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Assessment of Suicidal Cases Among Emergency Department Applicants Kutahya Evliya Celebi Training and Research Hospital Experience.

Introduction

Suicide attempts are acts undertaken to end an individual's life voluntarily but do not result in death, whereas if death is the outcome, it is called suicide. Suicide and suicide attempts are serious causes of morbidity and mortality, particularly in psychiatric emergencies (1). According to the World Health Organization, approximately one million people die every year worldwide because of suicide (2). According to the statistics of the Turkish Statistical Institute, this number was 3,212 in our country in 2015, an increase by 1.3%, from the 3,169 deaths in 2014. It means that four people die from suicide out of every one hundred thousand people (3).

Suicide attempts have an important place in the fields of psychiatry and crime intervention because of their urgency and life-threatening aspects. The first conscious intervention that should be performed is for this reason of great importance in terms of lifting life-threatening situations. In view of this situation, there is a need for systematic information about suicide attempts, particularly in terms of public health. It is crucial to determine the risk groups and their characteristics when deciding on which policies should be established for response and intervention (4,5).

We aimed to evaluate socio-demographic and clinical characteristics of patients who used our emergency service because if a suicide attempt. We think that our work is important in determining the risk factors in our region because ours is the only tertiary hospital in the city center.

Materials and Methods

This study was conducted by examining retrospective records of 292 patients who applied to the Emergency Department of Dumlupinar University Kutahya Evliya Celebi Training and Research Hospital because of a suicide attempt between January 01 and December 31, 2016, and filled in a "suicide attempt registration form." In this form, information including gender, age, marital status, educational status, profession, suicide method, reason for suicide, history of previous suicide attempts, and whether or not they had been treated psychiatrically in the last 6 months is recorded. The study was approved by the Dumlupinar University Faculty of Medicine Ethics Committee and was conducted in accordance with the principles of the Declaration of Helsinki (protocol no: 2017/02-7).

Statistical Analysis

The data were analyzed in SPSS (Social Sciences Statistical Package) version 20. Results are presented as mean and standard deviation for quantitative variables and as percentages for qualitative variables.

Results

Socio-demographic characteristics of these cases are provided in Table 1. Of the cases, 73.28% were female and 26.72% were male. When suicide attempts were examined according to the age group, most suicide attempts were in the age range of 15-24 years, with 55.13% cases. With respect to the marital status, 165 were single and 114 were married and 13 were other marital status. In cases that were married, this highest rate was found in the age group of 24-35 years. Among women who attempted suicide, 55.14% (n=118) were single. When the educational status was evaluated, the group that most frequently attempted suicide was found to be primary school graduates (41.43%; n=121). It was determined that 23.97% (n=70) of the cases did not work and 28.20% (n=82) of the cases were students. The gender distribution was 62.86% (n=44) women and 37.14% (n=26) male. Approximately 49.53% (n=106) of all women who were in non-working women group and housewives attempting to commit suicide. It was found that among males 46.75% (n=36) had a job.

The analysis of the methods applied and the reasons for suicide cases are given in Table 2. According to this, most suicide attempts in both genders were performed by poisoning with drugs (96.23%, n=281). The most common causes of suicide were family problems in 40.07% (n=117), mental illness in 19.52% (n=57) and mental illness in 11.30% (n=33). When the reasons according to gender were evaluated, this situation did not change in women, while in men the third reason was found to be work-related. A total of 56% (n=56) had previously attempted suicide and 18.50% (n=54) of the patients were found to have no history of psychiatric illness before making the attempt. When we look at all suicide attempts, particularly drug poisoning, there is no peak for a particular time period. However, it was found that attempts occurred most commonly between 4.00 p.m. and 12.00 a.m. in both gender (Figure 1).
Figure 1. Time period of suicide attempts A: 00.00-07.59, B:
08.0015.59, C: 16.00-23.59

A   22%
B   24%
C   54%

Note: Table made from pie chart.


Discussion

In studies examining suicide attempts, it has been pointed out that women attempt suicide at a higher rate than men (6,7). In our sample, the female to male ratio was found to be 2.74, which is in accordance with the literature. This may be related to the fact that women are influenced by events to a greater extent than men, and that the situation in society is also related to the compulsive nature of the women in the community and the negative conditions that women make over traditional practices.

The age group in which suicide was attempted most frequently in our study was found to be 15-24 years, as was found in similar studies in which the age group distribution was examined (8,9). Physical and mental changes due to adolescence as well as the desire to live independently and problems related to school and test anxiety may be seen as a frequent occurrence in this age group. Several studies have shown that suicide attempts are more prevalent among married couples (10,11).

