Changing Ethnic and Social Characteristics of Patients Admitted for Self-Poisoning in West London during 1971/2 and 1983/4

The characteristics of adult patients admitted for self-poisoning to an inner London district general hospital were examined during 1971/72 and 1983/84. The incidence of self-poisoning halved over the 12 years, from 326 to 178 per 100 000. Although no West Indians were admitted in the first period, they comprised 7% of such admissions 12 years later. The West Indian population in the catchment area remained constant at around 6%. Amongst all patients admitted for self-poisoning, there was a fall in the number of patients diagnosed as depressed, having a personality disorder or admitting to prior psychiatric care, but an increase in alcoholism. Paracetamol became more common as a drug used in self-poisoning and barbiturates were taken less often. Only one patient died in the series. These results should stimulate more soundly based epidemiological studies on ethnic variation in self-poisoning, and on self-injury in inner-city areas.

Effect of regulatory withdrawal of drugs and prescription recommendations on the pattern of self-poisonings in Oslo

A two-year prospective study of 1350 admissions for self-poisoning, covering the Oslo area was undertaken to identify the sources of the toxic agents. After the first year of the study, four barbiturates were withdrawn from the Norwegian market and recommendations were made by the Health Authorities to promote more restrictive attitudes when prescribing psychoactive drugs. The patterns of self-poisonings in the two periods were compared. The withdrawal of four barbiturates resulted in a 55% decrease in the rate of barbiturate poisonings in general (p less than 0.001). No increase could be detected in the rate of self-poisoning with benzodiazepines and other hypnotics, but the incidence of self-poisonings with antidepressants (p less than 0.01) and neuroleptics (p less than 0.01) was found to have increased significantly. The regulations and recommendations resulted in a significant decrease in drugs obtained from doctors randomly consulted (p less than 0.01), and a significant increase in drugs prescribed by psychiatrists (p less than 0.01). Drugs obtained from non-medical sources increased from 28% in the first period to 33.2% in the second. The total number of admissions and toxic agents taken remained unaltered. Thus, regulatory measures can influence the pattern of self-poisoning but do not seem to influence the tendency to abuse drugs or to take an overdose.

Self-poisoning treated in the ICU

This retrospective study compares number and type of self-poisonings admitted to the intensive care units (ICU) at Sahlgren's Hospital, Gothenburg, during 1972 and 1976. The total number of patients requiring intensive care was unchanged, but a change in the pattern of self-poisoning was seen. In 1976 the number of patients requiring intensive care following acute alcohol intoxication had increased, whereas the number of barbiturate and methaqualone poisonings decreased. Tricyclic antidepressants formed the largest group in both years. Fewer patients needed endotracheal intubation and IPPV in 1976 than in 1972. Also, fewer complications were seen, and the death rate among ICU-treated patients decreased. In the Gothenburg area barbiturates accounted for one half of all deaths due to self-poisoning and tricyclic antidepressants for one fifth. Any expected decrease in intensive care as a result of fewer barbiturate and methaqualone poisonings was obscured by an increase in severe alcohol intoxication.

The role of the otolaryngologist in managing suicidal adolescents

From 1978 to 1987, 18 suicidal children were cared for by the otolaryngology service at Children's Hospital of Pittsburgh. The evaluation and treatment of these patients are reviewed, and factors resulting in these self-destructive acts discussed. Pertinent risk factors and warning signals that may enhance the otolaryngologist's ability to make the diagnosis of attempted suicide and avert potential further harm are also presented.

Age-specific characteristics of attempted suicide in adolescence

A total of 422 suicide attempts of adolescents (15 to 19 years of age) were investigated and compared with 327 suicide attempts of young adults. Adolescents had more serious social problems than young adults. Their adaptive problems became worse while growing older until the age of 20. Adolescents made suicide attempts with serious intent more often than young adults, but their suicide attempts were not as often lethal as in young adults. Although repeated suicide attempts were relatively common in both groups, only 10 people were part of both materials. Adolescents were as often psychotic when attempting suicide as young adults were. Twenty-four percent of adolescents and 26% of young adults were admitted to a psychiatric hospital as treatment.

