The profile analysis of attempted-suicide patients referred to Pelonomi Hospital for psychological evaluation and treatment from 1 May 2005 to 30 April 2006

Background. Suicide is an increasing phenomenon worldwide. A suicide occurs every 40 seconds, and there is 1 attempt every 1 to 3 seconds. By 2020, these figures may have doubled. No accurate statistics regarding the occurrence of attempted suicide (or non-fatal suicidal behaviour) in South Africa exist, because there has been no systematic data collection. Aim . The aim of the study was to determine the profile of patients who had attempted suicide and were referred to Pelonomi Hospital, Bloemfontein, for psychological evaluation and treatment during the period 1 May 2005 to 30 April 2006. Method. A descriptive, retrospective study was conducted. The study population comprised 258 attempted-suicide patients referred to Pelonomi Hospital for psychological evaluation and treatment. A data form was compiled to transfer the relevant information from patients’ clinical files. Results . The majority of patients were female (68.9%). The median age was 22 years. The most common method used in suicide attempts was drug overdose (66%) – mostly antidepressants (19.7%)) and analgesics (8.2%). More females than males overdosed on drugs ( p =0.0103). The main precipitating factors included problematic relationships (55.4%), financial problems (22.9%), psychiatric problems (22.1%), arguments (19.8%), abuse (emotional, sexual, physical – 18.2%), low self-esteem/ worthlessness/hopelessness/humiliation (16.7%), and recent life changes (13.2%). Conclusion. The aim of the study was to determine the profile of patients who had attempted suicide. Possible factors associated with suicide attempts in our sample were identified and summarised in the form of a screening checklist. The value of the checklist is that it can be used as a screening method to identify possible suicide risk in patients.


The profile analysis of attempted-suicide patients referred to
Method.A descriptive, retrospective study was conducted.
The study population comprised 258 attempted-suicide patients referred to Pelonomi Hospital for psychological evaluation and treatment.A data form was compiled to transfer the relevant information from patients' clinical files.
Results.The majority of patients were female (68.9%

Conclusion.
The aim of the study was to determine the profile of patients who had attempted suicide.Possible factors associated with suicide attempts in our sample were identified and summarised in the form of a screening checklist.The value of the checklist is that it can be used as a screening method to identify possible suicide risk in patients.
Union seem to be below the world average of 15.7 per 100 000.Ireland, for instance, has an average suicide rate of 12.9 per 100 000 of the population. 7South African suicide statistics, at 19 per 100 000 of the population, seem to be higher in comparison with industrialised nations. 8ere are no accurate statistics regarding the occurrence of parasuicide or non-fatal suicidal behaviour in South Africa because there has been no systematic data collection.
Information therefore is mostly derived from ad hoc research.
These studies 9,10  According to these figures, it is estimated that, for every fatal suicide, there are at least 20 non-fatal suicide attempts. 9e Violence and Injury Mortality Survey of 1999, conducted in 5 South African provinces, found that suicide accounted for about 8% of all deaths, of which 79% were of males. 11 the pre-Apartheid era, suicidal behaviour was underresearched among the majority of the black population, and lower rates were reported in comparison with other ethnic groups. 12This should be taken into account when considering the 58.1% increase of suicidal behaviour noted among black South Africans over the past decade. 13e average age of those who commit suicide in South Africa is 25 years. 14A third of all suicidal behaviour involves adolescents or children.It should be taken into account that adolescent suicides are under-reported, because families and physicians conceal the true case of death to avoid stigma.Black youths aged 18 years and younger have been identified as a possible high-risk group because they presented as 24.5% of a total sample of suicidal behaviour cases admitted to a hospital during a study.Of these, 91.3% were females. 15e prevalence of non-fatal suicidal behaviour in South Africa indicates that females have higher rates of suicidal ideation and non-fatal suicidal behaviour than males. 9However, non-fatal suicide attempts by males may be under-reported because of the stigma associated with such behaviour. 16e most frequently used method for attempting suicide is selfpoisoning.Other common methods include cutting, hanging, firearms, gassing and burning.Men are more likely to use overtly violent methods, whereas women prefer less violent means such as self-poisoning by drug overdose. 17Painkillers, tranquillisers and antidepressants are commonly used for overdosing, followed by poison and other utility products. 18e presence of certain risk factors may indicate that a person is considering suicide.These factors can be demographic, medical and psychosocial (which may include psychiatric disorders). 19The risk of suicide increases if a person is widowed, divorced or single.The decision to commit suicide may also be influenced by a lack, or recent loss, of social support.Another risk factor is recent unemployment; a sudden decline in social or economic status plays a major role in committing suicide. 20e following factors have been associated with increased suicide risk: the presence of illness (physical or psychiatric), 21 alcohol or drug abuse, 22 previous suicide attempts, and the presence of a lethal weapon (e.g. a firearm) or another source of self-harm. 20ychosocial factors are especially prone to elicit suicidal behaviour in adolescents.These include family problems, behavioural problems, social problems and recent exposure to a suicide attempt.Family problems can comprise parental absence, parental abuse, parental substance abuse, a family history of suicide, and conflict with parents.
Impulsiveness, explosive temper, attention deficit hyperactivity disorder, depression and bipolar disorder are all classified as behavioural problems.Social problems may include academic problems, conduct problems or disciplinary crises, humiliation, or marriage with socioeconomic problems. 23 summary, it is evident that suicide is a worldwide problem.
There are no accurate statistics in South Africa regarding the behaviour surrounding parasuicide or attempted suicide because there has been no systematic data collection.
Information is therefore mostly derived from ad hoc research.For this reason, there was a need to determine the demographic profile, the nature of suicide attempts, and possible risk factors associated with attempted suicide.

