Printer Friendly

Main predictors for repetition of suicidal behaviour among women referred to a single public sector tertiary care hospital in Iran.

Byline: Babak Mostafazadeh and Esmaeil Farzaneh

Abstract

Objective: To assess the main predictors for repetition of suicidal behaviour among women.

Methods: This cross-sectional study was conducted at Loghman Hakim Hospital, Tehran, Iran, in 2014, and comprised women patients. The patients were divided into two groups, i.e. women repeating suicide and women without repeating suicide. Data was collected through a checklist and then analysed with SPSS 20.

Results: Of the 300 women, 121(40.3%) repeated suicide and 179(59.7%) did not. The overall mean age was 26.99.1 years (range: 14-80 years). High prevalence of psychological drug usage, alcohol use, history of self-mutilation (self-harm), psychotic disturbances, sexual relationships, as well as smoking and opium addition was revealed as major factors in repeated suicidal behaviour in women when compared with other women. The result of multivariate logistic regression model showed two factors of self-mutilation (odds ratio =2.692, p=0.002) and underlying psychotic disorders (odds ratio = 2.780, p0.05).

Conclusion: The presence of underlying psychotic disorders and self-mutilation were main predictors for repetition of suicidal behaviour.

Keywords: Suicidal attempts, Women, Behaviour, Self-mutilation, Psychotic disorders.

Introduction

A highly asymmetric completed suicide rates have been indicated between women and men named as paradox of suicidal behaviour.1 This phenomenon is highly different between different societies. Overall, attempting suicide is more frequent among women than men, while death due to suicide is more common in men.2 Thus, the potential role of gender in the incidence of suicide and its related death has been well recognised. In total, non-fatal suicidal behaviour is more common in women and this behaviour is dominant in younger ages.3 Along with the difference in the incidence rate of suicide in two genders, the method of suicide has been also reported to be different.4

In developed countries, the completed suicides are 2 to 4- fold more frequent among men, while suicide attempts are 2 to 3-fold more frequent among women.5

Self-injury, also known as self-harm and self-mutilation, occurs when someone intentionally and repeatedly harms herself/himself in a way that is impulsive and not intended to be lethal. The most common methods for self-mutilation are: skin cutting (70-90%), head banging or hitting (21%-44%), and burning (15%-35%).6

Various factors may be associated with increased suicidal ideation, including social and familial problems (unemployment and being single), mental disorders (including substance use and alcoholism), and previous attempted suicide.2,3,7 Environmental conditions, such as social and familial problems, can affect suicide risk and since these factors may differ across countries the importance of identifying the related factors in each nation is essential. Until now, no investigation has identified the risk of repeated attempted suicide among Iranian patients with psychiatric disorders.

Tendency to suicidal behaviours and also its adverse outcome can be affected by various underlying factors such as traditional and social gender role, different risk-taking behaviours, undermining social rights of women compared with men, cultural factors, employment or occupational condition, and difference in psychological stress.8,9 In this regard, the observed gap between the two genders in the incidence rate of suicide and also its determinants may be more widened in developing countries.10 On the other hand, burden of suicide is highest in low- and middle-income countries leading increased risk for post-suicidal mortality or morbidity.11 For instance, in an epidemiological survey in Iran performed between 2006 and 2010, suicide has been introduced in the list of the first ten main causes for death.7,12

Despite various published reports in different countries, the incidence of suicide and its risk factors among Iranian women remain unclear.

The existence of psychiatric disorders has been demonstrated in over 90% of people who attempt suicide and they are susceptible to repeated attempts, which results in a higher rate of morbidity and cost to the healthcare system.13

The increased incidence of suicide among Iranian young adults and women has been shown during recent years emphasising the need for preventive strategies to reduce the imposed financial, medical, social, and economic burden. The present study was planned to assess the main predictors of repeated suicidal behaviour among Iranian women.

Patients and Methods

This cross-sectional study was conducted at Loghman Hakim Hospital, Tehran, Iran, in 2014, and comprised women patients. The patients were divided into two groups: women repeating suicide attempts and those who were not. Women who had attempted suicide within the previous year and were recruited after presenting to the hospital emergency department after a non-fatal suicide attempt were included. Women with the history of life-threatening medical condition, evidence of cognitive impairment, or acute psychosis were excluded. The institutional ethics and research committee approved the study design.

