| Abstract|| |
Aim: This study was carried out to determine the reasons of the suicide probability and reasons for living of the inpatients hospitalized at the psychiatry clinic and to analyze the relationship between them.
Materials and Methods: The sample of the study consisted of 192 patients who were hospitalized in psychiatric clinics between February and May 2016 and who agreed to participate in the study. In collecting data, personal information form, suicide probability scale (SPS), reasons for living inventory (RFL), and Beck's depression inventory (BDI) were used. Stepwise regression method was used to determine the factors that predict suicide probability.
Results: In the study, as a result of analyses made, the median score on the SPS was found 76.0, the median score on the RFL was found 137.0, the median score on the BDI of the patients was found 13.5, and it was found that patients with a high probability of suicide had less reasons for living and that their depression levels were very high. As a result of stepwise regression analysis, it was determined that suicidal ideation, reasons for living, maltreatment, education level, age, and income status were the predictors of suicide probability (F = 61.125; P < 0.001).
Discussion: It was found that the patients who hospitalized in the psychiatric clinic have high suicide probability and the reasons of living are strong predictors of suicide probability in accordance with the literature.
Keywords: Depression, hospitalized patients, probability of suicide, psychiatry, reasons for living
|How to cite this article:|
Eskiyurt R, Ozkan B. The investigation of the relationship between probability of suicide and reasons for living in psychiatric inpatients. Indian J Psychiatry 2017;59:435-41
|How to cite this URL:|
Eskiyurt R, Ozkan B. The investigation of the relationship between probability of suicide and reasons for living in psychiatric inpatients. Indian J Psychiatry [serial online] 2017 [cited 2019 Nov 18];59:435-41. Available from: http://www.indianjpsychiatry.org/text.asp?2017/59/4/435/217298
| Introduction|| |
Nowadays, the purpose of psychiatry clinics is to help a patient to recognize the psychiatric problems that cause the patient to be hospitalized and to help them recover., Although hospitalization in hospitals has been on the decline from weeks to days, hospitalization continues as an option for treatment of individuals with emotional crises and mental disorders., In psychiatry clinics, individuals who committed suicide, who are at high risk for damaging to environment, or who need acute care for a short time due to loss of function are given priority. Although one of the reasons of hospitalization is to prevent suicide, it is reported that the suicide rate in psychiatric hospitals is quite high compared to the rate of suicide in the society.,,,, The presence of psychiatric illness is one of the risk factors which are reported consistently and consistently for suicidal behavior. In high-income countries, 90% of people who died from suicide have psychiatric disorders, whereas in the 10% group with no explicit diagnosis, the psychiatric symptoms are similar to those who died from suicide.
Major depression, bipolar disorder, and alcohol use disorders were found to significantly increase risk of suicidal ideation; substance abuse, panic disorder, and general anxiety disorder were found to significantly increase risk for suicide attempts. Suicides take place in all parts of the world and throughout life and can be seen in a wide range of populations, ranging from healthy people who respond to stressful life events to those with severe mental illness. It is stated that suicide is a public health problem with universal importance because about one million people die every year from suicide worldwide. Although suicides are preventable, one individual in every 40 s dies somewhere in the world because of suicide, and many people are attempting suicide. It is stated that approximately 45% of the people who died as a result of the suicide refer to the primary care physician within the 1st month of their death. The fact that suicide is a preventable cause of death makes it very important to evaluate the suicide risk.
As a result of researches related to suicidal behavior, risk factors for suicide are sorted as sex, despair, suicide attempt story in individual and family, psychiatric disorder, impulsivity, and childhood abuse, and to decrease suicide rates, targets for these risk factors are determined. However, it is seen that these methods are inadequate and that few studies focus on protective factors.,,
While suicide-related studies are generally focused on the “negative cognitions,” “reasons for living inventory (RFL)” developed by Linehan et al. focus on “positive cognitions” that protect people from suicidal behavior. There are belief systems which separate people who committed suicide and people who do not commit suicide from each other and these belief systems are named as reasons for living. The reasons for living are the reasons that the individual is bound to “do not kill himself” and “live.” It is argued that the reasons for living are reducing the power of the relationship between suicidal thoughts and hopelessness and protecting the individuals from negative effects of despair., Studies made in this area have indicated that most patients with suicidal ideation or suicide attempts may be less likely to die of suicide by choosing life rather than death.,,,,
Suicide resulted in death is more tragic than the death of the natural causes and affects both the environment of a person and the society where s/he lives, both materially and spiritually. Therefore, by evaluating suicidal risk, it becomes extremely important to know and prevent suicide extremely. For this reason, this study was conducted as a descriptive study to determine reasons of suicide probability and reasons for living of patients hospitalized at the psychiatry clinic and to analyze the relationship between them.
| Materials and Methods|| |
The study was conducted as a descriptive study. The study was conducted in Turkey at 2 education and research and 1 psychiatric clinic affiliated to a university hospital. The sample of the study consisted of 192 patients who were hospitalized between February and May 2016. The necessary approvals were obtained from the institutions where the study carried out, and the approval of the ethics committee was taken from an ethics committee in Turkey.
