SELMA SABANCIOĞULLARI, DİLEK AVCI, Selma DOĞAN, MERAL KELLECİ, ELVAN EMİNE ATA

Psikiyatri kliniğinde yatan hastalarda intihar olasılığı ve etkileyen etkenler

Amaç: Bu çalışmanın amacı psikiyatri kliniğinde yatarak tedavi gören hastaların intihar olasılığı düzeylerini ve etkile- yen etkenleri incelemektir. Yöntem: Tanımlayıcı ve kesitsel tipte olan araştırma Cumhuriyet Üniversitesi Eğitim ve Araştırma Hastanesi Psikiyatri Kliniğinde yatarak tedavi gören 155 hasta bireyle yürütülmüştür. Veriler Tanıtıcı Bilgi Formu ve İntihar Olasılığı Ölçeği ile toplanm ıştır. İntihar Olasılığı Ölçeği umutsuzluk, intihar düşüncesi, kendini olumsuz değerlendirme ve düşmanlık alt boyutlarından oluşmaktadır. Ölçekten alınan puanların yüksek olması intihar olasılığının yüksek olduğunu göstermektedir. İstatistiksel değerlendirmede tanımlayıcı istatistikler t testi, tek yönlü varyans analizi ve Kruskall Wallis testi kullanılm ıştır. Bulgular: Hasta bireylerin İntihar Olasılığı Ölçeği toplam puan ortalaması 82.54±14.76 olup orta düzeydedir. Hastaların yaş, cinsiyet, medeni durum, ekonomik durum özel- likleri açısından İOÖ puan ortalamaları arasında anlamlı bir fark saptanmam ıştır. Depresyon tanısı olan, daha önce kendisini öldürmeyi düşünen ve intihar girişiminde bulunan, şu anda intihar düşüncesi olan hastaların İOÖ puan ortalamaları diğerlerine göre anlamlı derecece yüksek saptanm ıştır. Tartışma: Hastaların intihar olasılığı genel puan ortalamaları orta düzeydedir. Daha önce intihar etmeyi düşünen ve intihar girişimi olan hastaların intihar etme olasılığı daha yüksektir. Sonuçlar psikiyatri kliniğinde hasta güvenliğini tehdit eden intihar potansiyelinin yüksek olduğunu göstermektedir.

Suicide probability and affecting factors in psychiatric inpatients BSTRACT

The aim of this study is to examine suicide probability and affecting factors in psychiatric inpatients. Methods: This descriptive and cross-sectional study was conducted with 155 psychiatric inpatients at Cumhuriyet University Training and Research Hospital. Data was collected using the Descriptive Information and the Suicide Probability Scale. The Suicide Probability Scale includes the following subscales: hopelessness, suicidal thoughts, negative self-evaluation, and hostility. Higher scores obtained from the Suicide Probability Scale indicate elevated suicide probability. In statistical analyses, descriptive statistics, t test, one way analysis of variance, and the Kruskall Wallis test were used. Results: Mean SPS total score of the patients was found to be 82.54±14.76, which indicates moderate suicide probability. There were no significant differences in SPS total scores according to age, gender, marital status, and economic status. The mean SPS scores of patients who were diagnosed with depression, had previous thoughts about committing suicide and previous suicide attempts, and had suicidal thoughts at the time of _the study were found to be significantly higher. Discussion: Mean suicide probability scores of the patients were at moderate levels. Patients who had previous suicidal thoughts and had previous suicide attempts have higher suicide probability. Our results show that suicide potential, which is a threat against patient safety in the psychiatry clinic, is high. <<<<<<<<<<<<<<<<<<

