Rev. Med. Chir. Soc. Med. Nat., Iai 2016 vol. 120, no.

INTERNAL MEDICINE - PEDIATRICS ORIGINAL PAPERS

ATTEMPTED SUICIDE: A CROSS-SECTIONAL SURVEY 2015

Mihaela Corlade-Andrei1 , Diana Carmen Cimpoeu 1*, Viorica Popa 1,

P. Nedelea1 , O. T. Popa1 , Simona Drochioi2 , Gabriela Grigorai 1
Grigore T. Popa University of Medicine and Pharmacy Iai
Faculty of Medicine
1. Department of Surgery (II)
2. Department of Mother and Child Medicine
*Corresponding author. E-mail: dcimpoiesu@yahoo.com

ATTEMPTED SUICIDE: A CROSS-SECTIONAL SURVEY 2015 (Abstract): Aim: Suicide

is a global health problem with an increasing incidence among young adults and teenagers.
The study was aimed at analyzing the profile and identifying the frequency, nature, and co n-
tributing factors of suicides. Material and methods: This retrospective study included all
patients who attempted suicide admitted to the Emergency Department (ED) of St Spiridon
Hospital Iasi - Romania, during 2015. They were analyzed by sex, age, residence, suicide
method, associated pathology, potential risk factors and interventions. Results and discus-
sion: The study included 368 patients (53.81% female and 46.19% male). 63.58% were ad-
mitted to ED for drug ingestion, 14.13% for ingestion of organophosphorus compounds, rat
poison, herbicide and corrosive substances and 22.28% for traumatic suicide attempts. Drug
ingestion (42.11%) was preferred by women while self-inflicted cut injuries (14.94%) and
corrosive substance ingestion (8.42%) were more common in males. Benzodiazepines inge s-
tion (20.10%) followed by self-inflicted cut injuries (13.85%) and corrosive substance inge s-
tion (6.52%) were the most frequently used suicide methods. At the time of admission to
ED31.52% of patients were on psychiatric treatment and 65.48% were at the first suicide a t-
tempt. The admission rate was 57% and mortality rate 0.27%. Conclusions: Suicidal behav-
ior can be prevented by psychotherapeutic, pharmacological or neuromodulatory treatments
for mental disorders. Also, regular follow-up of people who attempted suicide by mental
health services is key to preventing future suicide attempts. Keywords: SUICIDE, SUICIDE
METHOD, SUICIDE ATEMPT, RISK FACTORS, SELF-INFLICTED CUT WOUNDS.

Suicide is a major health problem
worldwide, particularly among teenagers
and young adults (1, 2, 3, 4).
Suicide attempt is the main cause of
death in young people, accounting for over
50% of violent deaths (5, 6, 7, 8, 9). Ac-
cording to the statistics published by spe-
cialized institutions (EUROSTAT, OECD
and WHO) for the years 2013 and 2014,
Romania ranked ninth among the countries
with the highest suicide rates (12.2 per
100,000 population), Lithuania ranked first
(27.1 per 100,000 population) followed by
Hungary (18 per 100,000) and Estonia
(17.3 per 100,000 population) (10, 11, 13).
Per the 2008-2015 annual reports of the
"Mina Minovici" Institute of Forensic Med-
icine, between 2,477 and 3,050 suicides
were recorded annually in Romania, ac-
counting for 25% of all violent deaths.

