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Profile Differences Between Overdose and Non-Overdose Suicide Attempts in a Multi-Ethnic Asian Society Cyrus S

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Profile Differences Between Overdose and Non-Overdose Suicide Attempts in a Multi-Ethnic Asian Society Cyrus S Ho et al. BMC Psychiatry (2016) 16:379 DOI 10.1186/s12888-016-1105-1 RESEARCH ARTICLE Open Access Profile differences between overdose and non-overdose suicide attempts in a multi-ethnic Asian society Cyrus S. H. Ho1*, Y. L. Ong1, Gabriel H. J. Tan1, S. N. Yeo2 and Roger C. M. Ho1 Abstract Background: This study explores differences in characteristics of overdose (OD) and non-overdose (NOD) suicide attempts in Singapore. Methods: Four hundred eighty-five medical records of people who attempted suicide were extracted from a local general hospital patient database and classified into OD and NOD groups. Differences in socio-demographic factors, suicide characteristics and hospital admission types between both groups were examined. Results: Indians were more likely than the Chinese and Malays to employ OD method in their attempts. More suicide attempts in the OD group than NOD group were self-reported. The most likely place for suicide attempts for both groups was at home, though more NOD suicide attempts were in public areas as compared to the OD group. Analgesics were the most used substance in the OD group. Those who attempted suicide using OD had a higher number of psychiatric ward admissions than the NOD group. Risk and protective factors varied between both groups. Conclusion: Differences in socio-demographics, suicide characteristics and admission characteristics between OD and NOD groups were observed. Recommendations for suicide prevention in the community are discussed. Further studies on the mediators and moderators of these trends and characteristics of suicide attempts are necessary to ensure maximal efficacy of prevention and management. Keywords: Overdose, Non-overdose, Suicide attempts, Multi-ethnic, Asian Background suicide methods persist. Suicide methods have been found Suicidal behaviour is a global public health concern that to be particularly influenced by the availability, knowledge, leads to not only an immense financial burden on society, past experiences, symbolism, cultural significance, and but also incurs a hefty psychological toll on survivors and mental state of the attempters [4]. The psychosocial needs their loved ones. Each year, 10–20 million individuals of suicidal individuals could also contribute to the chosen attempt suicide and over 800,000 lives are lost [1]. Despite method of suicide [5]. Differences in methods may lead to the fact that Asian countries account for about 60 % of different outcomes such as repetitive suicide attempts or global suicides [2], there is inadequate resources to tackle eventual suicide completion [6, 7], which have differing the magnitude of the problem in this region. This is com- implications on the regional health system and financial pounded by the lack of reliable statistics and rigourous costs. Modification of the environment by restricting suicide research. While extant literature has data on epi- access to lethal means such as firearms, pesticides and demiologic characteristics and trends of suicide methods charcoal burning have been found to reduce method- common in Asia [3], the gaps in knowledge on the influ- specific suicide rates, and when the method is prevalent, it ence of various characteristics and risk factors on different could lead to decline in the overall suicide rate [8]. Never- theless, there have also been other studies that suggested * Correspondence: [email protected] restriction of certain means might not effectively reduce 1Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Lower Kent suicide risk as it might prompt suicidal individuals to Ridge Road, Singapore 119 228, Singapore consider alternative means of suicide, which potentially Full list of author information is available at the end of the article © The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Ho et al. BMC Psychiatry (2016) 16:379 Page 2 of 7 could be more fatal [9]. Therefore, it is imperative that a general hospital (National University Hospital, Singapore) a greater emphasis be placed on understanding the intri- database. Data sources included the suicide risk assessment cacies of suicidal behaviour in Asia by elucidating the forms, psychiatric reports, in-patient records and electronic suicide characteristics of each country and culture. The notes. The assessment was done by the psychiatrist and this World Health Organisation (WHO) recommends the was part of the protocol of standard operating procedures enhancement of suicide prevention efforts by improving for patients admitted following a suicide attempt. The the availability and quality of data from hospital-based interview was based on a semi-structured checklist ap- systems [10]. The knowledge acquired from such data will proach. A formal diagnosis was made by the psychiatrist play a pivotal role in the formulation and implementation based on the Diagnostic and Statistical Manual of Mental of targeted suicide prevention measures. Disorders Fourth Edition (Text Revision) (DSM-IV-TR) Singapore which is ranked 97th in the world in terms criteria. of number of suicide deaths [11], is a culturally diverse The suicide risk assessment form that was used in the society (Chinese: 74.3 %, Malay: 13.3 %, Indian: 9.1 %, study contained stressors that comprised of work-related Others: 3.2 %) in Southeast Asia [12]. The most com- issues, family-related issues, relationship problems, finan- mon methods of suicide in Singapore include jumping cial difficulties and medical illnesses; risk factors that from height, hanging, and poisoning [13]. Most studies included history of psychiatric illnesses, family history of suicide in Singapore are based on data obtained from of psychiatric illnesses, staying alone, alcohol or substance the Registry of Birth and Death, and from Coroner’s misuse, ongoing interpersonal problems, lack of confi- Court reports [14, 15] and few studies have analysed dantes, serious physical illnesses, poor coping skills, severe thedatafromhospitals.Aspartofstandardoperating financial problems and unemployment; and protective procedures in the hospital systems of Singapore, a patient factors that consisted of faith in a religion, resolution admitted following his or her suicide attempt is required of precipitants, receiving support from dependents, to undergo psychiatric assessment. Data from such as- expression of regret, positive plan for the future, will- sessment holds valuable information such as socio- ingness to seek help and good emotional support. All demographics and characteristics of suicide attempters suicide attempters were also asked to rate their impression that can guide future policies and protocols in suicide of lethality of their suicide method as part of the suicide prevention. The study was therefore conducted to com- risk assessment, which ranged from ‘not lethal,’‘moderately pare and contrast the profiles of suicide attempters. As lethal’ to ‘very lethal’. jumping from height and hanging are more likely than This assessment form was created by a team of psychi- poisoning to lead to suicide completion and thereby atrists in the department based on known common risk resulting in the lack of data of interest, we classified the factors of suicide. The initial and main aim of the check- attempters into overdose (OD) and non-overdose (NOD) list form was to serve as a clinical tool for the assessing groups for comparison. In this study, people who took psychiatrist to avoid missing out on the common pos- medication at higher doses beyond what was recom- sible stressors and risk/protective factors. To standardize mended by doctors with an intention to commit suicide the assessment, all the psychiatrists were briefed and were labeled under the OD group. As there have been trained on asking the questions in the form so that few studies comparing the suicide profile of people who they could reach a common consensus on the terms overdosed on drugs compared to those who used other and what they meant prior to using the form. methods, this would be a pertinent area of study. With Attempters were classified into either the OD group variation in the nature, circumstances and lethality of if there were indications of consumption of pharma- suicide method between OD and NOD groups, we cological or chemical substances in the attempt or the hypothesised that there would be differences in socio- NOD group for all other forms of deliberate self-harm, demographics, suicide characteristics, as well as risk and including lacerations, stabbing, jumping from height protective factors between the two groups. The present and hanging. Written informed consent was obtained study also serves as an update to a previous study done from all the participants in the study. The study was between 2004 to 2006 [16] and explores the differences approved by the Domain Specific Review Board (DSRB) in characteristics between OD and NOD attempters (DSRB Reference: 2013/00800). in Singapore.
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