PDF

___

1. World Health Organization 2012. Public Health Action for the Prevention of Suicide. Geneva: WHO, 2012.
2. Fowler JC. Suicide risk assessment in clinical practice: pragmatic guidelines for imperfect assessments. Psychotherapy 2012; 49(1):81-90.
3. Qin P, Agerbo E, Mortensen PB. Suicide risk in relation to socioeconomic, demographic, psychi- atric, and familial factors: a national register- based study of all suicides in Denmark 1981- 1997. Am J Psychiatry 2003; 160:765-772.
4. Bursztein-Lipsicas C, Henrik-Mäkinen I. Immigra- tion and suicidality in the young. Can J Psychiatry 2010; 55:274-278.
5. Page RM, Yanagishita J, Suwanteerangkul J, Zarco EP, Mei-Lee C, Miao NF. Hopelessness and loneliness among suicide attempters in school-based samples of Taiwanese, Philippine and Thai adolescents. School Psychology Inter- national 2006; 27:583-598.
6. Combs H, Romm S. Psychiatric inpatient suicide: a literature review. Primary Psychiatry 2007; 14(12):67-74.
7. Meehan J, Kapur N, Hunt IM, Turnbull P, Robin- son J, Bickley H, et al. Suicide in mental health inpatients and within 3 months of discharge. National clinical survey. Br J Psychiatry 2006; 188:129-134.
8. Conwell Y, Thompson C. Suicide behavior in elders. Psychiatr Clin North Am 2008; 31:333-356.
9. Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Suicide and suicidal behavior. Epidemiol Rev 2008; 30:133-154.
10. Beghi M, Rosenbaum JF. Risk factors for fatal and nonfatal repetition of suicide attempt: a critical appraisal. Curr Opin Psychiatry 2010; 23:349-355.
11. Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, et al. Suicide prevention strategies: a systematic review. JAMA 2005; 294:2064-2074.
12. Kanerva A, Takanen L, Kivinen T. Patient safety in psychiatric inpatient care: a literature review. J Psychiatr Ment Health Nurs 2013; 20(6):541-548.
13. Dong JY, Ho TP, Kan CK. A case-control study of 92 cases of inpatient suicides. J Affect Disord 2005; 87(1):91-99.
14. Brickell TA, Nicholls TL, Procyshyn RM, McLean C, Dempster RJ, Lavoie JAA, et al. Patient Safety in Mental Health. Alberta: Canadian Patient Safety Institute and Ontario Hospital Association, 2009.
15. Melonas J. Patient-safety strategies can reduce suicide risk. Psychiatric News 2004; 39:24-28.
16. Chen YY, Liao SF, Teng PR, Tsai CW, Fan HF, Lee WC, et al. The impact of media reporting of the suicide of a singer on suicide rates in Taiwan. Soc Psychiatry Psychiatr Epidemiol 2012; 47:215- 221.
17. American Psychiatric Association. Practice guide- lines for the assessment and treatment of patients with suicidal behaviours. Am J Psychiatry 2003; 160(11):1-60.
18. Joint Commission 2008. The Joint Commissions Annual Report on Quality and Safety. USA, 2008.
19. Australian National Mental Health Working Group 2005. National safety priorities in mental health: A national plan for reducing harm. Australia, 2005.
20. Isabelle MH, Kirsten W, Nicola S, Jenny S, Louis A, Nav K. Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey. BMC Psychiatry 2010; 10:14.
21. Morgan HG, Priest P. Suicide and other unex- pected deaths among psychiatric in-patients: the Bristol confidential inquiry. Br J Psychiatry 1991; 158:368-374.
22. Deisenhammer EA, Huber M, Kemmler G, Weiss EM, Hinterhuber H. Psychiatric hospitalizations during the last 12 months before suicide. Gen Hosp Psychiatry 2007; 29(1):63-65.
23. Bowers L, Dack C, Gul N, Thomas B, James K Learning from prevented suicide in psychiatric inpatient care: An analysis of data from the National Patient Safety Agency. Int J Nurs Stud 2011; 48(12):1459-1465.
24. Agerbo E, Nordentoft M, Mortensen PB. Familial, psychiatric, and socioeconomic risk factors for suicide in young people: nestedcase-control study. BMJ 2002; 325:7355-7374.
25. Baca-Garcia E, Perez-Rodriguez MM, Mann JJ, Oquendo MA. Suicidal behavior in young women. Psychiatr Clin North Am 2008; 31:317-331.
26. Atlı Z, Eskin M, Dereboy Ç. İntihar Olasılığı Ölçeğinin (İOÖ) klinik örneklemde geçerlik ve güvenirliği. Klinik Psikiyatri 2009; 12:111-124.
27. Eskin M, Akoğlu A, Uygur B. Ayaktan tedavi edilen psikiyatri hastalarında travmatik yaşam olayları ve sorun çözme becerileri: intihar davranışıyla ilişkisi. Türk Psikiyatri Derg 2006; 17(4):266-275.
28. Lester D, Walker RL. Hopelessness, helpless- ness, and haplessness as predictors of suicidal ideation. Omega J Death Dying 2007; 55:321-324.
29. Brezo J, Paris J, Turecki G. Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: asystematic review. Acta Psychiatr Scand 2006; 113:180-206.
