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Open Access 01-12-2018 | Primary research

Characteristics of patients presenting post-suicide attempt to an Academic Medical Center Emergency Department in Lebanon

Authors: Imad El Majzoub, Christopher El Khuri, Karim Hajjar, Ralphe Bou Chebl, Farid Talih, Maha Makki, Aurelie Mailhac, Gilbert Abou Dagher

Published in: Annals of General Psychiatry | Issue 1/2018

Abstract

Background

Emergency Department (ED) visits for suicide attempts have been described worldwide; however, the populations studied were predominantly Western European, North American, or East Asian. This study aims to describe the epidemiology of ED patients presenting post-suicide attempt to an academic medical center in Lebanon and to report on factors that affect ED disposition.

Methods

A retrospective cohort study was conducted between 2009 and 2015. Patients of any age group were included if they had presented to the ED after a suicide attempt. Patients with unintentional self-harm were excluded. Descriptive analysis was performed on the demographics and characteristics of suicide attempts of the study population. A bivariate analysis to compare the two groups (hospitalized or discharged) was conducted using Student’s t test and Pearson Chi-square where appropriate. A multivariate analysis was then conducted to determine the predictors of hospital admission.

Results

One hundred and eight patients were included in the final analysis. Most patients were females (71.4%) and between 22 and 49 years of age. A considerable number of patients were unemployed (43%), unmarried (61.1%), and living with family (86.9%). Most suicide attempts were performed at home (93.5%) and on a weekday (71.3%). The most common mechanisms of injury were overdose with prescription medications (61.3%), overdose with over-the-counter drugs (27.9%), and self-inflicted lacerations (10.1%). The classes of medication most commonly abused were benzodiazepines (39.3%) followed by acetaminophen (27.3%). A large portion of our patients were admitted (70.3%), with the majority going to the psychiatric ward (71.1%). Of note, a quarter (27.5%) of our patients left the ED against medical advice, with 23.5% of admitted patients leaving the hospital before completion of treatment. The main predictors of admission were found to be overdose on prescription medications OR 9.25 (2.12–40.42 CI95%).

Conclusions

The characteristics of our suicide attempters mirror those of international and regional suicide attempters. Further work is required to quantify the effect of voluntary refusal of hospital treatment, the repercussions of family, and financial barriers to healthcare and suicide as a whole in our society.

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Suicide fact sheet, World Health Organization. Updated August 2017. http://www.who.int/mediacentre/factsheets/fs398/en. Accessed 27 Aug 2017.

Caterino JM, Sullivan AF, Betz ME, Espinola JA, Miller I, Camargo CA Jr, et al. Evaluating current patterns of assessment for self-harm in emergency departments: a multicenter study. Acad Emerg Med. 2013;20(8):807–15. https://doi.org/10.1111/acem.12188.CrossRefPubMedPubMedCentral

Betz ME, Boudreaux ED. Managing suicidal patients in the emergency department. Ann Emerg Med. 2016;67(2):276–82. https://doi.org/10.1016/j.annemergmed.2015.09.001.CrossRefPubMed

Claassen CA, Larkin GL. Occult suicidality in an emergency department population. Br J Psychiatry. 2005;186:352–3. https://doi.org/10.1192/bjp.186.4.352.CrossRefPubMed

Egan R, Sarma KM, O’Neill M. Factors influencing perceived effectiveness in dealing with self-harming patients in a sample of emergency department staff. J Emerg Med. 2012;43(6):1084–90. https://doi.org/10.1016/j.jemermed.2012.01.049.CrossRefPubMed

Haukka J, Suominen K, Partonen T, Lönnqvist J. Determinants and outcomes of serious attempted suicide: a nationwide study in Finland, 1996–2003. Am J Epidemiol. 2008;167(10):1155–63.CrossRefPubMed

Buzan RD, Weissberg MP. Suicide: risk factors and therapeutic considerations in the emergency department. J Emerg Med. 1992;10(3):335–43.CrossRefPubMed

Doshi A, Boudreaux ED, Wang N, Pelletier AJ, Camargo CA. National study of US emergency department visits for attempted suicide and self-inflicted injury, 1997–2001. Ann Emerg Med. 2005;46(4):369–75.CrossRefPubMed

Gairin I, House A, Owens D. Attendance at the accident and emergency department in the year before suicide: retrospective study. Br J Psychiatry. 2003;183(1):28–33.CrossRefPubMed

10.

