| BackgroundAttempted suicide is defined as the behavior of having taken action to hurt oneself, but not died successfully. It is estimated that at least10,000,000people have the attempted suicide each year in the world. Biological and genetic factors can result in attempted suicide. It was reported that low5-hydroxytrypatamine activity is associated with suicidal behavior and the T102C polymorphism in serotonin2A (5-HT2A) receptor gene is involved in alcohol consumption and substance dependence. However, there have been a few researches on the relationship between5-HT2A receptor T102C polymorphism and attempted suicide, but the results are controversial. Consequently, in this study, we try to explore the relationship between5-HT2A receptor T102C polymorphism and attempted suicide.The strongest predictor of future suicide attempt is a previous attempt. This study compared the difference in psychological status between subjects carrying different genotype over a year follow-up period, so as to provide effective reference for suicide prevention and invention.Objectives(1) To investigate epidemiological characteristics of attempted suicide in rural population of Shandong Province.(2) To compare the distribution of different types and frequency of gene5-HT2A reporter T102C gene polymorphism between the suicide attempters and the controls.(3) To find the risk factors and high-risk population of attempted suicide. This will provide new evidence for suicide prevention and intervention. (4) To compare the difference in psychological status between subjects carrying different genotype over a year follow-up period.Methods1. SubjectsSix counties, in disease surveillance points of Shandong Province, were selected. Data of rural attempted suicides aged15-70years old during the period from October1st,2009to March31st,2011, were consecutively collected. Meanwhile, the controls with same gender, age (no more than3years), and without suicide history, were random sampled in same district.2. InstrumentsAll data were collected by face to face interviews. All process included two stages:the first interview and the follow-up study. The instruments include Suicide Intent Scale (SIS), Self-Esteem Scale (SES), Trait Anxiety Inventory (TAI), Center for Epidemiologic Studies Depression Scale (CES-D), Interview for Recent Life Events (IRLE), Life Satisfaction Index A (LSIA), Beck Hopelessness Scales (BHS), Dickman Impulsivity Inventory (DⅡ), Duke Social Support Index (DSSI), Simplified Coping Style Questionnaire and Structured Clinical Interview for DSM-IV Axis I Disorders,2001, Research Version.3. Experimental methods1ml blood sample from the elbow vein of each object was collected and method of the high salt dissolution was employed for DNA extracting.5-HT2A receptor T102C gene polymorphism was analyzed by using PCR-LDR.4. Statistical methodsThe data were analyzed by software of SPSS16.0. Univariate analyses were carried out by t test or Chi square test. Chi square tests were used to test the difference of gene types and frequency. Multivariate conditional logistic regression model was used to analyze the risk factors for attempted suicide. Classification tree analysis was employed to determine the risk factors of attempted suicide and high risk populations.Main results1. The epidemiological characteristics of attempted suicide 366suicide attempters were tested in this study, in which the male attempted suicides were116(31.7%), the female were250cases (68.3%), and the male/female ratio was1:2.2. The average age of attempted suicides was43.87±13.23years old. Suicide seasons for suicide attempters were in spring (27.5%), summer (32.1%) and autumn (26.1%). Suicide attempters had low suicidal intention and the mean score of it, in which items4and8were deleted, was2.83±2.37(male vs. female, t=-1.564, P=0.119).307cases (83.9%) took pesticide and59(16.1%) took other methods. Attempted suicides with pesticide ingestion were more likely to be married, less physical illnesses (P<0.05). Compared with the attempted suicide with other method, the attempted suicide by pesticide ingestion had lower levels of anxiety, hopelessness, depression and self-esteem, while had higher levels of life satisfaction and social support.123(33.6%) suicide attempters were diagnosed as having at least one mental disorder in all attempted suicides, meanwhile33cases had at least two mental disorders. The mainly diseases involved the major depression disorders (56.1%), alcoholic abuse (22.8%), unspecified psychotic disorder (7.3%). Only30cases (24.4%) of all the patients had turned to the organization for people with mental illness.In comparison with the attempted suicide without mental disorders, attempted suicide with mental disorders had lower income and more negative life events. The scores of anxiety, hopelessness and depression were higher in attempted suicides with mental disorders, but the scores of life satisfaction and self-esteem were lower (P<0.001).2. The relationship between5-HT2AT102C polymorphism and attempted suicideThree gene types of5-HT2A receptor T102C polymorphism were found in both groups in this study. CC, CT, TT in attempted suicide were27.6%,44.0%,28.4%, and CC, CT, TT in normal controls were24.6%,49.4%,26.0%. There was no significant difference in gene type frequency between cases and controls. The allele C appeared more frequently in attempted suicide (49.6%) than in controls (49.3%), but the allele frequency was not different between attempted suicides and controls. There was no significant difference with in gene type frequency between the male and female. Gene polymorphism of5-HT2A receptor T102C was not correlated with suicidal method, mental disorders, and social psychological aspects.3. High-risk populations of attempted suicideHigh education level and the social supports were negatively while the hopelessness and the negative life events were positively associated with attempted suicide. High-risk characteristic clusters of suicide attempters in Shandong Province mainly were:①depression and hopelessness;②depression and no hopelessness;③no depression, negative life events and low life satisfaction.4. Follow-up study of subjects carrying different genotypeDuring the follow-up period there was no significant difference in the scores of life satisfaction, social support, anxiety, hopelessness and depression between attempted suicide carrying different genotype. The scores of life satisfaction and social support increased, while the scores of anxiety, hopelessness, depression, and life events obviously declined in attempted suicide. Compared with the normal controls, the attempted suicide had lower levels of life satisfaction and social support, while had higher levels of anxiety, hopelessness, depression, self-esteem and negative life events.Conclusions(1) People tended to commit suicide at home, in summer, spring, daytime, and by taking poison.(2) There were no significant differences in the distribution of genotype and allele frequency between attempted suicide and controls. It’s found that gene polymorphism of5-HT2A receptor T102C was not associated with attempted suicide. It’s found that gene polymorphism of5-HT2A receptor T102C was not correlated with suicidal method, mental disorders, and social psychological aspects.(3) High education level and the social supports were negatively, while, the hopelessness and the negative life events were positively associated with attempted suicide. High-risk characteristic clusters of suicide attempters in Shandong Province mainly were:①depression and hopelessness;②depression and no hopelessness;③no depression; negative life events and low life satisfaction.(4) During the follow-up period there was no significant difference in the scores of psychological status between attempted suicide carrying different genotype.(5) Although there were significant changes in the status of attempted suicide, they still had substantial differences from the normal controls. They were distinct high-risk subgroup that deserves specific interventions. |
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