Content uploaded by Hojka Gregoric Kumperscak
Author content
All content in this area was uploaded by Hojka Gregoric Kumperscak on Jan 27, 2017
Content may be subject to copyright.
Suicide attempts among adolescents in northeastern Slovenia: A 25 year report
Abstract
Slovenia is one of the countries with the highest national suicide rates (30/100,000/year). The rate of suicide attempts is accordingly high, for both adolescents and adults. Suicidal children and adolescents from the four North-eastern regions of Slovenia are hospitalised at the Child and Adolescent Psychiatry Unit of the General Hospital Maribor. The aim of this study was to show the pattern of changes in these hospitalisations along 25 years.
The data was collected retrospectively, using chart review of this unit by a psychiatrist for the years 1978 through 2004.
The data consists of two different samples. The first sample contains gender distribution (n = 774) from 1978 to mid 2004 with 664 girls and 110 boys, and the second sample (n = 1,477) consisted of suicide attempts as well as alcohol (n = 772) and drug abuse (n = 115) data for the last decade. The number of hospitalisations was increasing in a wavy curve with average 7,5 times more admitted girls than boys. In 98%, the suicide method was intoxication, and most were additionally diagnosed with "adolescent crisis" (ICD-10: F93.8).
The rise in the number of admitted suicidal adolescents was partly consequent to the improvement of their detection maybe because 25 years ago most of these cases were recorded as "accidental poisonings" and did not include the diagnosis of a suicide attempt. The socio-economic changes characteristic of a country in transition also contributed to this increase, as did the development of the Unit with more trained staff and advanced treatment.
... Data from literature revealed that hospital admissions due to alcohol intoxication in children generally increased by age, with boys being more likely than girls to be admitted in hospital and admissions increase among children and adolescents [24][25][26][27][28][29][30]. ...
... Hospital admissions due to alcohol intoxication in children and adolescents increased by age; boys were more frequently hospitalized, and similar characteristics were reported by other studies [24,[26][27][28][29][30]34]. ...
Background:
Binge drinking and other forms of ethanol abuse are, when present, a serious problem in preteens and adolescents worldwide.
Aim:
The present study has analyzed the trend in alcohol-related intoxications requiring the hospitalization of children, adolescents and young adults aged less than 21 years in Slovenia in the 1999-2018 period.
Methods:
We performed a retrospective study on patients discharged after hospitalizations due to mental and behavioral disorders due to acute alcohol intoxication (MBDAAI) or hospitalizations due to the toxic effects of alcohol (TEA We considered three groups: children (aged 10-14), adolescents (aged 15-19) and young adults (20-21 years old). Hospitalization rates and time trends were analyzed using joinpoint regression to obtain the annually calculated age- and sex-specific rates and the annual percentage of change (APC).
Results:
Considering a total of 2912 MBDAAI-hospitalizations, 15-19-year-old subjects showed a significantly higher hospitalization rate compared to the immediately younger and older age groups and a significant increase in hospitalization rates in the period 1999-2011, followed by a significant decrease. Considering 1143 TEA-hospitalizations, we observed a continuous decrease in the hospitalization rates for children and young adults and, conversely, a continuous even if less than significant increase for adolescents aged 15-19.
Conclusions:
Alcohol consumption in Slovenian children and adolescents is a highly important health concern. Special attention to public health problem of severe alcohol abuse requiring hospitalization in children and adolescents is needed, especially with possible crisis of SARS-CoV-2/Covid-19 situation.
Although considerable changes have taken place in Slovenia since it became independent in 1991, the psychiatric services face further challenges for their future. Among these, the two main priorities are a further development of the already proposed Patients Advocacy Act and Protection of Rights of Mental Patients Law, and a development of presently almost non-existent community psychiatric services (World Health Organization, Regional Office for Europe, 1999). The developing services should become needs-oriented as Slovenia is a country with extremely high suicide rate and has high rates of alcohol misuse and alcohol-related disorders, with both problems interacting significantly throughout the country.
The number of adolescents who attempt or complete suicide is increasing. Risk factors range from mental disorders, to problems at school, family problems, or difficulties in establishing relationships. A further important, and too often underestimated, risk factor for adolescent suicide is the presence of suicidal behavior in the adolescent's family. We investigated 184 high school adolescents in a region in Slovenia with a high suicide rate (30/100,000/year). They were questioned by means of an anonymous questionnaire about the presence of suicidal behavior in their relatives and about the presence of suicidal thoughts, plans, and acts in themselves. The results revealed that 13% of the adolescents studied had a relative who had attempted suicide and a further 9% of the adolescents had lost a relative due to suicide. About half of all females and almost a third of males had had suicidal thoughts (differences between sexes were statistically significant: χ² = 6.13; p < .01). Attempted suicide among relatives was positively correlated with the presence of suicidal plans among adolescents (Φ = 0.15; p < .05). This correlation proved to be even stronger and statistically more significant in men when we split the sample by gender. All variables (suicidal thoughts, suicidal plans, and suicide attempts) in the adolescent males positively correlated with attempted suicide among their relatives (Φ = 0.28, p < .01; Φ = 0.26, p < .05; Φ = 0.34, p < .01; respectively). Our results speak in favor of a higher risk of suicidal behavior among adolescents with suicidal behavior in their families.
