Psychiatric comorbidities among a sample of suicidal adolescents presenting to poison control center, Ain shams university

Background Suicide is a major cause of death all over the world with increasing risk especially in adolescents. Multiple studies have been conducted to study the risk factors and the underlying causes that lead to suicide. However, there is scarcity of data regarding suicide in adolescents. As it’s well known that most of psychiatric illnesses can be complicated with suicide especially those related to personality and substance use disorders. For Egypt, adolescents represent almost one third of the total population, hence the importance of studying the risk factors and associated psychiatric comorbidities that may lead to adolescence suicide in order to reach proper intervention plans. One of the most powerful double-sided weapons in that matter is the internet and social media use, as there has been a debate around whether it’s beneficial in seeking professional help or harmful as it may introduce methods of suicide and block any means of getting help Hence, was the hope of this study to provide an understanding of the prevalence of suicide among adolescents and the underlying psychiatric comorbidities to reach proper intervention and prevention plans. Aim of the Work This study aimed at detecting the occurrence rate of suicide and suicide related behaviors and the underlying psychiatric comorbidities among a sample of 241 suicidal adolescents aged 12-18 presenting to poison control center, Ain Shams University and also To identify factors which are associated with high suicidal intent And compare the sociodemographic variables and the increase in electronic device /social use among adolescents with suicidal attempts versus non-suicidal adolescents. Patients and Methods This is a descriptive Cross-sectional study hospital-based study conducted in poison control center of Ain Shams University hospital. The present study aimed at detecting the occurrence rate of suicide among 241 adolescents, over six months period from February 2019 to July 2019. The socioeconomic status was assessed using Socioeconomic status scale (SES), the suicide intent was assessed using the beck suicide intent scale and the psychiatric comorbidities were assessed using the MINI International Neuropsychiatry Interview for children and adolescents kid scale

The Role of Perceived Social Support in the Association Between Stressful Life Events and Suicidal Behavior

Background: Suicide is a serious public health concern for which there have been well-established protective and risk factors reported in literature. There is a lack of evidence on the indirect effects of other variables on these factors. Specifically, the association between stressful life events and suicidal behavior may be affected by perceived social support, but its role in this association is largely uninvestigated.Objectives: Thus, this paper aims to explore the role of perceived social support in the association between stressful life events and suicidal behavior. Perceived social support will be explored as a mediator and as a moderator in this association.Methods: Data were obtained from the Determinants of Suicidal Behavior Conventional and Emergent Risk (DISCOVER), a study conducted to identify risk factors of suicidal behavior. The study participants are individuals with suicide attempts admitted to hospital. Participants (n = 343) were recruited from hospital setting. Suicidal behavior was measured using two outcomes (1) the occurrence of a suicide attempt (2) level of suicide intent as measured by the Pierce Suicide Intent Scale. Perceived social support was measured using the Sarason Social Support Questionnaire.Results: Stressful life events were significantly associated with suicide attempts (OR 1.440, 95% CI 1.440, 1.682, p < 0.001) and perceived social support (B −0.785, 95% CI −1.501, −0.068, p = 0.032). There was no significant mediation effect by perceived social support in the association between stressful life events and suicide attempts (Sobel's test statistic 1.64, p = 0.100). Perceived social support did not moderate the relationship between stressful life events and suicide attempts [(OR 1.007, 95% CI 0.987, 1.027, p = 0.514] or the relationship between stressful life events and level of suicidal intent (B −0.043, 95% CI −0.132, 0.046, p = 0.343).Conclusion: Stressful life events are associated with increased risk of suicide attempts. The study also identified an inverse relationship between stressful life events and perceived social support. These associations were independent of perceived social support. This study highlights the effects of stressful life events on suicide risk is not affected by perceived social support, requiring further investigation into measures to reduce the impact of social stressors on people with risk of suicide.

