suicide patients

The aim of this study was to compare the attitudes of emergency room staff towards patients who have attempted suicide between two general hospitals, one with psychiatric consultation available and the other without. The Understanding Suicidal Patients (USP) Questionnaire was given to all staff in the emergency rooms of Jorvi Hospital (in the city of Espoo, with routine psychiatric consultation) and Malmi Hospital (in the city of Helsinki, without routine psychiatric consultation) (n=115). There were clear differences in staff attitudes between the hospitals. Female gender, older age and working in Malmi Hospital without routine psychiatric consultation were associated with more positive attitudes towards attempted suicide patients. Surprisingly, only working in Jorvi Hospital was associated with more negative attitudes. Differences in attitudes towards suicide attempters between personnel working in the different hospitals were found. Further investigation is needed to find the ideal psychiatric consultation arrangement for suicide attempters in good cooperation with emergency room staff.     

Recent changes in the age-and gender-specific rates of attempted suicide in Gent

Summary The gender-specific rate of attempted suicide, calculated from hospital admission data, was significantly lower in 1990 than in 1986 in females and, when age is taken into account, in females younger than 35 and in males younger than 25 years. The incidence of suicide attempts seen by general practitioners also decreased. Indications for rejection of the artefact hypothesis as explanation for this decrease have been investigated. It was shown that the decrease have been investigated. It was shown that the decrease in the prevalence was found at local and national levels and was not the result of a decrease in referrals to general hospitals. Moreover, the decrease in the rate was associated with an increase in the use of outpatient mental health facilities in females and with a trend to increase in the 15–24 age group. The number of suicide attempts referred by Community Mental Health Services to the general hospital and the suicide rate in out-patients remained constant during the study period. The findings do not support the artefact hypothesis but indicate that there was a real decrease in the rate of attempted suicide. Moreover, the findings suggest that out-patient treatment can be efficacious in the primary prevention of suicidal behaviour.     

Depression and attempted suicide: a comparative study

The Levine-Pilowsky depression questionnaire was used to compare the qualitative and quantitative characteristics of depression in 176 patients admitted to a general hospital following a suicide attempt and 65 psychiatric inpatients with a diagnosis of major affective disorder. The study showed that despite significant age and sex differences there was a striking similarity between the groups on all measures of depression. Diagnostic and therapeutic implications of these findings are discussed, and further research directions are suggested.     

Group crisis intervention in a school setting following an attempted suicide

The risk of suicide is, indeed, significant during adolescence. Regardless of whether the suicide attempt culminates in death (suicide), serious injury, minor injury, or no injury at all (parasuicides), the attempt, in and of itself, will send shock waves through any and all groups of which the adolescent was a member. These friends and family members of the adolescent who attempted suicide become the unwilling and vicarious victims of the suicide attempt. A rapid and assertive emergency mental health response to any given suicide attempt is clearly recommended. This paper reviews the phenomenon of adolescent suicide and offers a case study on the use of a rapid and efficient group crisis intervention, referred to as a Crisis Management Briefing (CMB; Everly, 2000), directed towards the vicarious victims of an adolescent suicide attempt.     

Attempted suicide by drug overdose and by poison-ingestion methods seen at the main general hospital in the Fiji islands: a comparative study

OBJECTIVE: This study examined the prevalence and the characteristics of deliberate self-poisoning patients seen at the main general hospital in the Fiji Islands. METHOD: Thirty-one consecutive patients with deliberate drug-overdose and 27 others with nonoverdosed self-poisoning were compared on sociodemographic and clinical variables. RESULTS: Deliberate self-poisoning cases represented 0.3% of the hospital admissions, and had a rate of 25.9 per 100,000 population. The overdose group was significantly older (P<.05), whereas the poison-ingestion group had significantly greater proportion of males (P<.03). The rate of psychiatric morbidity was significantly higher in the overdose group (P=.04), whereas the history of alcohol abuse was significantly higher in the other group (P=.04). Paracetamol (35.5%) and paraquat (29.7%) were the most commonly used agents. CONCLUSIONS: Age, gender, rate of psychiatric morbidity, or history of alcohol abuse could be predictive of whether drug overdose or poison ingestion would be used for deliberate self-poisoning. This information could be relevant in the formulation of suicide preventive strategies.     

The neuropsychiatry of carbon monoxide poisoning in attempted suicide: a prospective controlled study

OBJECTIVE: There are few prospective comprehensive controlled studies of the neuropsychiatric outcome in people who attempt suicide with carbon monoxide (CO). The present study aimed to evaluate this. METHODS: A consecutive series of 41 adults (81% men) with CO exposure presenting over 3 years, and 20 matched controls, were evaluated with instruments to assess orientation, attention, concentration, speed of information processing, verbal memory, premorbid intellect, executive function (working memory, verbal fluency and set-switching), mood disorder, psychotic disorder, alcohol dependence and obsessive-compulsive disorder, levels of depression, hopelessness, suicide intent, anxiety, neurobehavioural function and social and interpersonal functioning. At 2 months follow-up, the neuropsychological battery was extended to include further tests of executive function (including problem-solving) and memory (including visual memory), RESULTS: At initial assessment, control subjects showed similar levels of cognitive impairment as CO-exposed subjects (except in the case of four CO subjects with very severe impairment), but were more depressed. At 2-months follow-up, the trends were generally towards improvement in all subjects, with no between-group differences. CONCLUSIONS: Indirect effects on cognitive state may be at least as great as direct CO neurotoxicity in suicide attempters. The study did not support CO exposure exacerbating mood disorder in this sample.     

