| BackgroundAttempted suicide is defined as the behavior of having taken action to hurt oneself with the ideas or wishes of death, which cause damage to the body of itself to a certain extent but not died successfully. Suicidal ideation or physical damage is a necessary condition for attempted suicide but not a sufficient condition. Attempted suicide is the most reliable predictor of committing suicide, and the risk of people having history of attempted suicide suicide again is20-40times the normal population. Attempted suicide rates is far higher than committed suicide rates. Attempted suicide rate is0.4%-4.2%according to an epidemiological suicide survey by WHO. More Female suicide attempters than men and people aged between15and44years are the peak groups of attempted suicide. Although China’s suicide mortality decline significantly, but China’s attempted suicide rates may not be so, especially attempted suicide rates of teenager groups. Either the number of committed suicide or the number of attempted suicide are among the world’s first because of big population bases, and suicide is still is a major public health problem and social problem in China. Therefore, situation of China’s suicide prevention and control is still grim, and research related with attempted suicide and its risk factors for suicide prevention, control and intervention has an important practical significance.In this paper, questionnaire survey was carried out to the attempted suicide groups found in emergency room of three comprehensive hospitals and to the control groups strictly matched by the cases groups. Our purpose is to find out risk factors of attempted suicide from socio-demographic factors, family and social environment factors, physical diseases and mental disorder factors, personality characteristics, psychosocial stress factors by comprehensive and in-depth analysis, providing a scientific basis for suicide prevention and control and related research in the future. Objective:(1) To explore epidemiological characteristics of patients with attempted suicide at emergency room of a large general hospital in Changsha.(2) To explore risk factors of attempted suicide by comparing socio-demographic factors, family and social environment factors, physical diseases and mental disorder factors, personality characteristics and psychosocial stress factors of attempted suicide groups and control groups.(3) To provide a scientific reference for suicide prevention, psychological intervention and treatment of suicide attempters and related research in the future.Methods:(1) SubjectsThis study belonged to a case-control study and the subjects were divided into groups of case (attempted suicide) group and control group. Attempted suicide randomly selected from the emergency room of three general hospitals in Changsha City using cluster sampling methods. Questionnaire and qualitative interviews were carried out to patients of attempted suicide in line with the continuous treatment of meting the inclusion criteria during1September2011to31August2012. Community residents matching by the case group of the same sex, the same community and age (±2years) were randomly selected for complish the questionnaires using simple random sampling method.(2) Contents and InstrumentsUsing the Chinese version of general information questionnaire, Life Event Scale, Social Support Scale, Level of Depression Scales, Dickman Impulsivity Scale, Moos’s Coping Response Inventory, Beck Hopelessness Scale, Spielberger’s Trait Anxiety Inventory and Beck Scale for suicidal ideation as the tool to investigate socio-demographic factors, family and social environment factors, physical diseases and mental disorder factors, personality characteristics and psychosocial stress factors of attempted suicide groups and control groups. Excel2007, SPSS18.0and AMOS17.0software were used for statistical analysis. Results:(1)The average age of132cases were (31.72±7.54) years old, and the male to female ratio was1:2.1.63.6%of them had been married and living together,75.0%junior high school education or less,76.7%living in rural areas.More than half of them were with poor or average marital relationship, so it was with the father/mother in law. More males patients could get help from family members than females, the difference was statistically significant (P<0.05).3.0%of attempted suicide groups were looking for help to get a psychiatrist and other professional treatment when facing pressure or difficulty.(2)132cases with suicidal peak of May, there was a significant central tendency in April to June (Z=25.237, P<0.05);109cases of rural residence with suicidal peak in May, there was a significant central tendency in March to July (Z=25.318, P<0.05);23cases living in city did not have a significant central tendency (Z=1.708, P>1.708).132cases were with suicidal peak at12:01-20:00(Z=16.703, P<0.05).50.8%(67/132) of patients suicide by taking pesticide,28.8%other poison or excessive medication,9.8%cutting their wrists.78.0%(103/132) of patients suicide at home.53.8%of patients without any preparation to commit suicide,78.0%of patients did not mention suicide ideation with people before suicide,86.4%no funeral arrangements,91.7%not leave the last words, a suicide note or the relevant diary. Direct cause of suicide among the top three was in order of a quarrel between husband and wife, accounted for27.0%(31/115); suffering from physical or mental illness, accounted for13.9%(16/115); life stress, alive boring, accounting for13.0%(15/115).8.3%(11/132) had a history of attempted suicide. Overall mental illness rate was11.4%(15/132), men’s mental illness rate (20.9%,9/43) was significantly higher than females (6.7%,6/89), the difference was statistically significant (x2=5.400, P=0.020); more mental illness patients were with a history of suicide attempts than those without mental illness, the difference was statistically significant (%2=19.558, P<0.001).