Suicide attempt in rural area of vietnam: Follow - up with regard to repeated attempt and completed suicide

Nội dung text: Suicide attempt in rural area of vietnam: Follow - up with regard to repeated attempt and completed suicide

1. JOURNAL OF MILITARY PHARMACO-MEDICINE N 07-2016 SUICIDE ATTEMPT IN RURAL AREA OF VIETNAM: FOLLOW-UP WITH REGARD TO REPEATED ATTEMPT AND COMPLETED SUICIDE Nguyen Van Tuan*; Peter Allebeck** SUMMARY Objectives: To follow-up individuals after the index attempt regarding repeated attempt, completed suicide, methods used and socio-demographic characteristics in rural area in Vietnam. Subjects and methods: All suicide attempt patients (104) during 2003 - 2007 were identified in a population. They were diagnosed and re-evaluated by trained physicians according to the research criteria of the WHO Multicentre Study of Attempted Suicide. All people who had attempted suicide were followed for 1.5 - 6.5 years with regard to reattempted or completed suicide. Information was collected by interviews with those who had attempted suicide and family members of those who had committed suicide. Interviews were performed by trained medical staff to investigate socio-demographic characteristics and methods used for suicide attempt and completed suicide. Results: Of the 104 attempt suicide people, 13 people (12.5%) repeated suicide attempt and six people (5.8%) committed suicide during the follow-up period. Drugs were used in mainly reattempt cases (8 cases) and pesticides (5 cases) for repeated suicide attempt, and pesticides, hanging and drowning for completed suicide. All repeated attempt suicides were under 45 years old, whereas those who completed suicide had a more diverse age distribution. The proportion of unemployed and disabled people was higher than that at index attempt. 10.6% of attempt suicide people received psychiatric care at the index attempt. Conclusion: The risk of reattempt and completed suicide is increased among patients who have attempted suicide. Drugs were used in many reattempt cases, whereas completed suicide mainly performed by pesticides or hanging. Mental health services should be strengthened to take care of and follow-up patients who have attempted suicide. Pesticides are still a public health problem in rural areas and should be better controlled. * Key words: Suicide; Attempt suicide; Completed suicide. INTRODUCTION first year after the index attempt [5]. In follow-up studies, the repetition rate within Attempted suicide is a strong predictor a year has varied between 9% and 32% for completed suicide, but it is also a health problem in itself, since it may [6, 7, 8]. Many attempts occur already cause severe harm and disability [1]. within 6 months and this rate has been found to be between 10% and 37% [9]. Individuals who have attempted suicide often reattempted suicide [2, 3]. Repetition We have found few studies on suicide has been found to be a predictor for attempts from Asian countries. The crude completed suicide [4]. Repetition of suicide rate of suicide attempt in India has been attempt is especially common during the reported to be 49 - 81/100 000 annually [11]. * Hanoi Medical University ** Karolinska Institute, Stockholam, Sweden Corresponding author: Nguyen Van Tuan (vntuannmh@hmu.edu.vn) 59
2. JOURNAL OF MILITARY PHARMACO-MEDICINE N 07-2016 In Singapore, Tsoi reported 55 - 92/100 harvest time to work as temporary 000 in 1986 [11]. Especially, South East workers in the city or in other provinces. Asian countries with a rapid economic The major ethnic group is Kinh, which is development and social transition are the biggest group in Vietnam. important to monitor with regard to the The health care system in this area is epidemiology of suicide and suicide organized according to the national system attempt. In an urban area of Vietnam, the of rural health services of Vietnam. The prevalence rate for lifetime suicide public health care services consist of two attempts has been estimated to 0.4% district hospitals, with approximately 120 [12]. A study on suicide attempt in Hanoi beds in each, and 29 community health [13] found that medical attention following stations. District hospitals are mainly a suicide attempt was needed in 22.25% responsible for curative care, while of the attempts. 