Kapur N, Cooper J, Hiroeh U, May C, Appleby L, House A. Emergency department management and outcome for self-poisoning: a cohort study. Gen Hosp Psychiatry. 2004;26(1):36–41.CrossRefPubMed

11.

Kennedy SP, Baraff LJ, Suddath RL, Asarnow JR. Emergency department management of suicidal adolescents. Ann Emerg Med. 2004;43(4):452–60.CrossRefPubMed

12.

Berk MS, Asarnow JR. Assessment of suicidal youth in the emergency department. Suicide Life Threat Behav. 2015;45(3):345–59. https://doi.org/10.1111/sltb.12133.CrossRefPubMed

13.

Carroll R, Benger J, Bramley K, Williams S, Griffin L, Potokar J, et al. Epidemiology, management and outcome of paracetamol poisoning in an inner city emergency department. Emerg Med J. 2015;32(2):155–60. https://doi.org/10.1136/emermed-2013-202518.CrossRefPubMed

14.

Zeppegno P, Gramaglia C, Castello LM, Bert F, Gualano MR, Ressico F, et al. Suicide attempts and emergency room psychiatric consultation. BMC Psychiatry. 2015;15:13. https://doi.org/10.1186/s12888-015-0392-2.CrossRefPubMedPubMedCentral

15.

Zhao CJ, Dang XB, Su XL, Bai J, Ma LY. Epidemiology of suicide and associated socio-demographic factors in emergency department patients in 7 general hospitals in northwestern China. Med Sci Monit. 2015;21:2743–9. https://doi.org/10.12659/MSM.894819.CrossRefPubMedPubMedCentral

16.

Lin CJ, Lu HC, Sun FJ, Fang CK, Wu SI, Liu SI. The characteristics, management, and aftercare of patients with suicide attempts who attended the emergency department of a general hospital in northern Taiwan. J Chin Med Assoc. 2014;77(6):317–24. https://doi.org/10.1016/j.jcma.2014.02.014.CrossRefPubMed

17.

Ting SA, Sullivan AF, Boudreaux ED, Miller I, Camargo CA Jr. Trends in US emergency department visits for attempted suicide and self-inflicted injury, 1993–2008. Gen Hosp Psychiatry. 2012;34(5):557–65. https://doi.org/10.1016/j.genhosppsych.2012.03.020.CrossRefPubMedPubMedCentral

18.

Baraff LJ, Janowicz N, Asarnow JR. Survey of California emergency departments about practices for management of suicidal patients and resources available for their care. Ann Emerg Med. 2006;48(4):452–8.CrossRefPubMed

19.

Kazarian SS. Family functioning, cultural orientation, and psychological well-being among university students in Lebanon. J Soc Psychol. 2005;145(2):141–54.CrossRefPubMed

20.

Zohre E, Ayrik C, Bozkurt S, Kose A, Narci H, Cevik I et al. Retrospective analysis of poisoning cases admitted to the emergency medicine. Arch Iran Med. 2015;18(2):117–22. https://doi.org/015182/AIM.0011.

21.

Bakhaidar M, Jan S, Farahat F, Attar A, Alsaywid B, Abuznadah W. Pattern of drug overdose and chemical poisoning among patients attending an emergency department, western Saudi Arabia. J Community Health. 2015;40(1):57–61. https://doi.org/10.1007/s10900-014-9895-x.CrossRefPubMed

22.

Mahfoud ZR, Afifi RA, Haddad PH, Dejong J. Prevalence and determinants of suicide ideation among Lebanese adolescents: results of the GSHS Lebanon 2005. J Adolesc. 2011;34(2):379–84. https://doi.org/10.1016/j.adolescence.2010.03.009.CrossRefPubMed

23.

Alves VDM, Silva AM, Magalhaes AP, Andrade TG, Faro AC, Nardi AE. Suicide attempts in a emergency hospital. Arq Neuropsiquiatr. 2014;72(2):123–8. https://doi.org/10.1590/0004-282X20130212.CrossRef

24.

Karam EG, Mneimneh ZN, Dimassi H, Fayyad JA, Karam AN, Chatterji S, Nasser SC, Kessler RC. Lifetime prevalence of mental disorders in Lebanon: first onset, treatment, and exposure to war. PLoS Med. 2008;5(4):e61.CrossRefPubMedPubMedCentral

25.