841
 Mihaela Corlade-Andrei et al.
Analyzing the deaths registered in the last 8
years by the mechanisms of death, the most
common were: mechanical asphyxia by
hanging (78.62%), voluntary intoxication
(7.12%) and falling (5.56%) (4, 13, 14).
MATERIAL AND METHODS
A retrospective descriptive study was
conducted that included all patients who
presented in 2015 (January 1 - December 31,
2015) to the Emergency Department of the
Iasi Sf. Spiridon Hospital and were diag-
nosed at presentation with suicide attempt.
Our study included 368 patients, 198
(53.81%)women and 170 (46.19%) men.
The selection of cases was based on the
diagnosis at the time of admission, positive
findings on physical examination, results of
laboratory tests that confirmed the ingestion
of drugs or other toxic substances, patient or
witness statements. Toxicological determi-
nations were made by using a Triage Meter
Pro that allows fluorescence immunochemi-
cal tests. The device is available in the ED
and provides quality results fast (~15
minutes), next to the patient.
The study cases were selected per the
inclusion criteria from a total of 69,232
patients admitted to the ED of the Iasi Sf.
Spiridon hospital during the year 2015.
Thus, included in the study were 368 pa-
tients aged 18 to 87. Excluded from the
study were the patients under 18 years of
age, patients who died before reaching the
hospital, patients with accidental ingestion
of toxic substance, and patients with incon-
clusive history.
The data collected and inserted in data-
bases were statistically analyzed using
Microsoft Excel and SPSS 18.00 statistics
software. Patients characteristics were
expressed as the mean standard deviation
or as a number and percentage.
842
RESULTS
Only 0.53% (368 from 69.232) of all
patients presenting to the Emergency De-
partment of the Iasi "Sf. Spiridon", Hospi-
tal during 2015 were eligible for the study
(368, aged 18 to 86).
Data processing was primarily intended
to identify the personal characteristics of the
selected patients. It is a first starting point in
strategic planning best practices. Most study
patients were in the 18-30 age group
(38.31%) and gender distribution showed a
relatively equal distribution of subjects
(53.81% women and 46.19% men, respec-
tively), unlike the national statistics showing
that the percentage of men attempting sui-
cide was constantly higher than that of
women ((82% vs.18%, respectively).
The sociocultural, educational and eco-
nomic implications lead to an uneven distri-
bution of cases by area of residence, 638%
of the study cases being rural patients.
Regarding the suicide mechanism,
63.58% were admitted to the ED for volun-
tary drug ingestion, 14.13% reported intake
of toxic substances (organophosphates,
rodenticides, corrosives, herbicides and
alcohols) and 22.28% traumatic suicide
attempts (cut wounds, stab wounds, self-
immolation, mechanical asphyxia by hang-
ing and falls from heights).
Fig. 1. Method of suicide attempt
 Attempted suicide: a cross-sectional survey 2015
The most common suicide method
among female patients was voluntary drug
ingestion (78.28%), while men preferred
traumatic mechanisms (35.29%) and inges-
tion of toxic substances (18.23%). Accord-
Fig. 2. Suicide method by gender
Of the patients who attempted suicide
by drug ingestion, 73.07% were brought to
hospital by ambulance from home, being
found by the family, the average time in-
terval elapsed between ingestion and hospi-
tal arrival being 2 to 6 hours (61.96%).
32.90% of patients used their prescribed
medication for suicidal purposes.
Qualitative toxicological determinations
in the ED revealed the presence of benzo-
diazepines in 29.67% of cases, followed by
antiepileptics (17.41%) and tricyclic anti-
depressants (4.27%). 31.19% of patients
took drugs in combination with alcohol.
In patients who ingested toxic substanc-
es, the most common were: corrosive sub-
stances (48.07%), organophosphates
(21.15%), rodenticides (11.53%), toxic
alcohols (7.69%) and herbicides (1.92%).
Traumatic suicide attempt was mostly
preferred by male rural patients and the
most common mechanisms were self-
inflicted wounds (70.83%), followed by
foreign body ingestion (12.5%), mechani-
ing to the statistical study conducted, pa-
tients in rural areas resorted much easier to
ingestion of toxic substances and traumatic
mechanisms, while patients in urban areas
preferred drug ingestion.
cal asphyxia by hanging (9.72%), self-