22.2% of respondents community health stations are responsible who reported one or more suicide attempts for primary health care including essential required medical attention or hospital curative care and preventive care. There admission. We have not found any study is a small pharmacy available in each from Vietnam following person who have community health station and only a few attempted suicide, to assess predictor of private pharmacies are located in this area. repeated attempt or completed suicide. In this study, we have followed up 2. Data collection. these subjects with the aim to analyze the As described previously [14], we identified occurrence of reattempted suicide and people who had been admitted to the completed suicide in this population. In district hospitals, as well as all health care particular, we want to 1) Assess prevalence stations, during 2003 - 2007 in Gialuong and methods used of reattempted suicide; area after having committed either a 2) Assess prevalence and methods used definite suicide attempt or an uncertain of completed suicides; and 3) Find out suicide attempt according to ICD-10. In to differences of socio-demographic addition, cases that were treated at home characteristics among this population at by medical staff from the community health the index attempt. stations after suicide attempt were also PATIENTS AND METHODS included. For those who had committed more than one suicide attempt during 1. Setting. study period, the first attempt was defined The study was conducted in a rural as the index attempt. Each case of suicide area of Gialuong in Bacninh province, attempt was diagnosed and re-evaluated located in the Red River Delta of the by trained physicians according to the northern part of Vietnam. The majority of research criteria of the WHO Multicentre residents are farmers. Others are civil servants, manual workers and small Study of Attempted Suicide [1]. traders. The main economic activity in the Data was initially collected retrospectively area is farming. During the last years, a in 2008 based on records kept at the growing number of people have left after health services and interviews with medical 60
3. JOURNAL OF MILITARY PHARMACO-MEDICINE N 07-2016 staff and covering the period from 1, Multicentre Study of Attempted Suicide [1] January 2003 to 31, December 2007. A to record data on age, gender, marital total of 104 people, 54 males and 50 status, types of living, occupation, date of females were identified in this procedure. the event, methods used, reattempted and In 2009, a follow-up study was performed completed suicide after the index attempt. on these subjects up to 30, June 2009, in The study was approved by the order to identify repeated suicide attempt Institutional Review Board of Hanoi Medical and completed suicide with a follow-up University time of at least one and a half year. * Statistical analyses: All individuals who had attempted suicide and their family members who had Data were analyzed by using SPSS for completed suicide after the index attempt Window Version 10.0 (SPSS, Chicago. were interviewed face-to-face at their IL, USA). Statistical significance for differences home by trained medical staff working at between groups was assessed by chi-2 the community health stations. We used test or whenever appropriate Fisher’s the instrument developed by the WHO exact test. RESULTS Of the 104 subjects, 13 people reattempt suicide and six people committed suicide during the follow-up period after the index attempt. Table 1: Methods used in reattempted and completed suicide in relation to methods in the index attempt. Index attempt Reattempted suicide Completed suicide (n = 104) (n = 13) (n = 6) X61: X68: X68: X70: X71: antiepileptics pesticides pesticides hanging drowning X60: non-opiate analgesics, antipyretics 3 and anti-rheumatics X61: antiepileptic, 34 8 sedative-hypnotic, anti- parkinsonism and psychotropic drugs X68: pesticides 66 5 2 X70: hanging 0 3 X71: drowning 0 1 X78: blunt object 1 Drugs were used in mainly reattempt cases (8 cases) and pesticides (5 cases). Thus, the proportion of attempt by drug poisoning was significantly higher (p = 0.032) than at the index attempt. 61