(3) Overall average score of case groups’s social support rating was 29.68±5.97points, control group of38.80±4.17points; scores for each subscale of control groups’s social support rating were higher than the case groups, the difference was statistically significant (P<0.001). Overall average score of case groups’s depression rating was28.68±11.49points, control group of10.47±7.68points, except the positive dimension, scores for each subscale of control group’s epression rating were lower than the attempted suicide group, the difference was statistically significant (P<0.001). The most common life events before1year of suicide were a bitter quarrel incidence with their spouses or partners (30.3%), fighting with their spouses or partners (16.7%), quarrel with family members (16.7%), catching with discrimination or being misunderstanding (15.2%) and a falling revenues (12.1%). The total incidence of negative life events was75.0%, and the average negative life events of case groups were2.38±2.34. Stimulating quantity of related negative life events of case groups were significantly higher than that of the control groups, the difference was statistically significant (P<0.001). Case groups’s impulsive personality rating were11.33±3.14points, control groups of9.67±3.65points, case groups in overall impulsive personality rating and the non-functional impulsive personality rating were significantly higher than the control groups (P<0.001); but there was no statistically significant difference in functional impulsive personality rating (t=1.585, P=1.585). Case groups’s positive response action rating was35.11±10.75points, control groups of46.55±9.05points. Case groups’s passive avoidance response rating was36.17±8.80points, control groups of35.27±8.29points.Case groups’trait anxiety level rating was52.28±5.90points control groups of41.92±5.77points; case groups’ despair level rating was60.83±9.13points, control groups of44.71±7.15. Trait anxiety level and despair level rating of case groups were significantly higher than that of control group, the difference was statistically significant (P<0.001).57.6%of case groups had suicidal ideation when interviewing, while7.6%of the control groups.(4)Multivariate logistic regression analysis of overall paired samples showed that low educational level (OR=9.981,95%CI:1.376-72.396), low family status or general (OR=2.982,95%CI:1.163-7.645), high level of depression (OR=151.994,95%C I:14.679-1573.774), high levels of hopelessness (OR=28.888,95%CI:3.721-224.257), high levels of impulsivity (OR=4.952,95%CI:2.072-11.838) were risk factors for attempted suicide, and high level of social support (OR=0.008,95%CI:0.001-0.076) and could get help when facing stress or difficulties (OR=0.076,95%CI:0.012-0.501) were protective factors for attempted suicide; age and gender interaction was not statistically significant (P>0.05).Multivariate conditional logistic regression analysis of Women paired samples showed that low educational level (OR=7.919,95%CI:1.464-42.827), instability type of marital status (OR=68.514,95%CI:2.094-2241.272) high levels of depression (OR=27.768,95%CI:5.146-149.844), high levels of hopelessness (OR=3.531,95%CI:1.050-11.872), high levels of impulsivity (OR=3.379,95%CI:1.228-9.299) were risk factors for attempted suicide, and the high level of social support (OR=0.002,95%CI:0.001-0.079) were protective factors for attempted suicide.(4) Multivariate logistic regression of males paired samples analysis showed that low educational level (OR=23.850,95%CI:2.831-200.891), high levels of hopelessness (OR=21.315,95%CI:2.473-183.6842) and high levels of impulsivity (OR=11.926,95%CI:1.463-97.189) were risk factors for attempted suicide, and the high level of social support (OR=0.002,95%CI:0.001-0.062) and could get help when facing stress or difficulties (OR=0.024,95%CI:0.003-0.022) were protective factors for attempted suicide. There were a negative interaction between hopelessness and education, social support in overall paired samples (P<0.05). There were a negative interaction between depression and social support in overall paired samples (P<0.05). There were a negative interaction between hopelessness and education, social support in females paired samples (P<0.05). There were a negative interaction between depression and social support in females paired samples (P<0.05). There were a negative interaction between depression and social support in males paired samples (P<0.05). (5) The fitting structural equation model showed that hopelessness acted as a mediating variable of suicide. Hopelessness levels had the strongest positive effect for suicidal ideation, and its overall effect was0.692; followed by impulsive personality, the overall effect was0.438,0.426of overall effect and indirect effects of anxiety,0.322of overall effect and indirect effects of social support. Overall effect of depression was0.103,0.036of direct effect,0.067of indirect effect. Decision tree analysis found that the risk of attempted suicide groups were characterized by:accompanied by feelings of hopelessness, anxiety and depression; accompanied by feelings of hopelessness, anxiety, and low educational; accompanied by feelings of hopelessness and the occurrence of negative life events.Conclusion:(1) Female patients attempted suicide are about2times of men, mainly by pesticide suicide, and most suicide sites occur at home. The suicidal peak time point is12:01-20:00, peak of May in rural areas.8.3%have a history of attempted suicide, and the overall mental illness rate is11.4%, male20.9%and female6.7%.(2) Low level of education, high levels of despair and high impulsivity level are risk factors for suicide attempts, and high level of social support, can get help when facing stress or difficulties are protective factors for suicide attempts. There is a negative interaction between hopelessness and education level, social support, and a negative interaction between depression and social support. Low education level is likely to be an independent risk factor of suicide for men and women. Depression is likely to be an independent risk factor of suicide for women.(3) Feelings of hopelessness existed as a mediating variable of stimulation of negative life events, anxiety, social support and other factors to suicide. There is a high correlation between feelings of hopelessness and suicidal intent strength. Characteristics of impulsivity personality have a direct effect to suicide attempters, while depression has little effect to suicide attempts. (4) High risk characteristics group of attempted suicide: accompanied by feelings of hopelessness, anxiety and depression; accompanied by feelings of hopelessness, anxiety, and low educational; accompanied by feelings of hopelessness and the occurrence of negative life events. |
PDF Full Text Request