Attempted suicide in Hong Kong

In 1986, psychiatrists saw a total of 307 attempted suicide cases presented to a regional general hospital in Hong Kong, whether admitted or not. Compared with suicide attempts in Hong Kong in 1954 and those in Western countries, suicide attempts in Hong Kong in 1986 were significantly more likely to be precipitated by interpersonal conflicts, and significantly less likely to be precipitated by economic stress. Compared with the methods of attempted suicide in Hong Kong in 1986, those in Hong Kong in 1954 were significantly more likely to be fatal, while those in Western countries are significantly more likely to be ingestion of hyponotics and sedatives. Suicide attempters in Hong Kong are significantly more likely to be diagnosed as schizophrenics or paranoid psychotics than those in Western countries.

Suicidal attempts by ingestion of various substances in 2050 children and adolescents in Greece

This study investigates suicidal attempts by ingestion of drugs or other chemicals in 2050 children and adolescents (312 boys and 1738 girls) under seventeen years of age as seen over a six year period, 1977-1982, at the Poison Control Center, "P.A. Kyriakou" Children's Hospital, Athens, Greece. Demographic, clinical, psychosocial and cultural data were presented and discussed. It is the authors' opinion that more attention should be paid to the increased incidence of suicidal attempts in younger persons and therefore the urgent need for early recognition and prevention of this event is necessary. This is the first broad study of its kind in Greece which reflects a segment of the psycho-biosocial developments in this country.

Motivation in deliberate self-harm

Fifty adult patients presenting with deliberate self-harm at the Royal Victoria Hospital were given a choice of nine reasons for their actions. Most chose more than one reason and all but two of the 24 who said that they wished to die chose at least one other motive. There were no trends with respect to sex, past history, or method of deliberate self-harm. These results illustrate the complexity of this condition and show the importance of investigating motives beyond simply the intent to die.

A diagnostic outcome study of children and adolescents with severe burns

The results of a diagnostic outcome study of children and adolescents with severe burns are presented. The positive research findings include evidence of present and lifetime full and partial anxiety and depressive disorders and statistically significant within-sample, burn-related, and demographic differences. The negative findings are less depression and post-traumatic stress disorder by DSM-III criteria than expected, the presence of a subgroup of severely burned children who appeared to be functioning well with only a few or no diagnoses, and absence of significant differences on many variables on within-group comparisons. Based on these data, periodic psychiatric evaluation or reevaluation and specifically targeted followup treatment are indicated for many burned children, adolescents, and their families.

Suicidal behavior in adolescents and young adults: the international picture

This chapter has reviewed the scope of suicide and attempted suicide among the young from an international perspective. Socio-demographic trends have been analyzed and explanatory theories for international differences proposed. An international strategy for prevention is discussed and specific recommendations are presented. Efforts are to be made to translate international strategies to prevent youth suicide into community, clinical, and research programs that can be effectively implemented around the world.

[The suicidal patient. 2. Methods of suicide, diagnoses and social conditions]

By means of a multipractice investigation in which 347 general practitioners participated, 293 schemata were collected about patients who had undertaken suicidal acts. The material consists of 66 suicides and 227 attempted suicides. By and large, the sex and age distributions correspond to those in previous investigations. The number of attempted suicides in this investigation was only half of that anticipated. This may be due to lapse, seasonal variations, underrepresentation of urban practice etc. Strikingly many patients undertook acts in this material without having psychiatric diagnoses and the psychiatric diagnosis did not appear to play any part as regards whether the suicidal act lead to suicide. The methods employed appear otherwise to reflect development in society and pharmacotherapy. Where men were concerned, it appears that suicide is relatively most common among widowers, unemployed and early retirees while, where women were concerned, divorcees and early retirees were most frequently involved. Attempted suicide is most frequently carried out by unemployed men and by divorced and early retirees of both sexes. This investigation cannot indicate any definite occupational group which involves a risk as regards suicidal acts and economical factors appear only to play a part where attempted suicide is concerned.