4. JOURNAL OF MILITARY PHARMACO-MEDICINE N 07-2016 Although the study size is small, it is noteworthy that pesticides, hanging and drowning are main methods used in completed suicide. Table 2: Duration between index attempt and reattempted and completed suicide. Reattempted suicide Completed suicide (n = 13) (n = 6) < 1 years 8 4 1 - 2 years 4 2 3 - 6.5 years 1 0 The majority of cases of reattempted as well as completed suicide were committed in the first year after the index attempt. Only one case of repeated attempt occurred more than 3 years after the index attempt. Table 3: Socio-demographic characteristics of patients at the index attempt compared to people who reattempted and completed suicide after the index attempt. Index Repeated Completed attempt attempt suicide (n = 104) (n = 13) (n = 6) Age (years) < 20 27 5 1 20 - 44 57 8 2 45 - 64 15 0 3 ≥ 65 5 0 0 Sex Male 54 6 3 Female 50 7 3 Marital status Unmarried 31 2 2 Married 68 9 4 Divorced/separated/widowed 5 2 0 Highest Primary education 5 0 2 completed Secondary education 29 6 1 education Non-university higher education 47 5 1 University education 21 2 2 Others 2 0 0 Employment Employment/studying/ 97 8 3 status housewife/homemaker/retired Unemployment 4 3 2 Disabled, permanently sick 3 2 1 Psychiatric No psychiatric care 93 10 6 care In-patient psychiatric care 5 2 0 Out-patient psychiatric care 6 1 0 62
5. JOURNAL OF MILITARY PHARMACO-MEDICINE N 07-2016 Table 3 shows characteristics of those Repetition of attempted suicide is who reattempted suicide and completed common during the first year after the suicide, in relation to characteristics at the index attempt [3, 5]. Our findings show index attempt. All reattempted suicides that also in a Vietnamese rural population, were under 45 years old, whereas those the rate of repetition is high in general during who completed suicide had a more diverse the first year after the index attempt. This age distribution. The male-to-female ratio should be known to general health services, of reattempted suicide and completed since mental health services are not suicide was basically the same the index developed in the countryside in Vietnam, attempt. Also the distribution regarding as it is the case for many countries in the to marital status and highest completed area. The rate of reattempted suicide in education was basically similar to that at our study within a year (during 2003 to the index attempt. 2009) was 8%, which is in the lower range The proportion of unemployed and of what has been reported in the literature disabled people were significantly higher (9 - 32%) [7, 8]. (p = 0.004) compared to other groups. The use of pesticides was less common None of those who completed suicide had among reattempted suicide compared to been in contact with psychiatric care after at the index attempt. This may reflect a the index attempt, and only 3 of those who tendency of more attempted suicide being reattempted suicide were found among committed by drugs compared to pesticides the 11 of attempt suicides who received as previously shown [14]. This should be psychiatric care after the index attempt. known by general health services as these often are the main points of contact DISCUSSION as mentioned above. The study is based on a limited number 2. Completed suicide. of cases, but it is the only population Six percent of our subjects were based follow-up patients who have completed suicide during the follow-up attempted suicide in Vietnam and a few in and the majority of these during the first Asian countries [13]. year after the index attempt. This rate is 1. Reattempted suicide. higher than the figure given by Hawton In our study, 12.5% of the patients (or and Fagg (1988) (1%) but lower than 31/100,000 person-years) reattempted Isometsa and Lonnqvist’s report (10%). suicide during the follow-up period. This We thus confirmed that also in this is three times higher than the rate of Vietnamese population, the risk of attempted suicide in the general population completed suicide after the index attempt (10.2/100000 person-years) in the same is considerable, as it has been noted in area [14]. The rate of reattempted suicide many Western studies. in our study is lower compared to the Methods used in completed suicide were results from other studies, 49-81/100 000 high lethal methods, including pesticides, in India and 55-92/100 000 in Singapore hanging and drowning. It is interesting to [7, 11]. note that we found no cases of completed 63