The baseline data, including demographic characteristics, type of psychological disorder, history of imprisonment, history of suicide or self-mutilation, sexual relationships, history of significant systemic disorders, marital status, educational level, previous use of alcohol, and substance use was collected using checklists from information registered with the hospital.

Results were presented as mean standard deviation (SD) for quantitative variables and were summarised by frequency (percentage) for categorical variables. Continuous variables were compared using T test or Mann-Whitney U test whenever the data was not normally distributed or when the assumption of equal variances was violated across the study groups. Categorical variables were, on the other hand, compared using chi-square test. To determine major correlates of suicide in study subjects, the multivariate logistic regression modelling was used with the presence of baseline variables. SPSS 20 was used for data analysis. P<0.05 was considered statistically significant.

Results

Of the 300 women, 121(40.3%) repeated suicide and 179(59.7%) did not. The overall mean age was 26.99.1 years (range: 14-80 years). Besides, 154(51.3%) women were married and 106(35.3%) had primary education level. History of self-mutilation was found in 61(20.3%) women. History of medication without prescription was found in 33(11%) women, and history of alcohol use was found in 20(6.7%). Moreover, 12(4%) participants had history of imprisonment, 92(30.7%) had previous experience of other systemic disorders and 98(32.7%) had history of psychological disturbances. In addition, 70(23.3%) women were smokers and 11(3.7%) were substance users. History of sexual relationships, such as extramarital, bisexual or lesbian relationships, was revealed in 109(36.3%) of all women which was not significantly different between two groups.

With regard to employment status, only 109(36.3%) women had a proper job and the rest of them did not have a job. Most of mothers and fathers of women had primary education. History of special social conditions such as emotional abuse, sexual abuse, early death of parents, or parental separation was observed in 147(49%) participants. History of substance use was reported in 79(26.3%) fathers of the patients, and 62(20.7%) of the fathers had attempted suicide (Table-1).

Table-1: Characteristics and related factors for suicidal behaviours in women with and without repeated suicide.

Groups###With repeated###Without repeated###P-value

Characteristics###suicide (n = 121)###suicide (n = 179)

Mean Age (years)###26.70 8.91###27.09 9.58###0.721

Marriage###n (%)###n (%)###0.075

Single###44 (36.4)###55 (30.7)

Married###53 (43.8)###101 (56.4)

Divorced###24 (19.8)###23 (12.8)

Education level###n (%)###n (%)###0.403

Illiterate###4 (3.3)###5 (2.8)

Primary level###40 (33.1)###66 (36.9)

Diploma###52 (43.0)###60 (33.5)

College degree###25 (20.6)###48 (26.8)

Psychological medication###19 (15.7)###14 (7.8)###0.032

Alcohol use###15 (12.4)###5 (2.8)###0.001

Smoking###37 (30.6)###33 (18.4)###0.015

Substance use###8 (6.6)###3 (1.7)###0.026

Self-mutilation###38 (31.4)###23 (12.8)###<0.001

Imprisonment###6 (5.0)###5 (2.8)###0.445

Systemic disease###78 (64.5)###130 (42.6)###0.133

Psychotic disturbances###59 (48.8)###39 (21.8)###<0.001

Sexual relationships###42 (34.7)###67 (37.4)###0.631

Addiction in parent###34 (28.1)###45 (25.1)###0.568

History of suicide in parent###31 (25.6)###31 (17.3)###0.082

Comparing women with and without repeated suicide showed that the two groups were similar in all characterised variables such as age, gender, marital status, educational level, history of imprisonment, underlying systemic disease, employment status, fathers' or mothers' educational level, and history of addiction or suicide in their parents. However, the prevalence of psychological drug usage, alcohol use, and history of self-mutilation, psychotic disturbances, sexual relationships, as well as smoking and opium addiction were more common in women with the history of suicide compared to others. By using the multivariate logistic regression model, two factors of self-mutilation (odds ratio [OR] = 2.692, p=0.002) and underlying psychotic disorders (OR = 2.780, p<0.001) among all factors were the main predictors of repeated suicide in women (Table-2).