Gender data portal, The World Bank, 2017. http://datatopics.worldbank.org/gender/country/lebanon. Accessed 17 June 2017.

26.

Kawashima Y, Yonemoto N, Inagaki M, Yamada M. Prevalence of suicide attempters in emergency departments in Japan: a systematic review and meta-analysis. J Affect Disord. 2014;163:33–9. https://doi.org/10.1016/j.jad.2014.03.025.CrossRefPubMed

27.

Ronquillo L, Minassian A, Vilke GM, Wilson MP. Literature-based recommendations for suicide assessment in the emergency department: a review. J Emerg Med. 2012;43(5):836–42. https://doi.org/10.1016/j.jemermed.2012.08.015.CrossRefPubMed

28.

Oliffe JL, Ogrodniczuk JS, Gordon SJ, Creighton G, Kelly MT, Black N, Mackenzie C. Stigma in male depression and suicide: a Canadian sex comparison study. Community Ment Health J. 2016;52(3):302–10.CrossRefPubMedPubMedCentral

29.

Karam G, Itani L, Fayyad J, Karam A, Mneimneh Z, Karam E. Prevalence, correlates, and treatment of mental disorders among Lebanese older adults: a national study. Am J Geriatr Psychiatry. 2016;24(4):278–86.CrossRefPubMed

30.

Sullivan E, Annest JL, Luo F, Simon TR, Dahlberg LL. Suicide among adults aged 35–64 years—United States, 1999–2010. Center for Disease Control and Prevention, Morbidity and Mortality Weekly Report. 2013.

31.

Kohn R. Psychiatric epidemiology and international mental health as a career in cultural psychiatry. Transcult Psychiatry. 2011;48(1–2):53–65.CrossRefPubMed

32.

Gum AM, King-Kallimanis B, Kohn R. Prevalence of mood, anxiety, and substance-abuse disorders for older Americans in the national comorbidity survey-replication. Am J Geriatr Psychiatry. 2009;17(9):769–81.CrossRefPubMed

33.

Mojtabai R. Americans’ attitudes toward mental health treatment seeking: 1990–2003. Psychiatr Serv. 2007;58(5):642–51.CrossRefPubMed

34.

Jang HS, Kim JY, Choi SH, Yoon YH, Moon SW, Hong YS, et al. Comparative analysis of acute toxic poisoning in 2003 and 2011: analysis of 3 academic hospitals. J Korean Med Sci. 2013;28(10):1424–30. https://doi.org/10.3346/jkms.2013.28.10.1424.CrossRefPubMedPubMedCentral

35.

Ramadan WH, El Khoury GM, Deeb ME, Sheikh-Taha M. Prescription patterns of benzodiazepines in the Lebanese adult population: a cross-sectional study. Neuropsychiatr Dis Treat. 2016;12:2299–305. https://doi.org/10.2147/NDT.S113078.CrossRefPubMedPubMedCentral

36.

Patterson WM, Dohn HH, Bird J, Patterson GA. Evaluation of suicidal patients: the SAD PERSONS scale. Psychosomatics. 1983;24(4):343–5, 8–9. https://doi.org/10.1016/s0033-3182(83)73213-5.

37.

Mental Health Atlas. World Health Organization. 2011. http://www.who.int/mental_health/evidence/atlas/profiles/en/. Accessed 20 Feb 2017.

38.

Sturm R, Wells K. Health insurance may be improving—but not for individuals with mental illness. Health Serv Res. 2000;35(1 Pt 2):253–62.PubMedPubMedCentral

39.

Reynders A, Kerkhof AJ, Molenberghs G, Van Audenhove C. Help-seeking, stigma and attitudes of people with and without a suicidal past. A comparison between a low and a high suicide rate country. J Affect Disord. 2015;178:5–11.CrossRefPubMed

Title: Characteristics of patients presenting post-suicide attempt to an Academic Medical Center Emergency Department in Lebanon
Authors: Imad El Majzoub
Christopher El Khuri
Karim Hajjar
Ralphe Bou Chebl
Farid Talih
Maha Makki
Aurelie Mailhac
Gilbert Abou Dagher
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Annals of General Psychiatry / Issue 1/2018
Electronic ISSN: 1744-859X
DOI: https://doi.org/10.1186/s12991-018-0191-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Characteristics of patients presenting post-suicide attempt to an Academic Medical Center Emergency Department in Lebanon

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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