6. JOURNAL OF MILITARY PHARMACO-MEDICINE N 07-2016 suicide by pharmaceutical drugs, REFERENCES although several of those who 1. Schmidtke A, Bille-Brahe U, DeLeo D, reattempted suicide using pharmaceutical Kerkhof A, Bjerke T, Crepet P, et al. drugs. It is possible that people who do Attempted suicide in Europe: rates, trends and have an intention to die from the act used sociodemographic characteristics of suicide higher lethal methods and in that case it is attempters during the period 1989 - 1992. “better” that pharmaceutical drugs are Results of the WHO/EURO Multicentre Study used in case of suicide attempt rather on Parasuicide. Acta Psychiatr Scand. 1996, May, 93 (5), pp.327-338. than pesticides. From our study as well as many other previous findings, we thus 2. Cedereke M, Ojehagen A. Prediction of repeated parasuicide after 1 - 12 months. Eur confirmed that pesticides are still common Psychiatry. 2005, Mar, 20 (2), pp.101-109. and serious method of suicide in low and 3. Appleby L, Shaw J, Amos T, McDonnell middle income countries. R, Harris C, McCann K, et al. Suicide within In spite of small size of the study, it is 12 months of contact with mental health noteworthy that none of those who completed services: national clinical survey. BMJ. 1999, suicide had been in contact with psychiatric May, 8, 318 (7193), pp.1235-1239. care after the index attempt. This gives 4. Beck AT, Kovacs M, Weissman A. further strength to the point raised in our Assessment of suicidal intention: the Scale for previous paper [14] that access to and Suicide Ideation. J Consult Clin Psychol. public acceptance of mental health care 1979, Apr, 47 (2), pp.343-352. should be strengthened in Vietnam. 5. Carter GL, Whyte IM, Ball K, Carter NT, Dawson AH, Carr VJ et al. Repetition of CONCLUSION deliberate self-poisoning in an Australian hospital-treated population. Med J Aust. 1999, The rate of re-attempted and completed Apr, 5, 170 (7), pp.307-311. suicide is increased among patients who 6. Foster T, Gillespie K, McClelland R. have attempted suicide, also in Vietnam. Mental disorders and suicide in Northern Drugs were the main method used in re- Ireland. Br J Psychiatry. 1997, May, 170, attempt, whereas completed suicide pp.447-452. mainly was performed by pesticides or 7. Gilbody S, House A, Owens D. The hanging. Mental health services should be early repetition of deliberate self harm. J R strengthened to take care of and follow-up Coll Physicians Lond. 1997, Mar-Apr, 31 (2), people who have attempted suicide. pp.171-172. Pesticides are still a public health problem 8. Hassanyeh F, O'Brien G, Holton AR, in rural areas and should be better controlled. Hurren K, Watt L. Repeat self-harm: an 18- month follow-up. Acta Psychiatr Scand. 1989, ACKNOWLEDGEMENTS Mar, 79 (3), pp.265-267. 9. Hawton K, Arensman E, Townsend E, This study was funded by the Swedish Bremner S, Feldman E, Goldney R et al. International Development Cooperation Deliberate self harm: systematic review of Agency (SIDA) within the project of efficacy of psychosocial and pharmacological collaboration between Hanoi Medical treatments in preventing repetition. BMJ. University and Karolinska Institute. 1998, Aug, 15, 317 (7156), pp.441-447. 64
7. JOURNAL OF MILITARY PHARMACO-MEDICINE N 07-2016 10. Runeson B, Tidemalm D, Dahlin M, 13. Fleischmann A, Bertolote JM, De Leo Lichtenstein P, Langstrom N. Method of D, Botega N, Phillips M, Sisask M et al. attempted suicide as predictor of subsequent Characteristics of attempted suicides seen in successful suicide: national long term cohort emergency-care settings of general hospitals study. BMJ. 341, c3222. in eight low-and middle-income countries. 11. Thanh HT, Jiang GX, Van TN, Minh DP, Psychol Med. 2005, Oct, 35 (10), pp.1467- Rosling H, Wasserman D. Attempted suicide 1474. in Hanoi, Vietnam. Soc Psychiatry Psychiatr 14. Nguyen VT, Dalman C, Le CT, Nguyen Epidemiol. 2005, Jan, 40 (1), pp.64-71. VT, Tran VN, Allebeck P. Suicide attempt in a 12. Tran Thi Thanh H, Tran TN, Jiang GX, rural area of Vietnam: Incidence, methods Leenaars A, Wasserman D. Life time suicidal used and access to mental health care. thoughts in an urban community in Hanoi, International Journal of Mental Health System. Vietnam. BMC Public Health. 2006, 6, p.76. 2010. 65