Table-2: Univariate analysis of main determinants of repeated suicide in women.

Factors###B###SE###P-value###Odds Ratio###95%CI for Odds Ratio

###Lower###Upper

Psychological medication###0.528###0.441###0.231###1.695###0.715###4.020

Alcohol use###0.736###0.657###0.263###2.087###0.576###7.564

Self-mutilation###0.990###0.320###0.002###2.692###1.437###5.044

Psychotic disturbances###1.023###0.278###0.000###2.780###1.612###4.796

Sexual relationships###0.550###0.536###0.305###1.733###0.606###4.960

Smoking###-0.055###0.341###0.872###0.946###0.485###1.847

Substance use###0.382###0.816###0.640###1.465###0.296###7.245

Constant###-5.246###1.064###0.000###0.005

Discussion

In the current study, we attempted to determine main predictors of repeated suicide in women who were hospitalised because of the recent episode of suicide. Although none of the demographic characteristics and socio-economic status could predict repeating suicide, two factors of underlying psychotic disorders (p=0.001) and self-mutilation (p=0.002) were shown to be predictors for suicide in hospitalised patients. On the other hand, these two parameters could increase the risk for repeating suicide. Various baseline, clinical and historical factors have been introduced as the main correlates of suicide, especially social characteristics, ethnical factors, economical burden, and even religious behaviours. In a recent study by Aichberger et al.14 on women of Turkish origin in Berlin who attempted suicide, younger age has been found as the main predictor for suicide in that population particularly in the age range 18 to 24 years.

In another study by Poorolajal15 conducted in western Iran, male gender, advanced age, widow status, employment, and lower educational level were main predictors for completed suicidal behaviours. In another multicentre study on European suicide attempters,16 economic level was the main predictor for repeated suicide. In a systematic review on Indian population,17 low socio-economic status, mental illness (especially alcohol misuse) and inter-personal difficulties are the factors that are most closely associated with suicide. In an interesting research on African-American female suicide attempters,18 reasons for living were negatively associated with suicidal intent. In a study on Swedish population, the predictors of attempting suicide included male gender and major depression.

Beautrais19 also found among New Zealand young subjects that social and educational disadvantage, childhood and family adversity, psychopathology, individual and personal vulnerabilities, exposure to stressful life events and circumstances, and social, cultural and contextual factors were main risk profiles for attempting suicide. Reviewing the literature suggests various risk factors and determinants for repeating suicide, including demographic parameters in some societies and psychological problems in some others.20 In our study population who lived in Tehran, the capital of Iran, self-mutilation and psychotic disorders known as effective factors were predictors of repeated suicidal behaviours.

Although the current study was performed in Tehran, our hospital is a great referral centre for treating suicide attempters from throughout the country with various ethnicities, behaviours and religious affiliations. This may have different results in our study with factors reported in some studies conducted in some local areas.

One of the limitations of this study was the fact that results only pertained to those women who were unsuccessful in "repetition of suicidal behaviour" and survived after the repeat suicide attempt.

Shakeri et al. showed that age, marital status and type of psychiatric disorder were the only determinants of suicide method. Adjustment disorders were the most common psychiatric disorders among Iranian women but did not predict the risk of further attempts.13

Conclusion

The presence of underlying psychotic disorders and self-mutilation were main predictors for repetition of suicidal behaviour. Because of critical role of psychological disorders in triggering attempt to suicide, initial diagnosing and controlling these abnormal conditions may serve as a protective approach against suicidal behaviours. On the other hand, improving interventions among individuals who predispose to suicide attempting should emphasise early diagnosis of psychological impairments to reduce suicidal behaviours.

Acknowledgment

We are grateful to all the people who helped in sampling the study and necessary data collection.

Disclaimer: None.

Conflict of Interest: None.

Source of Funding: None.

References

1. Udry, J. Richard.The Nature of Gender. Demography. 1994; 31:561-73.

2. Canetto SS, Sakinofsky I. The Gender Paradox in Suicide. Suicide and Life Threatening Behavior 1998; 28:1-23.

3. Crosby AE, Han B, Ortega LA, Parks SE, Gfroerer J, Centers for Disease Control and Prevention (CDC). Suicidal thoughts and behaviors among adults aged 18 years-United States, 2008-2009. MMWR Surveill Summ. 2011; 60:1-22.