A Systematic Review of Neuromodulation Treatment Effects on Suicidality

Introduction: Neuromodulation is an important group of therapeutic modalities for neuropsychiatric disorders. Prior studies have focused on efficacy and adverse events associated with neuromodulation. Less is known regarding the influence of neuromodulation treatments on suicidality. This systematic review sought to examine the effects of various neuromodulation techniques on suicidality.Methods: A systematic review of the literature from 1940 to 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was conducted. Any reported suicide-related outcome, including suicidal ideation, suicide intent, suicide attempt, completed suicide in reports were considered as a putative measure of treatment effect on suicidality.Results: The review identified 129 relevant studies. An exploratory analysis of a randomized controlled trial comparing the effects of sertraline and transcranial direct-current stimulation (tDCS) for treating depression reported a decrease in suicidal ideation favoring tDCS vs. placebo and tDCS combined with sertraline vs. placebo. Several studies reported an association between repetitive transcranial magnetic stimulation and improvements in suicidal ideation. In 12 of the studies, suicidality was the primary outcome, ten of which showed a significant improvement in suicidal ideation. Electroconvulsive therapy (ECT) and magnetic seizure therapy was also shown to be associated with lower suicidal ideation and completed suicide rates. There were 11 studies which suicidality was the primary outcome and seven of these showed an improvement in suicidal ideation or suicide intent and fewer suicide attempts or completed suicides in patients treated with ECT. There was limited literature focused on the potential protective effect of vagal nerve stimulation with respect to suicidal ideation. Data were mixed regarding the potential effects of deep brain stimulation on suicidality.Conclusions: Future prospective studies of neuromodulation that focus on the primary outcome of suicidality are urgently needed.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=125599, identifier: CRD42019125599.

Higher Suicide Intent in Patients Attempting Suicide With Violent Methods Versus Self-Poisoning

Background: Suicidal intent for patients attempting suicide using violent methods (VMs) is assumed to be higher than for those using self-poisoning (SP), which may explain the higher mortality observed in follow-up studies. However, this has not been studied prospectively. Aims: We aimed to compare patients attempting suicide using VMs with those using SP regarding suicidal intent, suicidal ideation, depression, and hopelessness during hospital stay and after 1 year. Methods: Patients hospitalized after suicide attempt by VMs ( n = 80) or SP ( n = 81) completed the Beck scales for Suicide Intent, Suicide Ideation, Depression Inventory, and Hopelessness on admission and at the 12-month follow-up. Results: On admission, those using VMs had higher suicidal intent than those using SP ( M = 16.2 vs. 13.3, p < .001), but lower depression scores ( M = 22.2 vs. 26.8, p < .05). No significant differences were found in suicidal ideation ( M = 20.1 vs. 23.1) or hopelessness ( M = 10.1 vs. 11.9). At 12-month follow-up, depression scores decreased significantly for both groups, while hopelessness decreased only for the SP group. Limitations: The statistical power achieved was lower than intended. Conclusion: The higher levels of suicidal intent, but lower levels of depression, may indicate more impulsivity among people attempting suicide using VMs. Suicidal ideation was relatively stable.

Impact of perceived social support and parental bonding in predicting suicidal intent among self-harm patients

Objective: The present study investigated the impact of perceived social-support and parental-bonding in predicting suicidal intent among self-harm patients.Methods: Cross-sectional research design was used in current study. Study was conducted at Foundation University, Rawalpindi from February, 2019 to September, 2019. A purposive sample of 50 self-harm patients was collected from different mental health departments of hospitals of Rawalpindi, Jhelum and Peshawar. Participants were administered Multidimensional Scale of Perceived Social Support (MSPSS), Parental-Bonding Instrument (PBI) and Beck Suicide Intention Scale (BSIS). Data was analyzed through SPSS using correlation, t test and regression. Differences on the basis of demographic variable were also studied.Results: The main results of the study specified that social support and parental bonding’ factor ‘care’ had significant negative correlation with suicide intent. Moreover, it negatively predicted suicide intent. Whereas, parental boding’ factor ‘overprotectiveness’ had significant positive correlation with suicide intent and significantly positively predicted suicide intent. Conclusion: The outcomes of present study emphasized that social-support and parental bonding both can play substantial roles in saving lives. Researchers and mental health experts will be able to start examine about the factors that distinguish deliberate self-harm from attempted suicide as well as the characteristics common to both conducts. Continuous...