30. Beck A, Wissman A, Lester D, Trexler L. The measurement of pessimizm: The Hopelessness Scale. J Consul Clin Psychol 1974; 42(6):861- 865.
31. Zhang J, McKown RE, Hussey JR, Thompson SJ, Woods JR. Gender differences in risk factors for attempted suicide among young adults: Findings from the Third National Health and Nutrition Examination Survey. Annuals of Epidemiology 2005; 15:167-174.
32. Langhinrichsen-Rohling J, Arata C, Bowers D, OBrien N, Morgan A. Suicidal behavior, negative affect, gender, and self-reported delinquency in college students. Suicide Life-Threat Behav 2004; 34(3):255-267.
33. Thomas HV, Crawford M, Meltzer H, Lewis G. Thinking life is not worth living. Soc Psychiatry Psychiatr Epidemiol 2002; 37:351-356.
34. Molina JA, Duarte R. Risk determinants of suicide attempts among adolescents. Am J Econ Sociol 2006; 65(2):407-434.
35. Park HS, Schepp KG, Jang EH, Koo HY. Predictors of suicidal ideation among high school students by gender in South Korea. J Sch Health 2006; 76(5):181-188.
36. Whetstone LM, Morrissey SL, Cummings DM. Children at risk: The association between perceived weight status and suicidal thoughts and attempts in middle school youth. J Sch Health 2007; 77(2):59-66.
37. Harriss L, Hawton K, Zahl D. Value of measuring suicidal intent in the assessment of people attending hospital following self-poisoning or self- injury. Br J Psychiatry 2005; 186:60-66.
38. Kumar CTS, Mohan R, Ranjith G, Chandrase- karan R. Gender differences in medically serious suicide attempts: A study from South India. Psychiatry Res 2006; 144:79-86.
39. Fennig S, Geva K, Zalsman G, Weizman A, Fennig S, Apter A. Effect of gender on suicide attempters versus nonattempters in an adolescent inpatient unit. Compr Psychiatry 2005; 46:90-97.
40. Deveci A, Taşkın O, Erbay-Dündar P, Demet MM, Kaya E, Özmen E, ve ark. Manisa ili kent mer- kezinde intihar düşüncesi ve girişimi yaygınlığı. Türk Psikiyatri Derg 2005; 16(3):170-178.
41. Oktik N, Top A, Sezer S, Bozver Ü. Muğla ili intihar ve intihar girişimlerinin sosyolojik olarak incelenmesi. Kriz Dergisi 2003; 11(3):1-19.
42. Bağlı M. Batman intiharları bağlam ında özgürlüğün ve geleneksel toplumsal yapının kentsel kurgusu. Kriz Dergisi 2004; 12(1):21-40.
43. Şenol V, Ünalan D, Avşaroğulları L, İkizceli İ. İntihar girişimi nedeniyle Erciyes Üniversitesi Tıp Fakültesi Acil Anabilim Dalına başvuran olguların incelenmesi. Anadolu Psikiyatri Derg 2005; 6:19- 29.
44. Demirel-Özsoy S, Eşel E. İntihar (Özkıyım). Anadolu Psikiyatri Derg 2003; 4(3):175-185.
45. Çayköylü A, Coşkun İ, Kırkpınar İ, Özer H. Özkıyım girişiminde bulunanlarda sosyodemografik özellikler ve tanı dağılım ı. Kriz Dergisi 1997; 5:37- 42.
46. Sağınç H, Kuğu N, Akyüz G, Doğan O. Yatarak tedavi gören hastalarda intihar öyküsünün araştırılması. Anadolu Psikiyatri Derg 2000; 1:83-88.
47. Gould MS, Grenberg T, Velting DM, Shaffer D. Youth suicide risk and preventive interventions: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 2003; 42:386-405.
48. Arensman E, Kerkhof JF. Classification of at- tempted suicide: a review of empirical studies, 1963-1993. Suicide Life Threat Behav 1996; 26:46-67.
49. Steen DM, Mayer P. Patterns of suicide by age and gender in the Indian states: A Reflection of human development? Arch Suicide Res 2003; 7:247-264.
50. He ZX, Lester D. Sex differences in suicidal ideation in a community sample from China. Crisis 2001; 22(3):132-134.
51. Türkiye İstatistik Kurumu (TÜ İK). İntihar İstatistikleri 2011. Ankara, 2011.
52. Azorin JM, Kaladjian A, Besnier N, Adida M, Hantouche E, Lancrenon S, et al. Suicidal be- haviour in a French Cohort of major depressive patients: characteristics of attempters and non- attempters. J Affect Disord 2010; 123:87-94.
53. Maclean J, Kinley DJ, Jacobi F, Bolton JM, Sareen J. The relationship between physical conditions and suicidal behavior among those with mood disorders. J Affect Disord 2011; 130(1- 2):245-250.
54. Mousavi G, Tallaei H. Suicide risk, aggression and violence in major psychiatric disorders. Journal of Research in Medical Sciences 2004; 1:23-25.
55. Phillips MR, Yang G, Zhang Y, Wang L, Ji H, Zhou M. Risk factors for suicide in China: a national case-control psychological autopsy study. Lancet 2002; 360:1728-1736.
56. Ersoy E. Yatarak Tedavi Gören Psikiyatri Hastalarında İntihar Eğilimi ile İlişkili Özellikler. Yayımlanmam ış Yüksek Lisans Tezi, İstanbul, İstanbul Üniversitesi, Adli Tıp Enstitüsü, 2008.
57. Lizardi D, Sher L, Sullivan GM. Association between familial suicidal behavior and frequency of attempts among depressed suicide attempters. Acta Psychiatr Scand 2009; 119:406-410.