Objective
The aim of this study was to determine the profile of attempted Specific objectives were to determine: • the demographic profile of the participants • the nature of the suicide attempts, and • possible risk factors associated with non-fatal suicides.

Study design
The study was a descriptive, retrospective study.

Study population
All attempted suicide patients referred to Pelonomi Hospital's clinical psychologists for psychological evaluation and treatment during the period of 1 May 2005 to 30 April 2006 were included -a total of 259 patients.

Measurements
A computerised data form was compiled that was used to record relevant information from the patients' clinical files.

After receiving written permission from the Chief Executive
Officer, the files were obtained from clinical psychologists at Pelonomi Hospital.The researchers themselves completed the data forms according to the contents of the patients' files.

Pilot study
A pilot study was conducted using 20 files of patients referred during 2005 and 2006.The data forms were adjusted after the pilot study.Data obtained from these files were included in the main study.

Data analysis
Analysis was done by the Department of Biostatistics, University of the Free State.The data were summarised as frequencies and percentages (categorical variables), and means or percentiles (numerical variables).

Ethics
The study was approved by the Ethics Committee, Faculty of Health Sciences, University of the Free State.Permission was obtained from the Chief Executive Officer of Pelonomi Hospital.Patient names were not noted on the data forms, and all data were treated confidentially.

Demographic information
The majority (68.9%) of the attempted suicide patients was female.This finding was expected and correlates with other studies. 9,15,17One of the reasons for this finding could be that males succeed in their attempts more often because they use more violent and lethal methods. 16Another reason may be that males under-report their attempts, because of the stigma associated with such behaviour. 19It could also be that females have a greater suicidal inclination -and therefore make more frequent suicide attempts.
The age group with the highest number of attempted suicides was that between 18 and 31 years.The median was 22 years.This finding is closely related to the average age (25 years) of those who commit suicide in South Africa. 14,22 he youngest was a 7-year-old boy, and the oldest an 87-yearold man.There was a significant difference in age between males and females (Table I) (p=0.0021), with females making their suicide attempts at a younger age.This reflects the higher tendency of females attempting suicide, possibly as a result of their being more sensitive to life stressors.

Nature and frequency of the suicide attempts
The graph in Fig. 1 shows the number of attempted suicides during the review period.
Most of the attempted-suicide patients in 2005 were admitted in May (26), followed by November (25), August (23) and June (20).The increase in November might have been because of exams, work or other year-end stressors.
In the holiday and festive season, less support from the family, loneliness and adaptation challenges of the New Year.
The findings concerning the methods used in attempted suicides are presented in Fig. 2. Self-poisoning was used in 234 cases (90.7%).Most (183 -66%) of the participants overdosed using prescription medication, followed by the use of household chemicals in 33 cases (12%) and other chemicals in 18 cases (7%).Five participants (2%) used a method other than self-poisoning.In 35 cases (13.7%), the method of suicide attempt was not mentioned.
Most (19.7%) of the participants who overdosed used antidepressants.Analgesics were used in 8.2% of instances.

Possible risk factors associated with parasuicide/attempted suicide
The

Conclusion
The aim of the study was to determine the profile of patients who presented with attempted suicide and were referred to Pelonomi Hospital for psychological evaluation and treatment Of particular interest in our study was the identification of the main predisposing factors in patients presenting with attempted suicide.These factors are summarised in Table II, which could be used as a screening method to identify possible suicide risk in patients.
Although this study produced significant findings the results should be interpreted with great care, especially as far as generalisation is concerned; for example, only patients referred to Pelonomi Hospital were included in the study.
However, the study should not be under-estimated, because it not only contributes to important academic data in this field, but also provides information on demographic profile, nature of suicide attempts, and possible factors contributing to attempted suicide.

Pelonomi Hospital for psychological evaluation and treatment from 1
May 2005 to 30 April 2006 E H du Toit, medical student J M Kruger, medical student S M Swiegers, medical student M van der Merwe, medical student F J W Calitz, BA Hons, MA (Clin Psychol), D Phil Department of Psychiatry, University of the Free State, Bloemfontein L Philane, MA (Clin Psychol) Pelonomi Hospital, Bloemfontein G Joubert, BA, BSc Department of Biostatistics, University of the Free State, Bloemfontein Background.Suicide is an increasing phenomenon worldwide.A suicide occurs every 40 seconds, and there is 1 attempt every 1 to 3 seconds.By 2020, these figures may have doubled.No accurate statistics regarding the occurrence of attempted suicide (or non-fatal suicidal behaviour) in South Africa exist, because there has been no systematic data collection.Aim.The aim of the study was to determine the profile of patients who had attempted suicide and were referred to Pelonomi Hospital, Bloemfontein, for psychological evaluation and treatment during the period 1 May 2005 to 30 April 2006.
suicide patients who were referred to Pelonomi Hospital for Volume 14 No. 1 March 2008 -SAJP psychological evaluation and treatment from 1 May 2005 to 30 April 2006.

Table I . Age of attempted suicide cases
2006, most attempted-suicide patients were admitted in January (44), followed by February (33) and March (29).The reason for the high number of admissions at the beginning of 2006 may be associated with increased levels of stress after Volume 14 No. 1 March 2008 -SAJP articles