4. Thompson MP, Light LS. Examining Gender Differences in Risk Factors for Suicide Attempts Made 1 and 7 Years Later in a Nationally Representative Sample. J Adolesc Health. 2011; 48:391-7.

5. Mendez-Bustos P, Lopez-Castroman J, Baca-Garca E, Ceverino A. Life Cycle and Suicidal Behavior among Women. Scientific World Journal. 2013; 2013:485851.

6. Selby EA, Kranzler A, Fehling KB, Panza E. Nonsuicidal self-injury disorder: The path to diagnostic validity and final obstacles. Clin Psycho Rev. 2015; 38:79-91.

7. Hawton K, Van-Heeringen K. Suicide. Lancet 373; (9672):1372-81.

8. Payne S, Swami V, Stanistreet D. The social construction of gender and its influence on suicide: a review of the literature. J Men's Health. 2008; 5:23-35.

9. Mller-Leimkhler AM. The gender gap in suicide and premature death or: why are men so vulnerable. Eur Arch Psychiatry Clin Neurosci. 2003; 253:1-8.

10. Girard Ch. Age, Gender, and Suicide: A Cross-National Analysis. Am Soc Rev. 1993; 58:553-74.

11. Webster Rudmin F, Ferrada-Noli M, Skolbekken J. Questions of Culture, Age, and Gender in the Epidemiology of Suicide. Scand J Psychol. 2003; 44:373-81.

12. Vrnik P. Suicide in the world. Int J Environ Res Public Health. 2012; 9:760-771.

13. Shakeri J, Farnia V, Abdoli N, Akrami MR, Arman F , Shakeri H. The Risk of Repetition of Attempted Suicide Among Iranian Women with Psychiatric Disorders as Quantified by the Suicide Behaviors Questionnaire. Oman Med J. 2015; 30:173-80.

14. Aichberger MC, Heredia Montesinos A, Bromand Z, Yesil R, Temur-Erman S, Rapp MA, et al. Suicide attempt rates and intervention effects in women of Turkish origin in Berlin. Eur Psychiatry. 2015; 30:480-5.

15. Poorolajal J, Rostami M, Mahjub H, Esmailnasab N. Completed suicide and associated risk factors: a six-year population based survey.Arch Iran Med. 2015; 18:39-43.

16. Fountoulakis KN, Kawohl W, Theodorakis PN, Kerkhof AJ, Navickas A, Hschl C, et al. Relationship of suicide rates to economic variables in Europe: 2000-2011. Br J Psychiatry. 2014; 205:486-96.

17. Rane A, Nadkarni A. Suicide in India: a systematic review.Shanghai Arch Psychiatry. 2014; 26:69-80.

18. Flowers KC, Walker RL, Thompson MP, Kaslow NJ. Associations between reasons for living and diminished suicide intent among African-American female suicide attempters. J Nerv Ment Dis. 2014; 202:569-75.

19. Skogman K, Alsen M, Ojehagen A. Sex differences in risk factors for suicide after attempted suicide-a follow-up study of 1052 suicide attempters. Soc Psychiatry Psychiatr Epidemiol 2004; 39:113-20.

20. Beautrais AL. Risk factors for suicide and attempted suicide among young people. Aust N Z J Psychiatry. 2000; 34:420-36.
COPYRIGHT 2017 Asianet-Pakistan
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2017 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Publication:Journal of Pakistan Medical Association
Geographic Code:7IRAN
Date:Sep 28, 2017
Words:2908
Previous Article:Clinical outcomes of prophylactic platelet transfusion in patients with dengue: A retrospective study of patients at a tertiary care hospital in...
Next Article:Value of Leucine-rich alpha-2-glycoprotein-1 (LRG-1) on diagnosis of acute appendicitis in female patients with right lower-quadrant abdominal pain.
Topics:

Terms of use | Privacy policy | Copyright © 2019 Farlex, Inc. | Feedback | For webmasters