immolation (2.77%) and falls from heights
(2.77%). Six patients (7.31%)were impris-
oned with a history of multiple suicide at-
tempts, and sought medical care for foreign
body ingestion (66.66%) and self-inflicted
wounds. Per the Suicide Prevention Alli-
ance, every year in Romania there are
around 13 deaths by suicide per 100,000
inhabitants, thus ranking third in the hierar-
chy of violent death circumstances.
Of all the study patients 83.69% said
that it was the first attempted suicide, trig-
gered by a family conflict or pre-existing
psychiatric diseases.
The average length of stay in ED was
about 6 hours, during which the patients
received therapy to stabilize the vital signs.
Early diagnosis and initiation of specific
therapy is the best way to reduce the com-
plications that may occur.
Importance was given to medical histo-
ry and physical examination. Blood and
urine toxicology tests had an important
843
 Mihaela Corlade-Andrei et al.
place among the biological parameters
analyzed in all study patients. Throughout
the ED stay, all the patients were moni-
tored in terms of Glasgow Coma score,
blood pressure, heart rate, respiratory rate,
peripheral blood oxygen saturation
(SatO2), temperature and diuresis. 92.94%
of patients were hemodynamically stable,
however 7.06% of patients required sup-
portive care (orotracheal intubation, me-
chanical ventilation and positive inotropic
and chronotropic agents). Also, depending
on the associated pathology, patients re-
ceived specialist advice (toxicology, cardi-
ology, surgery, gastroenterology, gynecol-
ogy, etc.). Simultaneously with the symp-
tomatic treatment and detoxification the
supportive therapy was initiated, by which
the patients were helped to understand how
and why they resorted to these methods and
what they can do in the future to prevent
relapse.
All patients presenting to the emergency
department were stabilized. Subsequent-
ly,57% of the patients required hospital
admission because of significant medical
complications that required further treat-
ment and follow-up. The remaining 43% of
patients were hemodynamically stable and
were referred to other hospitals, returned
home or left the ED against medical advice.
Two cases (3.84%) of voluntary methyl
alcohol ingestion referred to the Nephrol-
ogy Clinic required hemodialysis. One
death was recorded (0.27%) because of
mechanical asphyxiation by hanging in a
patient with pre-existing psychiatric dis-
order.
DISCUSSION
Comparing the rate of suicide attempts
in our study with the national statistics for
Bucharest, the capital municipality of Ro-
mania, reported by the "Mina Minovici"
844
Institute of Forensic Medicine we found an
equal incidence, in both cases with an av-
erage of 10% (13, 14).
Nationally, mechanical asphyxia by
hanging is the most frequently used suicide
method followed by voluntary drug inges-
tion (14) and fall from heights while in the
Iasi County 63.58% reported voluntary
drug ingestion and 14.13% ingestion of
toxic and non-pharmacological substances
for suicidal purposes and only 22.28% had
attempted suicide by traumatic mechanism.
As suicide mechanism women prefer drug
ingestion, while men resort to more painful
methods: traumatic mechanisms or inges-
tion of toxic substances, which can lead to
a much higher death rate among men.
The time elapsed between ingestion of
toxic substance and arrival at the hospital is
extremely important in determining patient
prognosis.
Even if worldwide suicide attempt is the
main cause of death in young people, ac-
counting for over 50% of violent deaths, in
our case study one death was recorded
(0.27%) because of mechanical asphyxiation
by hanging in a patient with pre-existing
psychiatric disorder (4, 5, 6, 7, 8, 9).
Mental disorders and physical illness
may lead persons to commit suicide. In a
retrospective study of suicide notes, medi-
cal and police charts of persons who com-
mitted suicide, the patients were examined
at the Department of Forensic Medicine of
Ludwig-Maximilians-University Munich
between 2009 and 2011. The study includ-
ed 1069 cases,18.9 % gave a physical dis-
order as reason for committing suicide and
32.7 % a medical disorder. Regarding to
method of suicide, patients with mental
disorders had more often previous suicidal
attempts and jumping in front of a car was
the most frequent method of suicide while
persons with physical diseases most often
 Attempted suicide: a cross-sectional survey 2015

