Clinical feature of suicidal behavior in patients with depression

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To study clinical features of suicidal behaviors in patients with depression. Subjects and methods: Thirty-six patients with depression were treated at the Department of Psychiatry, Military Hospital 103.

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Nội dung Text: Clinical feature of suicidal behavior in patients with depression

Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 CLINICAL FEATURE OF SUICIDAL BEHAVIOR IN PATIENTS WITH DEPRESSION Dinh Viet Hung1, Nguyen Van Linh1 Nguyen Dinh Khanh1, Ngo Dac Sang2 SUMMARY Objectives: To study clinical features of suicidal behaviors in patients with depression. Subjects and methods: Thirty-six patients with depression were treated at the Department of Psychiatry, Military Hospital 103. Results: The patients with disease duration from 1 - 3 years accounted for the highest rate (69.45%); Patients with recurrences of two and three times accounted for 58.32%, and severe depression accounted for 61.11%. Prominent symptoms include depressed mood, anhedonia, a feeling of sadness, suicidal idea. In terms of thought form, slow rhythm accounted for 88.89%, and alogia accounted for 80.56%. Most patients with severe depression experiencing only one time of suicidal behavior accounted for 58.34%; the suicidal methods were varied, in which overdosing psychotic and sedative medications were the most frequent (30.55%), time of suicidal behavior being at day accounted for 72.22%, and suicidal accommodation being at home accounted for 69.45%. Conclusion: Suicidal behaviors in patients with depression were varied and directly threatened patients’ lives. * Keywords: Depression; Suicidal behaviors. INTRODUCTION attempted suicide and approximately 5 - 6% of death is originated from suicide. Threat Currently, approximately 10 - 20 million factors of attempted suicide in such attempted suicide persons are found in patients include depression, loss of hope, the world. Suicide is the 13th cause of unemployment, psychosis and post- death in the world. In USA, suicide is the discharge. In Vietnam, there are some 6th death cause, male/female ratio of studies on attempted suicide. However, attempted suicide is 2:1. In Vietnam, they only stop at psychotic patients in suicide is the 2nd death cause in young general. No study on attempted suicide in people, just behind traffic accidents. heavy depression cases is launched. That Attempted suicide due to depression is why the topic of “A study on clinical makes up the highest rate. Approximately characteristics of suicide in depressed 20 - 30% of depression patients have patients” is launched by the authors. 1 Military Hospital 103, Vietnam Military Medical University 2 Vietnam Military Medical University Corresponding author: Dinh Viet Hung (bshunga6@gmail.com) Date received: 26/02/2021 Date accepted: 16/3/2021 178
Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 SUBJECTS AND METHODS 1. Subjects Thirty-six patients diagnosed with the depressive disorder according to ICD-10 were treated at the Department of Psychiatry, Military Hospital 103 from May 2016 to May 2020. 2. Research method Using the retrospective sectional method and analyzing each case. The clinical symptoms were consulted when patients were hospitalized. The consultation was performed by two independent psychiatrists. 3. Data analysis Data analysis was performed base on SPSS 20.0. A statistically significant difference was determined for tests (p < 0.05). RESULTS AND DISCUSSION 1. Features of depression disorder symptoms Table 1: The onset age in patient with depressive disorder. Statistics index Number (n) Percent (%) Age group < 20 2 5.56 20 - 29 6 16.67 30 - 39 10 27.78 40 - 49 12 33.32 50 - 59 4 11.11 > 60 2 5.56 Mean age 33.27 ± 11.48 Our main findings unveiled that the onset age making up the highest prevalence was 20 - 49 (77.77%); it is equivalent to the results from previous studies. Depression often onset at the early stage of growth and start of self-independence life. This was also a phase that a series of problems are faced by people, especially difficulties in life, strengths and weaknesses of the body are also demonstrated, socio-economic conditions affecting the personal life cause stress to the body. As a result, the disease may start. Indicator signs of depression disorders were often shown by fatigue, sleep disorders, and impaired work performance [1]. 179
Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 Table 2: The disease duration in patients with depressive disorder. Statistics index Number (n) Percent (%) Disease duration < 1 year 7 19.44 1 - 2 years 10 27.78 2 - 3 years 15 41.67 > 3 years 4 11.11 Table 2 unveiled that the patients with 1 - 3 years disease made up the highest percentage (69.45%), the number of patients with a disease period of over 3 years made up the lowest percentage (11.11%). Depression may be prolonged for years and become chronic. Hence, the disease period was generally prolonged. Due to unclear understanding about the disease, many patients became serious before the examination at the psychotic department [1]. Table 3: The number of recurrences of depressive disorder. Statistics index Number (n) Percent (%) Number of recurrences 1 time 4 11.11 2 times 9 25.00 3 times 12 33.32 4 times 6 16.67 5 times 3 8.34 > 5 times 2 5.56 Table 3 unveiled that the number of disease re-occurrence two times and three times accounted for the highest percentage (58.32%), and the lowest one was the case with five times of occurrence (5.56%). The development of depression was to re-occur. Between the stable phases, the depressed patients were still found with disease persistence. In comparison, the patients’ post-discharging monitoring and maintenance treatment was not paid with special concerns. Many patients omitted medicine as they denied the disease and incorrect recognition. That is why the high rate of re-occurrence patients for 2nd time or more account is recorded. Moreover, Vietnamese awareness about mental health is still restricted, resulting in prolong disease time and low treatment efficiency [1]. 180
Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 Table 4: Clinical types of depressive disorder. Statistics index Number (n) Percent (%) Clinical types Bipolar disorder with current depressive phage 4 11.11 Depressive disorder 22 61.11 Recurrent phage 10 27.78 Among study patients, most of them in the depression phase included 22 persons, accounting for 61.11%; ten patients with re-occurrence of depression account for 27.78%, and the lower rate of bipolar emotional disorder was found in 4 patients, accounting for 11.11%. Our study is consistent with the study of Viswanath B. (2012) that assumed that the depression phase is ranked at the top, next is the depression re-occurrence and bipolar emotional disorder. The study indicated that bipolar emotional disorder generally onset at a young age. However, when it was in the depression phase, it related to a series of factors such as disease time, living quality, and discrimination, the attempted suicide was partially explained in the depression phase [2]. Table 5: Symptoms of mood disorder in the patient. Statistics index Number (n) Percent (%) Symptoms Depressed mood 36 100.00 Anhedonia 36 100.00 Feeling of sadness 36 100.00 Reduced energy 35 97.22 Loss of confidence 34 94.44 Loss of concentration 32 88.89 Table 5 unveiled that the outstanding emotion symptoms included reduced complexion, loss of interest/concern, and bored feelings with 100%. The study of Lin C (2019) indicated that these are core symptoms of depressive disorder and obligatory appearance of emotional symptoms in acutely psychotic patients, i.e., reduced complexion and loss of interest/concern. In addition, other symptoms of depression were emphasized, for example, anxiety, reduced energy and discouragement [3]. 181
Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 Table 6: Symptoms of dyskinesia in the patient. Statistics index Number (n) Percent (%) Symptoms Sucidal ideation 36 100.00 Psychomotor retardation 34 94.44 Anxiety 32 88.89 Ignore social activities 31 86.11 None of co-operation in treatment 29 80.55 Food refusal 11 30.56 Table 6 unveiled that the restricted affect disorders were mostly found in symptoms with intentional suicide (100%), next was delayed movements and anxiety (94.44%); 88.89% and especially 30.56% patients refused food. These specific symptoms were often found in depression disorder patients under ICD 10-1992. A study on restricted affect disorders in depression patients launched by Pettersson A. (2015) realized that in addition to the specific signs (i.e., attempted suicide, restricted affect), other diversified movement disorders were also recorded in the patients with depression, including anxiety, social activity omission and non-cooperation with treatment. An important characteristic of restricted affect disorders of patients with depression was suicide attempt. Hence, such disorders must be especially concerned during the treatment of patients with depression. The close and inevitable gap was found from depression to suicide behavior [4]. Table 7: Disorders of the form of thought in the patient. Statistics index Number (n) Percent (%) Symptoms Poor language 32 88.89 Sluggish language 29 80.56 Interruption answer 23 63.89 Whispering 12 33.33 Don't speak 6 16.67 As a result, thinking disorders in patients with depression showed poor, sluggish language and interruption answer accounted for a large percentage, i.e., 88.89%, 80.56%, and 63.89%, respectively. Through such symptoms, patients were realized with mental health problems. Patients were found with anxiety, silence, or even they did not want to talk. This result is well-matched with the main findings of Riga D (2017), where conclusions were drawn that the thinking disorders in elderly patients with depression are generally found [5]. 182
Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 2. Clinical characteristics of attempted suicide in depression patients Table 8: Number of suicide attempts in study patients. Statistics index Number (n) Percent (%) Number of suicide Once time 21 58.34 Two times 7 19.44 Three times 4 11.11 Four times 3 8.33 Five times 1 2.78 Table 8 specified that majority of patients having at least once attempted suicide accounts for 58.34%; next was those having two and three attempted suicide times, accounted for 19.44% and 11.11%, respectively. This result is well-matched with the main findings of Park S (2018), where it is assumed that the majority of depression patients with suicide to be treated in the Department of Psychiatry has just only one suicide time. The author further emphasized that the number of attempted suicide would be repeated if patients are not well treated, managed, and