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Procedia Social and Behavioral Sciences 5 (2010) 1982–1985

WCPCG-2010

Suicidal attempts among individuals seeking treatment for substance dependency Bakhshani NM.a * ,Bahareh B.b, Bakhshani S.b, Lashkaripour K. b F

a

F

Zahedan University of Medical Sciences- Research center for children and adolescents health b Zahedan University of Medical Sciences- college of Medicine-Baharan Psychiatric Center Received January 9, 2010; revised February 19, 2010; accepted March 4, 2010

Abstract Addiction is identified as an important risk factor for suicidal behaviors .The aim of this study was to investigate the prevalence of suicidal attempts among individuals seeking treatment for addiction. The sample consisted of 250 individuals (16 women and 234 men) substance users fulfilling DSM-IV diagnostic criteria for substance dependence disorders, who were attending a university clinic for addiction in Iran. The results revealed that 16.8% of subjects reported attempting suicide at least once (17.9% of male addicts, whereas none of 16 women reported suicidal attempts). Crack users, I.V drug abusers, younger and single patients had more suicide attempts. Using knife was the most prevalent type of attempt (52.33%). The findings confirmed other reports of higher rates of suicide attempts among addicts and may suggest a greater emphasis should be placed on the identifying suicide risk factors among addicts and using appropriate strategies for prevention and treatment. © 2010 Elsevier Ltd. Open access under CC BY-NC-ND license. Keywords: Addiction, drug abuse, suicide , Iran.

1. Introduction Addiction is regarded as a major health and social problem in many countries (Bakhshani, 2003; Bakhshani, Lashkaripour& Sadjadi, 2008) and has been identified an important risk factor for suicidal behaviors (Rounsavill, Anton, Carrol, et.al 1991; Anderson, Howardand &Walker, 1995; Harris & Barraclough, 1997). Suicide is one of the main causes of death (Davoli, Peruse, Rapiti, et al, 1997;Hser, Hoffman, Grella, & Anglin, 2001). Opiate dependent individuals13.5 times greater than general populations are at high risk for suicide (Wilcox, Conner&Cain, 2004). Among the general population, lifetime and 12- month prevalence suicide estimated approximately 3-5% and 2.2% respectively (Borges, Walters& Kessler, 2000; Pirkis, Burgess, & Dunt, 2000; Malakouti, Nojomi, Bolhari et al,2009). O’Boyle and Brandon (1998) found that about 20% of substance users who had entered a substance abuse program had a positive history of suicidal attempts. In a study Kausch & Mc Cormick (2002) concerning prevalence of suicide in chemical dependency programs found that 11 out of 248 complete suicides occurred in outpatient substance abuse programs and 5 suicides occurred

* Bakhshani, N.M. Tel.: +98-541-4518352; fax: +98-541-4518352. E-mail address: [email protected] . H

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1877-0428 © 2010 Published by Elsevier Ltd. Open access under CC BY-NC-ND license. doi:10.1016/j.sbspro.2010.07.400

Bakhshani NM. et al. / Procedia Social and Behavioral Sciences 5 (2010) 1982–1985

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among those receiving combined outpatient substance abuse and psychiatric treatment and no suicide was among inpatients. Majority of people who committed suicide were male and were abusing alcohol. Besides, mood and personality disorders were associated with higher rate of suicide. Rounsaville, Anton, Carroll, Prusoff& Gawin (1991) found that 22.5% of cocaine abusers seeking treatment had at least one life time suicidal attempt and some studies in Scandinavian countries have shown that 30- 45% of substance dependent individuals have attempted to kill themselves. Moreover, gender and culture may have different impact on suicide risk among substance abusers. It is estimated that women are committing suicide three times more than men, but men three times more likely to complete. Schneider, Kõlves, Blettner, et al (2009) indicted the importance of cultural, sociopolitical and regional impact of suicide risk in alcoholism. As described above, although some studies report a higher rate of suicide among some special populations with addiction but there is no sufficient data about Iranian patients with substance dependence disorder. The aim of this study was to investigate the prevalence of suicidal attempts among individuals seeking treatment for addiction in an Iranian population. 2. Method The sample consisted of 250 (including 16 women and 234 men) substance users fulfilling DSM-IV (American Psychiatric Association, 1994) diagnostic criteria for dependence, who were attending a university clinic for addiction (Baharan Psychiatric Center) in Iran. About 31.2% were single and 68.8% were married. Demographic information of participants in the study was summarized in Table1. The mean age of participants was 25.30 years (aged 18 to 48 years). The participants were asked to give information regarding demographic characteristics (such as age, education, and marital status) type and customary of substance usage as well as history of suicide attempts. 3. Results The results of this study revealed that 16.8% of subjects reported attempting suicide at least once (17.9% of male addicts, whereas none of 16 women reported suicidal attempts). Opium or its derivatives (shireh) with or without cigarette was the first substance used by 100% of women (n=16) and 89.3% of men. Crack (4.2%), Hashish (4.2%) and cigarette (2.1%) were other drugs that used by men. Almost 21.2% of samples (22.6% of men vs. 0% of women) were I.V drug abusers. Percentage of suicide attempts was greater among single men (42.6%) than amid married ones (6.3%). And also the prevalence of suicide attempts was greater among crack users than opium addicts (36.52% vs.0%) (Table 2). Among suicide attempters using knife was the most prevalent method of attempt (52.33%) whereas, using drug (16.5%). pieces of glass (14.3%), hanging (9.53%) and weapon (7.15%) were other forms of attempting suicide applied by addicted men. The mean age of suicide attempters (mean = 24.12 years, SD = 2.29) was significantly (p= 0.013) lower than that of non-attempters (mean= 31.55, SD=7.92).