Study of the pattern, intent behind and outcome of acute poisoning in a tertiary care centre

Background: Acute poisoning is one of the major medical emergencies with significant morbidity and mortality. Appropriate planning, prevention and management techniques can be designed by knowing the nature, severity and outcome of acute poisoning cases. Most of the poisoning is due to the intention of deliberate self-harm. This study aimed to study the pattern and outcome of acute poisoning and the intent behind poisoning. Methods: This is a cross sectional study which included 100 acute poisoning cases in a tertiary care hospital. The study includes data regarding age, sex, time elapsed after intake of poison; name of the poisonous substance, duration of hospitalization, severity and outcome were collected in the prestructured proforma. Intent behind poisoning was calculated using Beck’s suicide intent score. Results: Incidence was more common among males (69%) but there was no significant correlation between gender and mortality. Mean age of presentation was 35.66 years but age of presentation and mortality correlation was not statistically significant (t=0.92, p=0.3). Organophosphorous compound poisoning (36%) was the most common type of poisoning. Total mortality was found to be 12%. Beck’s suicide intent scores were higher in patients who died and statistically significant (t=8.96, p=0.0001). Maximum patients expired when there was a delay in admission to hospital by more than 8 hours after exposure. Conclusions: Poisoning is more common in young males. The overall mortality depends on type of poison, time elapsed since exposure to hospital arrival, suicidal intent and many other factors. Early care in a tertiary care center may help to reduce mortality in India.

Self-harm and the COVID-19 pandemic: a study of factors contributing to self-harm during lockdown restrictions

ABSTRACTIntroductionThe COVID-19 pandemic and resulting public health measures may have major impacts on mental health, including on self-harm. We have investigated what factors related to the pandemic influenced hospital presentations following self-harm during lockdown in England.MethodMental health clinicians assessing individuals aged 18 years and over presenting to hospitals in Oxford and Derby following self-harm during the period March 23rd to 17th May 2020 recorded whether the self-harm was related to the impact of COVID- 19 and, if so, what specific factors were relevant. These factors were organized into a classification scheme. Information was also collected on patients’ demographic characteristics, method of self-harm and suicide intent.ResultsOf 228 patients assessed, in 46.9% (N=107) COVID-19 and lockdown restrictions were identified as influencing self-harm. This applied more to females than males (53.5%, N=68/127 v 38.6%, N=39/101, χ2 = 5.03, p=0.025), but there were no differences in age, methods of self-harm or suicide intent between the two groups. The most frequent COVID-related factors were mental health issues, including new and worsening disorders, and cessation or reduction of services (including absence of face-to-face support), isolation and loneliness, reduced contact with key individuals, disruption to normal routine, and entrapment. Multiple, often inter- connected COVID-related factors were identified in many patients.ConclusionsCOVID-related factors were identified as influences in nearly half of individuals presenting to hospitals following self-harm in the period following introduction of lockdown restrictions. Females were particularly affected. The fact that mental health problems, including issues with delivery of care, predominated has implications for organisation of services during such periods. The contribution of isolation, loneliness and sense of entrapment highlight the need for relatives, friends and neighbours to be encouraged to reach out to others, especially those living alone. The classification of COVID-related factors can be used as an aide-memoire for clinicians.

Interpersonal theory of suicide: prospective examination

Background The interpersonal theory of suicide (IPTS) is one of the most intensively researched contemporary theories on the development of suicidal ideation and behaviour. However, there is a lack of carefully conducted prospective studies. Aims To evaluate the main predictions of the IPTS regarding the importance of perceived burdensomeness, thwarted belongingness and capability for suicide in predicting future suicide attempts in a prospective design. Method Psychiatric in-patients (n = 308; 53.6% (n = 165) female; mean age 36.82 years, s.d. = 14.30, range 18–81) admitted for severe suicidal ideation (n = 145, 47.1%) or a suicide attempt completed self-report measures of thwarted belongingness, perceived burdensomeness, capability for suicide, hopelessness, depression and suicidal ideation as well as interviews on suicide intent and suicide attempts and were followed up for 12 months. Logistic regression and receiver operating characteristics (ROC) analysis were conducted. Results The interaction of perceived burdensomeness, thwarted belongingness and capability for suicide was not predictive of future suicide attempts, but perceived burdensomeness showed a significant main effect (z = 3.49, P < 0.01; OR = 2.34, 95% CI 1.59–3.58) and moderate performance in screening for future suicide attempts (area under the curve AUC = 0.729, P < 0.01). Conclusions The results challenge the theoretical validity of the IPTS and its clinical utility – at least within the methodological limitations of the current study. Yet, findings underscore the importance of perceived burdensomeness in understanding suicidal ideation and behaviour.