not applied with electrical cardioversion [6]. Table 9: Methods of suicide attempt in study patients. Statistics index Number (n) Percent (%) Methods of suicide Sedatives 11 30.55 With pesticide, ratsbane 5 13.89 Using sharp objects such as knife, scissors to cut or throw 6 16.67 Hammers, bricks, and stones 4 11.11 Hanged 3 8.33 Jumping from above 3 8.33 By electric shock 2 5.56 Other forms 2 5.56 Table 9 described that the suicide forms taken by patients with depression were very diversified, the highest percent belonged to patients using sedatives (30.55%), next was using sharp objects such as knives, scissors to cut or throw (16.67%). This result is consistent with DSM 5 when it is assumed that the schizophrenic patient’s suicide methods are diversified, however, the most popular one is the violent ways such as stab, chopper, shoot, garrotte, etc. Girlanda F (2014) specified that the most popular attempted suicide form is to drink overdose medicines and toxics, accounting for 68.25%, next was to use a knife and sharp objects, accounting for 12.15%, jumping from the height accounted for 11.21% [7]. 183
Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 Table 10: Percentage of medicine the (22.9%) and not-defined (4.82%). Among patient took in. 244 depressed patients with attempted suicide, the patients were found to carefully Statistics index Number Percent prepare and conduct at an unexpected Type of medicine (n) (%) times [8]. Paraquat 2 12.5 Table 12: Location suicide attempt of Paracetamol 3 18.75 study patient. Sedatives 5 31.25 Statistics index Number Percent Organic phospho 2 12.5 Location suicide (n) (%) No organic phospho 1 6.25 Other 3 18.25 Their home 25 69.45 On road 7 19.44 The medicine group which was mostly used by the attempted suicide patients Other 4 11.11 was sedatives (31.25%), next was Most of the patients with attempted paracetamol (18.75%), sharing the same suicide conducted at home, accounting rate of 12.5% was agricultural pesticides for 69.45%; the second was on road and organic phosphor. These medicine (19.44%). Thus, the majority of patients groups were available for purchase. The with attempted suicide conducted suicide remaining was widely used in agriculture when no one was at home or when no and industry. With the data above, it is attention was paid. This result is well- alarming that such medicines must be matched with the main findings of Bui strictly managed to restrict the attempted Quang Huy (2016) [1]. suicide with such drugs and chemicals. Table 11: Time of study patient's CONCLUSIONS suicide attempt. Through the study on clinical characteristics of attempted suicide in depression patients, Statistics index Number Percent we realized that. Time of (n) (%) attempted suicide Patients with disease of 1 - 3 years, accounted for the highest percent (69.45%); Daytime 26 72.22 second and third time of occurrence Nighttime 10 27.78 accounted for 58.32% and patients in the Table 11 unveiled that the majority of depression phase made up 61.11%. attempted suicide patients conduct the The outstanding emotion symptoms behavior during the daytime (72.22%). include reduced complexion, loss of This result is well-matched with the main interest/concern, and bored feelings, and findings of Wee J H (2016). Accordingly, 100% of patients with attempted suicide. it is found that attempted suicide patients Regarding the thinking disorder, delayed conduct the suicide in the morning (35.14%), language and alogia account for 88.89% afternoon (21.25%), noon (15.89%), night and 80.56%, respectively. 184
Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 The majority of depression patients 4. Pettersson A, Boström KB, Gustavsson P, having one attempted suicide time et al. Which instruments to support diagnosis accounted for 58.34%; attempted suicide of depression have sufficient accuracy? A systematic review. Nord J Psychiatry 2015; with relatively diversified methods was 69(7):497-508. recorded, the highest percent belonged to patients using depression (30.55%); 5. Riga D, Schmitz LJM, Hoogendijk WJG, et al. Temporal profiling of depression and most attempted suicide in daytime vulnerability in a preclinical model of sustained accounts for 72.22% and attempted depression. Sci Rep 2017; 7(1):8570. suicide location was at home (69.45%). 6. Park S, Lee Y, Youn T, et al. Association between level of suicide risk, REFERENCES characteristics of suicide attempts, and mental 1. Bui Quang Huy, Phung Thanh Hai, disorders among suicide attempters. BMC Public Dinh Viet Hung. Disorder depression. Medical Health 2018; 18(1):477. Publishing House. Hanoi 2016:7-118. 7. Girlanda F, Cipriani A, Agrimi E, et al. 2. Viswanath B, Narayanaswamy JC, Effectiveness of lithium in subjects with Rajkumar RP, et al. Impact of depressive treatment-resistant depression and suicide risk: and anxiety disorder comorbidity on the Clinical Results and lessons of an underpowered expression of obsessive-compulsive disorder. randomised clinical trial. BMC Res Notes Compr Psychiatry 2012; 53(6):775-782. 2014; 7:731. 3. Lin C, Karim HT, Pecina M, et al. 8. Wee JH, Park JH, Choi SP, et al. Emotional awareness: A transdiagnostic Clinical features of emergency department predictor of depression and anxiety for patients with depression who had attempted children and adolescents. Neuroimage Clin to commit suicide by poisoning. Niger J Clin 2019; 21:101679. Pract 2016; 19(1):41-45. 185