[The suicidal patient. 1. Occurrence and relevance of contact with a general practitioner prior to the suicidal actions]

A multipractice investigation was undertaken concerning suicidal behaviour. Sixty-six patients committed suicide and 227 attempted suicide. During the month prior to the suicidal actions, 2/3 of the patients had had contact with their general practitioners. Only very few had been in contact with a psychiatric department or with a practising psychiatrist during the same period. In a few cases, the general practitioner found that the most recent consultation was relevant in cases of patients who committed suicide. 28% of the patients who committed suicide and also were seen by their general practitioners within the last month suffered from serious somatic disease. Where the cases of attempted suicide were concerned, the general practitioners considered that 40% of the most recent consultations were relevant. In order to improve attention to suicidal signals, other forms of cooperation between the primary sector and hospitals, eg in the form of district psychiatric teams, are suggested.

[Suicide risk after attempted suicide (its incidence and predictive evaluation]

The authors have revised the bibliography about predictive evaluation of suicide in attempted subject. It seems that the prediction is only possible determining the presence of a symptom: the hopelessness.

Suicide and attempted suicide in general practice, 1979-1986

Using data from the Continuous Morbidity Registration Sentinel Stations over the period 1979-1986, the authors tried to determine the incidence and the characteristics of patients in general practice who attempted or committed suicide. Almost half of the suicide attempts and suicides had contacted their general practitioner (GP) shortly before the suicidal act. A minority of these cases were recognized by the GP as having a high suicide risk. In almost 70% of the suicides and 58% of the suicide attempters the GPs reported the existence, currently or previously, of a depressive episode. About half of both the suicides and the suicide attempters had been treated or seen by mental health professionals or social workers. Given the fact that suicide and suicide attempt are relatively rare events in general practice, and given the fact that for the patients who contact their GP shortly before the suicidal act, it is not at all certain whether they present clearly recognizable signs of suicide risk at that time, the authors conclude that GPs cannot play an important role in the prevention of suicidal behaviour.

[Self-poisoning in Northwest Norway in 1975-1984]

During the ten-year period 1975-84, 251 patients were hospitalized because of self poisoning in Nordmøre, the northern part of Møre and Romsdal county. During the five last years, there was a large increase in hospital admittances because of self poisoning, especially of persons below the age of thirty. Men dominated in the age group 20-30 years, and women in the age group 15-20 years. There was a significant correlation between the number of unemployed and the number of self poisonings through out the ten-year period.

Regional use of violent suicide methods: an analysis of suicide attempts in Houston, Texas

A number of changes in the demographics of suicide and suicide attempters have occurred in the last 10 to 15 years. To assess some of the factors that may be involved in these changes, this study examines a group of suicide attempters in Houston, Texas, where a large percentage of the attempts were violent. These violent attempters are compared with nonviolent attempters, and the entire population of attempters is compared with suicide attempters in New Haven, Connecticut. Finally, the two attempter populations are compared with the underlying general population demographics of two regions (Houston and New Haven). Several differences emerged between attempters in Houston and in New Haven, including larger proportions of violent attempters, male attempters, and married attempters in Houston. Demographic factors in the general populations for the two regions are different, but these differences are not directly reflected in the nature of the attempter populations. Reasons for observed differences are discussed.

The prevalence of suicidal ideation among college students

A total of 737 university students were surveyed using a psychometrically sound self-report measure of suicidal ideation. Over 43% of those participating were found to have experienced some level of suicidal ideation during the previous year. Of those found to have had suicidal thoughts, 14.9% in some way acted on those thoughts without actually making suicide attempts. An additional 5.5% were found to have made attempts on their lives. Serious suicidal ideation and actual attempts were related to several demographic traits, and implications of the results are discussed. In general, findings indicate that the problem of youth suicide may involve a greater percentage of young people than previously thought. Moreover, findings provide indirect support for the hypothesis that the difference in male-female completed suicide rates is primarily a function of the lethality of the attempts.