The phenomenology of self-mutilation in a general hospital setting.

Comparison of a series of twenty-four wrist-cutters with a control group of self-poisoners showed a number of significant differences. The wrist-cutters were younger and their acts were regarded as being of low lethality; they are no more likely to have made previous suicide attempts; they complain less often of depression, and more frequently of 'emptiness' and tension as primary complaints. Sudden, unpredictable mood swings are common and there is a greater tendency for their physicians to diagnose personality disorders, often in pejorative terms. They frequently have substantial medical interests and paramedical occupations. A high proportion complain of dysorectic symptoms (anorexia or overeating or combinations of both), use drugs and/or alcohol in excess; show sexual disturbance and distress, and also promiscuity. They more frequently have a negative reaction to menarche and menstruation; have come from broken homes and have experienced parental deprivation. A proportion of the group exhibit difficulty in verbal communication, and absconding from hospital was more common in the group of cutters. Painless cutting after a period of depersonalization, followed by relaxation and repersonalization after bleeding, was the typical pattern.     

Correlates and antecedents of hospital admission for attempted suicide: a nationwide survey in Italy

The present study examined data on symptom patterns in the week prior to admission for suicide attempt, in a nationwide representative sample of patients. Socio-demographic, clinical, and treatment data was gathered for 1,547 patients admitted over a 12-day index period during the year 2004 to 130 public and 36 private psychiatric facilities in Italy. Patients were evaluated in terms of whether they had been admitted for having attempted suicide or not. A detailed checklist was used to assess symptom pattern at admission; diagnoses were based on ICD-10 categories. Two-hundred thirty patients (14.8%) in the sample had been admitted for suicide attempt. Patients with depression or with personality disorders were more frequently observed among suicide attempters. First-contact patients were significantly more likely to have been admitted after a suicide attempt, the only exception being individuals with bipolar disorder, manic phase. No diagnosis was statistically related to admission after suicide attempt, once symptoms pattern at admission had been accounted for. Disordered eating behavior, depressive symptoms, substance abuse, and non-prescribed medication abuse were positively related to attempted suicide, as were any traumatic events in the week prior to admission; symptoms of psychosis (hallucinations/delusions) and lack of self-care were negatively associated with suicide attempt admission. Greater attention to symptoms immediately preceding or concomitant with admission after a suicide attempt can be a key factor in establishing the best treatment plan and discharge strategy, the most effective community-service referral, and targeted intervention programmes for patients hospitalized for a suicide attempt.     

Completed versus attempted suicide in psychiatric patients: a psychological autopsy study

The aims of this study were to identify specific risk factors associated with completed suicide in a sample of suicide victims diagnosed with mental illness and to discriminate completed suicides from attempted suicide in individuals who did not kill themselves for at least the next 2 years after the index attempt. Ninety-four adults (34 women; 60 men; mean age = 50.81 [SD = 18.08]) admitted to the Division of Psychiatry of the Department of Neurosciences of the University of Parma who died by suicide between 1994-2004 were matched for sex and age (+/- 2 years) with 94 outpatients (mean age = 50.70 [SD = 18.08]) who made at least one suicide attempt during the years of the study. Data were gathered by proxy-based interviews with referring psychiatrists and general practitioners and from examination of medical records. Suicide victims were more likely to be not married, have poor social support (OR = 5.28), and have more voluntary and compulsory admissions to hospitals (1 admission: OR = 5.44; > 1 admissions: OR= 8.84) than suicide attempters. Suicide victims were also less likely to have had stressful life events during their childhood and adolescence (OR = 0.09) and to be divorced or widowed than were the attempters.     

The assessment of suicide risk in the general hospital

The assessment of suicide risk is a central activity of the general hospital psychiatrist for patients admitted following a suicide attempt and others who are identified after admission as being potentially suicidal. While biologic and psychosocial measures have some long-term predictive value, there is no valid measure to predict acute suicide risk. The lack of a valid measure does not, however, relieve the clinician of the obligation to perform an appropriate assessment. Pertinent appellate case law decisions note that the evaluation and record keeping must be “adequate”, though no definition for adequate standards is provided. This paper presents issues that are considered so fundamental for suicide assessment that failure to obtain and record such information would potentially constitute inadequate practice. These areas include: the patient's statement regarding current suicidal ideation and planning, the presence or absence of delirium, psychosis and depression, what the patient says it makes sense to do, confirmation by a third party, and global formulation. The guidelines in this paper are presented with the intention of establishing the basis for optimal clinical care and for minimizing legal vulnerability in the evaluation of the potentially suicidal patient in the general hospital.     

Follow-up study of patients with attempted suicide

Patients with a suicide attempt were re-examined 3 to 8 years after treatment in a crisis intervention ward by use of a semi-structured interview and self-rating scales. Their psychosocial development during the study period was evaluated in regard to number and quality of life-events, coping-behaviour and self-concept, sociodemographic variables, the subjective evaluation of the treatment in the crisis intervention ward by the patients and their compliance in respect of the proposed aftercare. Conclusions for treatment and further rehabilitation of patients with suicide-attempt will be drawn.