Suicide Prevention and Follow-Up Services: A Narrative Review

Previous suicide attempt is the most important predictor of death by suicide. Thus preventive interventions after attempting to suicide is essential to prevent reattempts. This paper attempts to determine whether phone preventive interventions or other vehicles (postal cards, email and case management) are effective in reattempt prevention and health promotion after discharge by providing an overview of studies on suicide reattempts. The research investigated in this review conducted from 1995 to 2014. A total of 26 cases related to the aim of this research were derived from 36 English articles with the aforementioned keywords Research shows that providing comprehensive aids, social support, and follow-up after discharge can significantly prevent suicide reattempts. Several studies showed that follow-up support (phone calls, crisis cards, mails, postal cards.) after discharge can significantly decrease the risk of suicide. More randomized controlled trials (RCT) are required to determine what factors of follow-up are more effective than other methods

Alcohol Abuse and Suicide Attempt in Iran: A Case-Crossover Study

Alcohol use and its disorders are associated with increased risk of suicidal behaviors Research has shown that 6-8 of those who use alcohol have a history of suicide attempt. Given the prohibition of alcohol use legally, the increased alcohol consumption, and the lack of strong evidence in favor of its use associated with suicide in Iran, this study was conducted to determine the link between suicide attempt and alcohol abuse. The case-crossover method was used in this research. Out of 305 referrals to the emergency room due to a suicide attempt, 100 reported drinking alcohol up to six hours before their attempt. Paired Matching and Usual Frequency were employed to analyze the data with STATA 12.0. The probability of attempting suicide up to six hours after drinking alcohol appeared increased by 27 times (95 CI: 8.1-60.4). Separate analysis for each of these hours from the first to the sixth hour after alcohol use was also performed. Fifty percent of attempted suicides happened one hour after alcohol use. Relative risk for the first and second hour was 10 and 5 respectively. Alcohol use is a strong proximal risk factor for attempted suicide among Iranian subjects. Prevention of alcohol use should be considered in setting up of the national Suicide attempt prevention program

The effect of counseling with a skills training approach on maternal functioning: a randomized controlled clinical trial

BACKGROUND: The role of the mother can be deeply satisfying, but it is associated with many challenges including challenges during the postpartum period that may impede the optimal development of the infant. Therefore, the aim of the present study was to investigate the effects of counseling using the Skills Training Approach (STA) on postpartum maternal functioning. METHODS: This randomized controlled trial was performed on 68 postpartum women who referred to health centers of Tabriz-Iran in 2019. Participants were assigned to one of two groups - either counseling or control through the block randomization method. The intervention group received four counseling sessions using the Skills Training Approach (STA). Before and two weeks after the completion of the intervention, the Barkin Index of Maternal Functionning (BIMF) was completed by the participants. The independent t-test and ANCOVA (Analysis of Covariance) was used to analyze the data. RESULTS: There was no statistically significant difference between the two groups in terms of sociodemographic characteristics and the baseline scores of the BIMF and its domains (p\u2009>\u20090.05). Before the intervention, the mean (SD) total score of the BIMF in the intervention group was 73.1 (8.5) and in the control group, it was 71.6 (4.8). Post-intervention, the mean (SD) of the total score of the BIMF in the intervention group was 95.8 (11.8) and in the control group, it was 70.3 (4.5). Based on the ANCOVA test and after adjusting the baseline score, the mean total score of the BIMF was significantly higher in the intervention group than in the control group (Mean Difference (MD): 22.9; 95% CI: 18.2 to 27.6; p\u2009<\u20090.001). The post-intervention scores of all domains of the BIMF including self-care (MD: 3.8), infant care (MD: 2.0), mother-child interaction (MD: 4.8), psychological wellbeing (MD: 8.4), social support (MD: 4.0), management (MD: 6.8), and adjustment to new motherhood (MD: 3.2) were significantly higher in the intervention group compared to the control group (P\u2009<\u20090.001). CONCLUSION: In this study, counseling, using STA, was effective in improving maternal functioning in all of the domains. This intervention, aimed at skill-building, should be strongly considered where improved postpartum functioning is the goal