Suicide attempts in runaway youths

This study explored suicidal behavior in 291 adolescents who were using runaway shelters in St. Louis. Thirty percent of the runaways reported having attempted suicide in the past. The suicide attempters had significantly more behavioral and mental health problems, and reported having more family members and more friends with problems, than nonattempters. A logistic regression showed that youths' substance use, behavior problems, family instability, and sex all helped to explain their suicide attempts. Most of the attempters made their first attempt by their midteens. One-quarter made their latest attempt shortly before entering the shelter, and one-fifth stated that they would still consider suicide. The great majority of attempts were not preplanned, but one-third followed troubles or arguments at home and feelings of confusion and depression. Remarkably, half of the teenage suicide attempters never received any professional help following their attempt.

Increased suicidality in depression: group or subgroup characteristic?

A lifetime history of depressive episodes and suicide attempts was ascertained from 172 depressed patients admitted to a psychiatric inpatient service. Fifty-five of these patients had made at least one suicide attempt. The correlation of depressive episodes and the total number of suicide attempts for this group was close to zero. However, when the data were converted into rate measures (number of episodes or attempts per year), the correlations were very high and significant. It appears that approximately one-third of severely depressed, hospitalized patients have a history of suicide attempts and, once a suicide attempt has occurred, the patient is at high risk for more suicide attempts if future depressions occur. Within the group of depressives with a history of suicide attempt, the risk of suicidal behavior is evenly distributed. No evidence in favor of a "hypervulnerable" subgroup was found.

Repetition of parasuicide: an epidemiological and clinical study

The dramatic clinical presentation of parasuicide tends to deflect attention from the repetitive pattern of this behaviour in many patients. In an epidemiological study of annual cohorts of parasuicides for 1972, 1977, and 1982 admitted to the Regional Poisoning Treatment Centre, Edinburgh, it was found that for certain subgroups of the population 'repeaters' were actually commoner than 'first-ever' patients, and a number of risk factors were identified, of which social class was particularly important. The clinical characteristics of patients distinguished by their frequency of repetition were also described, with special attention to the stability of these differentiating features over time. It is suggested that the habitual repeater requires closer study, and that the factors which lead to initiation into a parasuicidal 'career' are not necessarily those which conduce to repetition.

Ontario Child Health Study: suicidal behavior in youth age 12-16 years

The authors report on the prevalence and correlates of suicidal behavior in youth age 12-16 years. The data, from a community prevalence survey, show that 5%-10% of the male and 10%-20% of the female youth reported suicidal behavior within a 6-month period. Suicidal behavior in youth appeared to be related to psychiatric disorder in general as well as to family dysfunction and parental arrest.

Correlates of alcohol-related casualty in Kuwait

This paper reports the extent to which alcohol consumption is associated with casualties in a country in which alcohol is prohibited religiously and culturally. Selective screening of particular casualty groups by blood test established qualitative evidence of alcohol use in 107 out of 1058 patients (10%) examined at a general hospital and a traumatology hospital in Kuwait. The rate of alcohol-associated casualty was significantly higher in traumatology hospital patients (15%) than in general hospital (7%), stressing the association between alcohol and trauma. Absence of differences by place of casualty disproves lay beliefs that motor vehicle casualty is the major alcohol-associated risk in Kuwait. Other casualties, particularly work and domestic injuries, should be regarded as being affected by alcohol consumption. Statistically significant high alcohol-associated casualty rates characterized Kuwaitis (14%), the unemployed/retired (20%) and coma cases (22%) suggesting that these categories may suffer from serious alcohol problems.