Table 1. Frequency of drug dependent patients based on socio-demographic variables

U

Variables

Male F (%)

Female F (%)

Total F (%)

Age 18-23

59(23.6 )

5(2)

64(25.6)

1984

Bakhshani NM. et al. / Procedia Social and Behavioral Sciences 5 (2010) 1982–1985 24-29 30-35 36-41 41< Total Marital status Married Single total Education Illiteracy Primary/Middle school High school University total

59(23.6) 59(23.6 ) 31(12.4 ) 26(10.4) 234(93.6)

11(4.4) 16(6.4)

59(23.6) 59(23.6) 42(16.8) 26(10.4) 250(100)

159(63.6) 75(30) 234(93.6)

16(6.4) 16(6.4)

175(70) 75(30) 250(100)

16(6.4) 117(46.8

16(6.4)

16(6.4) 133(53.3)

53(21.2) 48(19.2) 234(93.6)

16(6.4)

53(21.2) 48(19.2) 250(100)

Table 2. Frequency of drug dependent patients with and without history of attempted suicide

U

Variables + Marital status married Single total Education Illiteracy ĻHigh school High school University total

Variables

%Suicide attempt

%Suicide attempt + -

-

4.3 13.7 17.9

63.6 14.6 83.1

2.1 9 2.1 4.4

4.4 41 15.4 14.4

Kind of drugs Crystal/crack Opiates total Route of use Injection Non injection total

17.9 0 17.9

31.2 50.9 82.1

13.6 4.3 17.9

9 73.1 82.1

4. Discussion and Conclusion Almost 17% of substance dependent patients of present study had a positive history of suicide attempts. The results of the present study were consistent with earlier studies (O’Boyle & Brandon, 1998; Roy, 2003; Wilcox, Conner & Caine, 2004; Conner, Britton, Sworts&Joiner Jr,2007) confirmed that addicts are at higher risk for attempting suicide than general population (De Leo, Cerin, Spathnis& Burgis, 2005; Malakouti, Nojomi, Bolhari et al,2009). The rates of suicide attempts obtained from the current study were lower than the prevalence data reported by Roy (2003). Roy observed that 39% of drug dependent, 39% of cocaine dependent and 42.7% opiate-dependent individuals had attempted suicide at least once. Similar evidence was also found by O’Boyle & Brandon (1998). They found that about 20% of substance users who had entered a substance abuse program had a positive history of suicidal attempt. The subjects who attempted suicide similar to evidence provided by Yoshiko, Nobuaki & Yoji (2006) were significantly younger than those who had never attempted suicide. While in our study female participants did not report any suicide attempt. Roy’s (2003) found that more suicide attempters were female. Because of inadequate number of women in our study, it was difficult to estimate the extent to which the findings would be generalized to other populations. Dealing and using substance is therefore, very hard for women in Iran. Furthermore, the Iranian women are controlled and watched by their families and community more than men. Presumably, these social factors can influence on prevalence of substance abuse for women and entering treatment programs. Mokri (2002) reported that 90-93% of patients who entered a treatment program for substance dependence disorders were male. As expected, our findings showed that singles reported suicide attempts more than married patients and also percentage of suicide attempt among intravenous drug users was higher than those who used smoking form of drugs. Moreover, the subjects who had used crack, reported suicide attempts more than those who used only opiate or its derivatives (Shireh). The most common method of suicide among drug addicts in UK was drug overdose