shoot themselves. Comparing to literature, Suicidal behavior can be prevented by

in our case, 83. 69% said that it was the
first attempted suicide, triggered by a fami-
ly conflict or pre-existing psychiatric dis-
eases (15).
CONCLUSION
Patients included in the study were in
most of cases women, with ages less than
30 years old, from urban area, who chose
as a suicide method the voluntary drug
ingestion.
Suicidal acts are rarely an act of free
will. In most cases, suicidal attempts are the
result of untreated psychiatric disorders.
psychotherapeutic, pharmacological or
neuromodulatory treatments for mental
disorders. Also, regular follow-up of peo-
ple who attempted suicide by mental health
services is key to preventing future suicide
attempts.
Reduced access to toxic substances (or-
ganophosphates, methyl alcohol) fighting
alcoholism, early detection, treatment and
medical care given to people with mental
disorders and monitoring people who have
experienced a suicide attempt are some
steps that should be taken to prevent and
reduce the size of this phenomenon.

REFERENCES

1. Ajdacic-Gross V, Weiss MG, Ring M, Hepp U, Bopp M, Gutzwiller F, Rssler W. Methods of sui-
cide: international suicide patterns derived from the WHO mortality database. Bull World Health Org
2008; 86(9): 726-732.
2. Scott A, Bing G. For which strategies of suicide prevention is there evidence of effectiveness? HEN
synthesis report J, 2012.
3. Chan M, Shekhar S, Krug E, Chestnov O. Preventing suicide: A global imperative. WHO, 2014.
4. Mergl R, Koburger N, Heinrichs K, et al. What are reasons for the large gender differences in the
lethality of suicidal acts? An epidemiological analysis in four European countries. PLoS One 2015;
10(7): e0129062.
5. Sheehan CM, Rogers RG, Boardman JD. Postmortem Presence of Drugs and Method of Violent
Suicide J Drug Issues. 2015; 45(3): 249-262.
6. Lukaschek K, Erazo N, Baumert J, Ladwig KH. Suicide Mortality in Comparison to Traffic Accidents
and Homicides as Causes of Unnatural Death. An Analysis of 14,441 Cases in Germany in the Year
2010 Int. J. Environ. Res. Pub Hlth 2012; 9: 924-993.
7. Varnik A, Kolves K, van der Feltz-Cornelis CM, Marusic A, Oskarsson H, Palmer A, Reisch T et col.
Suicide methods in Europe: a gender-specific analysis of countries participating in the European Al-
liance Against Depression J Epideml Comm Hlth 2008; 62: 545-555.
8. Corona-Miranda B, Alfonso-Sague K, Hernandez-Sanchez M, Lomba-Acevedo P Epidemiology of
suicide in Cuba, 1987-2014. MEDICC Review, 2016.
9. Moreno MA. Preventing Adolescent Suicide JAMA Pediatr 2016; 170(10): 1032.
10. *** EUROSTAT Eurostat statistics explained. Causes of death statistics. 2013
11. *** ORGANIZATION FOR ECONOMIC COOPERATION AND DEVELOPMENT. Suicide rates.
OECD Health Statistics. DOI:10.1787/data-00540-en
12. *** WHO Regional Office for Europe. European mortality database, 2016.
13. *** Raport asupra activitii reelei de medicin legal din Romania ntre anii 2010-2014.
14. Rdulescu SM. Evoluii i tendine ale fenomenului suicidar n Romnia, n perioada 1996-2012. Rev
Rom Sociol 2014, 3-4: 175-202.
15. Fegg M, Kraus S, Graw M, Bausewein C. Physical compared to mental diseases as reasons for com-
mitting suicide: a retrospective study. BMC Palliative Care 2016; 15: 14.

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