A predictor model for suicide attempt: Evidence from a population-based study

Background: There is an extreme need for planning to prevent suicide in developing countries. It is necessary to detect the risk factors of this problem and plan to control them. The aim of this study was to determine a predictive model for suicide attempt based on its risk factors in order to give information for planning therapeutic, preventive, and educational interventions in Karaj City. Methods: The setting was Karaj City, Tehran Province, Iran and the study design was cross-sectional. In this study, data were collected by using the World Health Organization (WHO) questionnaire of SUPRE-MISS study. The questionnaire included questions about demographic characteristics, personal and family history of suicide behaviors, use of psychotropic drugs, physical and mental disorders, and community stress. All parts of the questionnaire were filled out by interview. A total of 2300 individuals participated in this study having considered the 1.2 prevalence of suicide attempt in the pilot study, and with type one error rate of 5, the sample size was calculated as 2300. Results: About 65 of the participants were females. Most of the participants had high-school education (48) and 57.2 of them were married. Housewives included most of the occupation categories (46). The mean age of the suicide aftempters and nonattempters was 26 (±9) and 32 (±13) years, respectively. This difference was statistically significant. Younger age, female sex, history of mental disorders, lifelong use of tobacco and alcohol, and unemployment were the independent predictors of suicide attempt. Conclusion: Prevention of suicide is possible by understanding its risk factors and planning to control them

Mindfulness-based Cognitive Therapy for Generalised Anxiety Disorder: a Systematic Review and Meta-analysis

BACKGROUND: Generalised anxiety disorder (GAD) has harmful effects on physical and mental health and quality of life. Mindfulness-based cognitive therapy (MBCT) is a treatment option for GAD. This meta-analysis was conducted to determine the effectiveness of MBCT on GAD. METHODS: Two authors independently performed the eligibility, quality assessment, and data extraction processes, and consensus was reached in case of discrepancies. Electronic databases were searched for eligible studies (randomised controlled trials, randomised trials, cluster randomised controlled trials, and clinical trials) up to November 2018 using keywords: mindfulness-based cognitive therapy OR mindfulness based cognitive therapy OR MBCT AND general anxiety disorder OR GAD*. The methodological quality of studies was assessed using the revised Jadad scale. Cohen's formula was used to determine the effect size based on the mean and standard deviation of the changes in the study groups before and after the intervention. RESULTS: Six studies that compared the effectiveness between MBCT and controls were included for analysis. The mean revised Jadad score of the six studies was 4.3 (range, 3-6). The overall mean effect size was -0.65. The funnel plot of effect sizes in relation to the effect size standard error showed a symmetrical distribution. Compared with controls, MBCT significantly improved the treatment outcome of GAD in all studies, except one. CONCLUSION: MBCT was effective for treating GAD

Characteristics of attempted suicides seen in emergency-care settings of general hospitals in eight low- and middle-income countries

Background. The objective was to describe patients presenting themselves at emergency-care settings following a suicide attempt in eight culturally different sites Campinas (Brazil), Chennai (India), Colombo (Sri Lanka), Durban (South Africa), Hanoi (Viet Nam), Karaj (Iran), Tallinn (Estonia), and Yuncheng, (China). Method. Subjects seen for su icide attempts, as identified by the medical staff in the emergency units of 18 collaborating hospitals were asked to participate in a 45-minute structured interview administered by trained health personnel after the patient was medically stable. Result s. Self-poisoning was the main method of attempting suicide in all eight sites. Self-poisoning by pesticides played a particularly important role in Yuncheng (71·6% females, 61·5% males), in Colombo (43·2% males, 19·6% females), and in Chennai (33·8% males, 23·8% females). The suicide attempt resulted in danger to life in the majority of patients in Yuncheng and in Chennai (over 65%). In four of the eight sites less than one-third of subjects received any type of referral for follow-up evaluation or care. Conclus ions. Action for the prevention of suicide attempts can be started immediately in the sites investigated by addressing the one most important method of attempted suicide, namely self-poisoning. Regulations for the access to drugs, medicaments, pesticides, and other toxic substances need to be improved and revised regulations must be implemented by integrating the efforts of different sectors, such as health, agriculture, education, and justice. The care of patients who attempt suicide needs to include routine psychiatric and psychosocial assessment and systematic referral to professional services after discharge. © 2005 Cambridge University Press