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(Oyefeso, Ghodse, Clancy & Corkery 1999) however; in our study using knife or blades for cutting was reported as the most prevalent method of suicide. Limited number of women in our study retrospective and self- reported method for gathering the information were the most crucial restriction of this study. Nevertheless, the findings confirmed other reports of higher rates of suicide attempts among addicts and might suggest a greater emphasis should be placed on identifying suicide risk factors among patients with addiction and using appropriate strategies for prevention and treatment. References American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders. Fourth. American Psychiatric Association, Washington, DC. Anderson, B.A., Howard, M.O., Walker, R.D., & Suchinsky, R.T. (1995). Characteristics of substance-abusing veterans attempting suicide: A national study. Psychological Reports, 77, 1231-1242. Bakhshani, N.M.(2002). Prevention and treatment manual of addiction. Zahedan: Zahedan University of Medical Sciences. Bakhshani, N,M; Lashkaripour, K; & Sadjadi, S.A. (2008).A Randomized Effectiveness Trial of Methadone, TENS and Methadone plus TENS in Management of Opiate Withdrawal Symptoms. J Pak Med Assoc. , 58,667-671. Borges, G., Walters, E.E; & Kessler, R.C.(2000). Associations of substance use, abuse, and dependence with subsequent suicidal behavior. American Journal of Epidemiology,151,781–789. Conner, K.R; Britton, P.C; Swords, L.M;& Joiner Jr, T.E .(2007). Suicide attempts among individuals with opiate dependence: The critical role of belonging. Addictive Research. 32, 1995-1404. Davoli, M., Perucci, C.A., Rapiti, E., Bargagli, A.M., Dippoliti, D., Forastiere, F.,& Abeni, D.( 1992). A persistent rise in mortality among injection drug users in Rome, 1980 through 192. Am. J. Pub. Health, 87, 851–853. De Leo, D; Cerin, E; Spathonis, K;& Burgis, S.(2005). Lifetime risk of suicide ideation and attempts in an Australian community : Prevalence, suicidal process, and help-seeking behavior. Journal of Affective Disorders, 86, 215-224. Harris,C;& Barraclough,B.(1997). Suicide as an outcome for mental disorders. British Journal of Psychiatry, 170 ,205–228. Hser,Y.I; Hoffman, V; Grella, C.E;& Anglin, M.D.(2001). A 33-Year Follow-up of Narcotics Addicts. Arch Gen Psychiatry, 58,503-508. Kausch, O;& McCormick, R.A. (2002).Suicide prevalence in chemical dependency programs: preliminary data from a national sample, and an examination of risk factors. J Subst Abuse Treat,22,97-102. Malakouti, S,K; Nojomi, M; Bolhari, J; Hakimshoshtari,M; Poshtmashhadi,M;& De Leo, D.(2009). Prevalence of suicide thoughts, Plans and Attempts in a community sample from karaj. Community Ment Health J, 45,37-41. Mokri,A.(2002). Brief Overview of the Status of Drug Abuse in Iran. Arch Iranian Med,5, 184-90 O’Boyle, M; & Brandon, E.A.A.(1998). Suicide Attempts, Substance Abuse, and Personality. Journal of Substance Abuse Treatment,15, 353356. Oyefeso A, Ghodse H, Clancy C ; & Corkery JM(1999).Suicide among drug addicts in the UK. British Journal of psychiatry 175:277-282. Pirkis, J., Burgess, P., & Dunt, D (2000) Suicidal ideation and suicide attempts amongst Australian adults. Crisis, 21(1), 16-25. Roy, A.(2003). Characteristics of drug addicts who attempt suicide. Psychiatry Research, 121, 99-103. Rounsaville, B., Anton, S., Carroll, K., Prusoff, B., & Gawin, F.(1991). Psychiatric diagnoses of treatment-seeking cocaine abusers. Arch. Gen Psychiatr. 18, 48–61. Schneider, B; Kõlves, k; Blettner, M;, Wetterling, T; Schnabel, A; & Värnik, A. (2009). Substance use disorders as risk factors for suicide in an Eastern and a Central European city (Tallinn and Frankfurt/Main).Psychiatry Research ,165 ,263–272. Wilcox, H.C; Conner, K.R; & Caine, E.D .(2004). Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies. Drug and Alcohol Dependence, 76S, S11-S19. Yoshiko, O; Nobuaki, M; & Yoj, N.(2006). Study on suicide attempts among drug addicts- The prevalence of suicide attempts and investigation of related factors. Japanese Journal of Alcohol Studies& Drug Dependence ,41,39-58 (abstract). H

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