Similarly, in our study, suicide attempts were more common than successful suicides. The age group in which suicide attempts occurred most frequently was be determined to be the student age group. Because the level of education increases, suicidal tendency decrease. Factors such as harmony, communication, and self-expression can be held responsible for this situation. When the work situation is taken into consideration, the risk groups are students, housewives, and individuals who do not work at all. This situation was found to be consistent with that observed in similar studies (12,13). When we look at the sociodemographic characteristics of our study, we believe that the sociocultural and socioeconomic development of the region is a parameter to be considered. In a separate analysis, we evaluated cases according to the method used for the attempt. According to this, the most frequent suicide method was the intake of drugs and toxic substances. In studies conducted in this aspect both in Turkey and in other countries, it is stated that most of the suicide attempts are by chemical substance intake. The most frequently identified substances were found to be prescription drugs found at home (14-16).

In this case, we think that measures taken by the competent authorities against this phenomenon will be effective in reducing suicide attempts and will contribute to the country's economy. Psychiatric illnesses have been found to be closely related to issues such as adverse family conditions and socioeconomic and sociocultural factors (17-19). The most common cause of suicide in our study was family problems. In our country, domestic problems and incompatibility are considered to be among the most frequent causes of suicide in most studies (20-22). In such cases, it is suggested that individuals who have attempted suicide should be interviewed with their families, and risk-bearing individuals should be identified and counselled within family communication settings. In other studies, on this issue, intervention has been counterproductive as a factor, actually increasing the risk of suicide (23). In our study, recurrent intervention was observed to have taken place in a proportion of children (19.18%). Care should be taken that this may pose a risk of suicide or death in individuals prone to attempt suicide. Studies have also revealed that people with a history of psychiatric treatment constitute a high-risk group in terms of new suicide attempts (23). Our work partially supports this observation. Therefore, psychiatric consultation should be made available both during the intervention and follow-up of cases with a history of psychiatric illness that attempt suicide and use emergency services.

Another parameter that should be discussed here is the increased frequency of suicide cases between 4.00 p.m. and 12.00 a.m. Studies in this field are generally consistent (20,21). If you look at this situation, this is the time zone when family members stay together. As the most common reason for suicide is related to family problems, attempts are expected to be concentrated in this period.

Conclusion

We evaluated some features that might be a risk factor for suicide attempts. However, eliminating these factors is not enough to prevent suicide attempts. With the help of the resulting data, preventive strategies should be developed and implemented, such as developing screening programs for risk groups, providing psychosocial support, preventing stigmatization in the community, and raising awareness (increasing social awareness).

Ethics

Ethics Committee Approval: The study was approved by the Dumlupinar University Faculty of Medicine Ethics Committee and was conducted in accordance with the principles of the Declaration of Helsinki (protocol no: 2017/02-7).

Informed Consent: Retrospective study.

Peer-review: Internally peer-reviewed.

Financial Disclosure: The author declared that this study received no financial support.

References

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(iD) Emine Kadioglu

Department of Emergency Medicine, Kutahya Health Sciences University, Kutahya, Turkey

Corresponding Author: Emine Kadioglu, Department of Emergency Medicine, Kutahya Health Sciences University, Kutahya, Turkey

Phone: +90 274 265 22 86 E-mail: dreminekadioglu@gmail.com ORCID ID: orcid.org/0000-0003-0950-0477

Cite this article as: Kadioglu E. Assessment of Suicidal Cases Among Emergency Department Applicants Dumlupinar University Kutahya Evliya Celebi Training and Research Hospital Experience. Eurasian J Emerg Med. 2020;19(2):111-14

Received: 09.10.2017

Accepted: 25.10.2017

DOI: 10.4274/eajem.galenos.2017.29484
Table 1. Groups of sociodemographic characteristics

                                    Number, n   Percentage, %

Gender        Female                214         73.28
              Male                   78         26.72
Age groups    15-24                 161         55.13
              25-34                  71         24.33
              35-49                  43         14.72
              50 and over            17          5.82
Marital       Married               114         30.05
status
              Single                165         56.50
              Other (widowed.        13          4.45
              divorced. separated
              living)
Educational   Primary school        121         41.43
status
              High school            98         33.56
              University             55         18.83
              Illiterate             11          3.76
              Unknown                 7          2.39
Work status   Working                70         23.97
              Non-working            70         23.97
              Student                82         28.20
              Housewife              63         21.70
              Unknown                 6          2.06

Table 2. The analysis of the methods applied and reasons for suicid

                                      Number, n   Percentage, %

Suicidal      Drugs                   281         96.23
attempt
              Cutter drill injury       5          1.70
              Hang                      3          1.05
              High jump                 2          0.68
              Firearm injury            1          0.34
Causes of     Family problems         117         40.07
suicide
              Mental illness           57         19.52
              Opposite sex problems    33         11.30
              School and test          22          7.54
              concerns
              Business and economic    20          6.85
              reasons
              Contact problems         18          6.17
              Loneliness               18          6.17
              Developmental             5          1.70
              problems
              Substance dependence      2          0.68
Previously    Yes                      56         19.18
attempted
suicide
              No                      236         80.82
History of    Yes                      54         18.50
psychiatric
illness
              No                      238         81.50
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Title Annotation:Original Article
Author:Kadioglu, Emine
Publication:Eurasian Journal of Emergency Medicine
Date:Jun 1, 2020
Words:2449
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