Correlates of video games playing among adolescents in an Islamic country

<p>Abstract</p> <p>Background</p> <p>No study has ever explored the prevalence and correlates of video game playing among children in the Islamic Republic of Iran. This study describes patterns and correlates of excessive video game use in a random sample of middle-school students in Iran. Specifically, we examine the relationship between video game playing and psychological well-being, aggressive behaviors, and adolescents' perceived threat of video-computer game playing.</p> <p>Methods</p> <p>This cross-sectional study was performed with a random sample of 444 adolescents recruited from eight middle schools. A self-administered, anonymous questionnaire covered socio-demographics, video gaming behaviors, mental health status, self-reported aggressive behaviors, and perceived side effects of video game playing.</p> <p>Results</p> <p>Overall, participants spent an average of 6.3 hours per week playing video games. Moreover, 47% of participants reported that they had played one or more intensely violent games. Non-gamers reported suffering poorer mental health compared to excessive gamers. Both non-gamers and excessive gamers overall reported suffering poorer mental health compared to low or moderate players. Participants who initiated gaming at younger ages were more likely to score poorer in mental health measures. Participants' self-reported aggressive behaviors were associated with length of gaming. Boys, but not girls, who reported playing video games excessively showed more aggressive behaviors. A multiple binary logistic regression shows that when controlling for other variables, older students, those who perceived less serious side effects of video gaming, and those who have personal computers, were more likely to report that they had played video games excessively.</p> <p>Conclusion</p> <p>Our data show a curvilinear relationship between video game playing and mental health outcomes, with "moderate" gamers faring best and "excessive" gamers showing mild increases in problematic behaviors. Interestingly, "non-gamers" clearly show the worst outcomes. Therefore, both children and parents of non-game players should be updated about the positive impact of moderate video gaming. Educational interventions should also be designed to educate adolescents and their parents of the possible harmful impact of excessive video game playing on their health and psychosocial functioning.</p

"How could neuroimaging be helpful in the assessment of Dementia in a clinical setting? "

This study was conducted to evaluate how neuroimaging procedures (MRI, SPECT) could be used in clinical setting for diagnosis of dementia.Forty out of 94 patients suspected of having a diagnosis of dementia, referred to Radiology Department for consecutive neuroimaging procedures, were selected. Patients’ medical records reviewed anda retrospective diagnosis was reached according to DSM-IV for Alzheimer’s disease (AD) and NINDS-AINS for vascular dementia (VaD). Mann-Whitney, fisher’s exact test, bivariat regression were used for analysis.Clinical features of majority of patients were complicated with mental symptoms. Subcortical lesions were observed in both dementias but it was significantly more frequent in the VaD (P=0.000). No significant differences in the number of patients with cortical atrophy between two groups was observed. Significant agreement between SPECT and retrospective clinical diagnosis was observed (kappa=0.18, P=0.02), but no significant pattern of hypoperfusion which could predict the clinical diagnosis was observed.This study emphasis on clinical diagnosis and the clarity of the referral process for doing neuroimaging evaluation. More sophisticated studies, either structural of functional such as volumetric measurement of medial temporal lobe, could be helpful to confirm clinicians in their diagnosis of patients with dementia