Authored by Saeed Shoja Shafti
Introduction: Suicidal behavior is seen in the context of a variety of mental disorders and while many believe that, in general, first episode psychosis is a particularly high-risk period for suicide, no general agreement regarding higher prevalence of suicide in first episode psychosis is achievable. In the present study, suicides and suicide attempts among child and adolescent psychiatric in-patients has been evaluated to assess the general profile of suicidal behavior among native psychiatric inpatients.
Methods: All child and adolescent psychiatric inpatients with suicidal behavior (successful suicide and attempted suicide, in total), during the last five years (2013-2018), had been included in the present investigation.
Results: Among 748 child and adolescent psychiatric patients hospitalized in razi psychiatric hospital during a sixty months’ period, 14 suicide attempts, without any successful suicide, had been recorded by the safety board of hospital. The most frequent mental illness was bipolar I disorder (50%), followed by conduct disorder (42.85%), and substance abuse disorder (7.14%), with no significant difference among them. In addition, no significant difference was evident between the first admission and recurrent admission inpatients, totally and separately.
Conclusion: While in the present study the suicidal behavior was non-significantly more evident in bipolar disorder in comparison with other psychiatric disorders, no significant difference was evident between first admission and recurrent admission child and adolescent psychiatric inpatients.
Keywords: Child and adolescent; Psychiatric disorders; Suicide; Suicide attempt; First admission; Recurrent admission; Bipolar disorder; Conduct disorder; Substance abuse disorder
Introduction
The WHO report “Preventing suicide: a global imperative” published in 2014 estimates that over 800,000 people die by suicide, and more than 20 million attempts suicide each year. This implies that every 40 seconds, a person dies by suicide somewhere on the globe, and every 1.5 seconds, someone will attempt to take his/her own life. However, those numbers are underreported, as not all countries in the world report suicide mortality to the WHO Globally, suicides account for 52 percent of all violent deaths in men and 71 percent of all violent deaths in women. In high-income countries, 79 percent of violent deaths in both males and females are caused by suicide. Suicide occurs in all regions of the world and throughout the life span, and it accounts for 1.4 percent of all deaths worldwide, by that, ranking as the 15th leading cause of death [1].Suicide is rare in childhood and early adolescence and becomes more frequent with increasing age. The latest mean worldwide annual rates of suicide per 100 000 were 0.5 for females and 0.9 for males among 5-14-year-olds, and 12.0 for females and 14.2 for males among 15-24-year-olds, respectively. In most countries, males outnumber females in youth suicide statistics. Although the rates vary between countries, suicide is one of the commonest causes of death among young people. Due to the growing risk for suicide with increasing age, adolescents are the main target of suicide prevention. Reportedly, less than half of young people who have committed suicide had received psychiatric care, and thus broad prevention strategies are needed in healthcare and social services. Primary care clinicians are key professionals in recognizing youth at risk for suicide [2]. In ten years follow up of eighty-eight subjects with adolescent-onset psychotic disorders, mainly schizophrenia and affective disorders, 4.5% of subjects had died from suicide while another 25% of the subjects had attempted suicide [3].
In the context of suicide, there is a growing body of evidence showing that exposure to early-life maltreatment can affect molecular mechanisms involved in the regulation of behavior through methylation and histone modification, supposed to induce behavioral deviations during the early development, and possibly later in life, affect genes involved in crucial neural processes. This mechanism is called epigenetics. Childhood abuse and other detrimental environmental factors seem to target the epigenetic regulation of genes involved in the synthesis of neurotrophic factors and neurotransmission [4]. On the other hand, some scholars believe that People with first episode psychosis (FEP) are at increased risk of premature death, suicide [5].
According to the findings of a study, the rate of attempted suicide among young people undergoing treatment for first episode psychosis was around 12%. Of these 72.6% attempted suicide on one occasion. 85.3% of attempts occurred when patients were treated as outpatients and were in regular contact with the service. 77.6%of suicide attempts tended to be impulsive triggered by interpersonal conflict or distress due to psychotic symptoms. Two thirds involved self-poisoning, usually by overdose of prescribed medications. All inpatient suicide attempts were by hanging or strangulation.
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