The study was carried out on a representative sample of Slovenian high school students (n = 3687) of whom 238 (137 girls and 101 boys) have already attempted suicide. Both suicide attempters and nonattempters were assessed by a questionnaire consisting of Zung's (1965) Depression Scale, Rosenberg's (1965) Self-Esteem Scale, sociodemographic data, information on suicide attempt, suicide ideation, family relations, and substance abuse. Statistical analyses indicated that groups differed in the levels of self-esteem, emotional reaction to family problems, running away from home, and substance abuse. The differences in the level of depression, frequency of suicide ideation, family suicide occurrence, smoking, and alcohol use were significant.
A developmental psychopathology conceptual model was provided to represent the major categories of risk and protective factors, including alcohol use and binge drinking, that predict suicidal behaviors that range from suicidal thoughts to completed suicides. The conceptual model emphasized the importance of identifying age-specific sets of risk and protective factors to facilitate the development of effective interventions. As an empirical illustration, a multivariate mediation path model was specified and evaluated with a sample of teens. Findings indicated that several distal variables (e.g., difficult temperament, coping motives for drinking, lower family support, higher percentage of friends using alcohol) significantly predicted mediators (e.g., depression, stressful events, binge drinking) that, in turn, predicted suicidal behaviors. Binge drinking significantly predicted suicide attempts over and above the influence of depression and stressful events.
Sex and the age structure have been for decades the crucial factors determining the dimensions of suicide. In the literature of the subject, it is possible to find different interpretations concerning the widely known facts of larger effectiveness of suicide among males. Females, on the other hand, exhibit suicidal behaviour and suicide attempts several times bigger than the number of completed suicides. In comparison with wide literature dealing with the problematic of completed suicide, the number of publications concerning suicide attempts is, both in foreign and in Polish literature rather scarce. That is why the present authors have undertaken the analysis of suicide attempts by subjects hospitalized in the Department of Clinical Toxicology Jagiellonian University College of Medicine in Krakow in the years 2000-2002. On the basis of the medical documentation, 2757 cases of attempted suicide through self-intoxication by subjects undergoing treatment in the toxicological department. In the period concerned, the number of hospitalizations after suicide attempts increased from 856 cases in the year 2000 to 971 cases in 2001, and subsequently slightly decreased to 930 cases in 2002. The highest indicator of suicide attempts through self-intoxication has been observed among adolescents and young adults. In the absolute values, within the span of the years in question, there is a substantial predominance of suicide attempts undertaken by adults ranging in age from 20 and 50. On the contrary, in the oldest age group (over 60), the number of suicide attempts through self-intoxication was in the years concerned the lowest. In contrast with completed suicide, where the proportion of males to females is 4:1, in the group examined, females constituted 50% of subjects after suicide attempts. The number of females after suicide attempts in the consecutive years analysed was higher among adolescents and young women under 30. Despite drawbacks in data gathering, there is convincing testimony indicating that suicide is the result of number of complex risk factors. Sex and the age structure belong to non-modifiable factors, and thus emphasis should be put on the importance of the gathering of relevant data and on further research into the factor of sex and age structure in suicide attempts and completed suicide.
According to WHO, every year, suicide is committed by at least 1 mln people in the world. In Europe, suicide is committed by about 43 thousand people a year, most frequently by middle-aged and elderly males, and attempted by 700 thousand people. In Poland, in 2002, 5100 people committed suicide. The number of suicide attempts is probably ten times higher. The aim of the study is to investigate the current state of knowledge concerning suicidal behaviour and attempted suicide in adolescents and young adults. The literature on the subject is analysed, and special attention is paid to the issue of suicide epidemiology, risk factors, prevention and treatment. Definitions of suicidal behaviour and presuicidal syndrome are debated. In the chapter concerning treatment, Bohme's model of crisis intervention in the case of suicidal patients is discussed, and detailed indications for treatment are presented. Suicide attempts are undertaken most frequently by young people, especially by teenage girls and young women. The ratio of suicide in this age group increased significantly in the last few years. Phenomena which are of special importance for the prevention of suicide among adolescents include suicidal thoughts, attempted suicide, and completed suicide. Multicentre study into suicidal behaviour conducted by WHO indicate that the highest average yearly European coefficients of suicide attempts have been detected in young females ranging in age from 15 to 24 years. Polish and foreign literature on the subject is dominated by publications regarding completed suicide. The issue of attempted suicide is treated rather marginally, which may be due to the scantiness of reliable data concerning large populations. The past few years, however, brought a significant advancement of the research into the epidemiology, etiology, and treatment of suicidal behaviour in adolescents. It is difficult to establish linear correspondence between risk factors and suicidal behaviour. The cause is usually a combination of constitutional factors including genetic ones, earlier personal experiences, and precipitating stressful events. Paradoxically, the risk of suicide among adolescents increases in highly developed countries, where the quality of life has undergone a significant improvement. In conclusion, the authors have stressed the importance of an interdisciplinary approach to work with individuals endangered by the risk of suicide. Attention has also been drawn to the importance of personal contact and the necessity to accompany the individual in suicidal crisis from the beginning to the end of the therapy.