Suicide and parasuicide in a hill resort in Malaysia

Ninety-five cases of suicide and 134 cases of parasuicide that occurred between October 1973 and September 1984 in the hill resort district of Cameron Highlands in Malaysia were analysed. Eighty-one per cent of suicides and 78% of parasuicides were of Indians, although they only form 25% of the population. The average annual suicide rate for Indians (over 10 years of age) was 157 per 100,000. About 94% of suicides and 66% of parasuicides were by ingesting agricultural poisons. The age- and sex-specific suicide rates for women were highest in the 20-24-year-old age group. Some possible reasons for high suicide rates among Indians are discussed.

The identification of clustering in parasuicide

A straightforward test for detecting clustering in patterns of parasuicide in individual patients is described and applied to data from the Edinburgh Regional Poisoning Treatment Centre.

Assessing the epidemiology of suicide and parasuicide

Suicide is a rare phenomenon – in most countries, it explains between 0.5 and 1% of all deaths – no more than 15 per 100 000 population. Although rates increase with age, its impact on the total mortality of the young is greater than its impact on the elderly. Despite its rarity, the subject has attracted, and continues to attract, wide interest among academics and popular writers.

Parasuicide in an Arab industrial community: the Arabian-American Oil Company experience, Saudi Arabia

The parasuicide phenomena was investigated for the first time in a retrospective and prospective way in an Arab industrial community in the Eastern Province of Saudi Arabia during 1985 and 1986. Though the parasuicide rate of 20.7 per 100,000 is substantially lower from the reported rates in the West, underreporting and misdiagnosing of the phenomena may explain the low rate. The results of this study confirm that the act is predominantly the activity of young females, and disordered interpersonal relationships with spouses and parents stand out as precipitating factors. Acute reaction to stress was the commonest diagnosis followed by depression. Deliberate self-poisoning by analgesics and psychotropic drugs was the commonest method used. The findings of this study refute the hypothesis that parasuicide is rare in this part of the world, and time probably has come to amend the law in order to give the opportunity for distressed people to receive help.

Geriatric suicide: the preventable death

Suicide is the ninth-leading cause of death of the elderly, yet it is the leading cause of preventable death in this population. White males over the age of 65 are at special risk for suicide, with a suicide rate twice the national rate for all ages and six times the rate for women over age 65. The nurse practitioner is in a unique position to intervene in geriatric suicide because suicidal geriatrics typically will not seek help from mental health professionals. Rather, they will seek help from the primary caregiver. Strategies for assessment of suicide risk are presented, in addition to strategies for intervention in a suicide-related crisis.

Suicide attempts in patients with borderline personality disorder

Among 180 patients with DSM-III borderline personality disorder, patients with concurrent affective and substance use disorders had a higher rate of serious suicide attempts than other patients. Clinicians should be alert to axis I disorders in assessing suicide potential in borderline patients.

Recent clinical and epidemiological trends in parasuicide in Edinburgh and Oxford: a tale of two cities

This is a report of clinical and epidemiological trends in parasuicide in Edinburgh and Oxford over the period of 1976 to 1984. Rates of parasuicide declined in both cities, but more markedly among women than men. Male rates tended to be higher in Edinburgh and female rates higher in Oxford. Age-specific rates were similar for the two cities in 1983-84, with peak rates for females among 15-19 year olds and those for males among 20-24 year olds in Edinburgh and 25-34 year olds in Oxford. Parasuicide incidence was higher in lower social class groups and among the unemployed in both cities. During the study period there was a massive decline in barbiturate overdoses, a more modest decline in minor tranquillizer overdoses but, in Oxford, a marked increase in self-poisoning with paracetamol. By the end of the study period the proportion of patients receiving a diagnosis of drug addiction had doubled in Edinburgh, although it had remained fairly constant in Oxford. There were differences in patterns of aftercare offered to patients in the two cities; these almost certainly reflect differing clinical policies.