Patient selection criteria for the study
- Accepting voluntarily participation to the work
- Being older than 18
- Mental and general medical condition to be in accordance with psychiatric consultation
- Having at least one psychiatric diagnosis according to the DSM-V
- Being approved by a psychiatrist to participate to the study
- Being hospitalized in psychiatry clinic.
Patients who were determined in this way and the patients whose duration of hospitalization was <1 day were not included to the study.
Data collection methods used in the research
For collecting data, personal information form, suicide probability scale (SPS), RFL, Beck's depression inventory (BDI), and volunteer form were used.
Personal information form
Within the scope of the research, the “personal information form” consisting of 13 questions prepared by the researcher in accordance with the literature was used to determine the demographic characteristics of the group consisting of patients who were hospitalized.,, In this form, there are questions about the participants' age, gender, education, marital status, child ownership, job, people living together at home, economic levels, and past experiences of stressful events.
Suicide probability scale
It is a 36-item self-assessment scale developed by Cull and Gill, rated 1–4 Likert type. The scale was developed to assess risk of suicide in adolescents and adults. It is aimed to determine the behavioral, cognitive, and emotional components of suicide. The score range is between 36 and 144, and high scores on the scale indicate high suicide probability. In our country, the studies conducted on the scale include findings that this scale is valid and reliable. The Cronbach alpha reliability coefficient of the scale was 0.95. As a result of the factor analysis, three factors explaining 51.9% of the total variance were found. The internal consistencies of the subscales of SPS in this study were found SPS anger as 0.70; SPS breakage from life loyalty as 0.69; and SPS negative self-evaluation and exhaustion as 0.83.,
Reasons for living inventory
This scale was developed to determine the reasons that connect people to life and it has been adapted to our culture using Linehan et al.'s “RFL” 48-item self-assessment scale., In this study, RFL was adapted to our culture and was used with 28-item form. The item-total correlation coefficients of the scale were ranged from 0.21 to 0.70. According to the discriminant analysis results, it was found that the correct discrimination rate of the scale between normal and depressive groups was 72.7%; the discrimination rate of suicide group and depressive group was 72.2%, and the rate of discrimination between suicide group and normal group was 61.1%. The internal consistencies of the subscales of the RFL in this study were found to be RFL commitment to life as 0.89; RFL hope and social support as 0.87; RFL religious obstacle as 0.61; and RFL struggle as 0.49.
Beck's depression inventory
The BDI was developed by Beck in 1961. Then, the scale was re-examined by Beck in 1978, and it became 21-item self-assessment questionnaire with the 4-point Likert type, scores ranging from 0 to 3. The 1978 version of the scale was adapted to Turkish by Hisli in 1989. The total score obtained from the scale ranges from 0 to 63. The high score obtained from the scale indicates an increase in depressive symptoms objectively. In this study, the Cronbach alpha coefficient was found as 0.92.
The evaluation of research data
The obtained research data were analyzed with using number, percentage, frequency, median, mean, standard deviation, Kruskal–Wallis H, Mann–Whitney U, correlation, and stepwise regression method in the IBM SPSS 21.0 package programs and the statistical significance was accepted as P < 0.05.
| Results|| |
The demographic characteristics of the patients hospitalized in the psychiatric clinic constituting the study group are shown in [Table 1].
There was no significant difference between the SPS median scores according to gender, age groups, marital status, persons living together at home, having children, experiencing suicide attempt by a relative, and losing a relative due to an accident (P > 0.05). According to the study, the significant difference was found between features such as level of education, working status in a job with income, economic status, having a depression diagnosis, suicidal thought and suicide attempt story, overcoming a life-threatening situation, being treated badly, or losing a relative from suicide (P< 0.05).
In the study, the RFL scale median score of the patients hospitalized in the psychiatry clinic was found as 137.0, the SPS scale median score was found as 76.0, and BDI scale median score was found as 13.5. It was found that there was a moderate, negative, and significant relationship between the RFL total score and the SPS total score medians of the patients (0.40 < | rho = 0.448 | < 0.69; [P< 0.001]), and as the RFL total score median increases, the SPS total score median decreases, and there was found a positive, strong (high), and significant relationship between BDI total score and SPS total score (0.70 < | rho = 0.755 || < 0.89; [P< 0.001]) [Table 2].
|Table 2: Correlations between suicide probability scale, Beck's depression inventory, and reasons for living|
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SPS-dependent variable was investigated by stepwise regression method using gender, age, marital status, having children, education level, income level, people living together at home, suicide ideation, story of suicide, overcoming a life-threatening situation, being treated badly or losing a relative from suicide, reasons for living and depression as independent variables. As a result of stepwise regression, the independent variables that were predicted to have a significant impact on the SPS total score medians were found depression, suicidal thoughts, reasons for living, being treated badly, education level, income status, and age. With these determined independent variables, the explanatory coefficient of the model was found to be R2 = 0.728, and it was found that the model was statistically significant (F = 61.125; [P< 0.001]) [Table 3].
| Discussion|| |
Considering studies conducted on the possibility of clinical or nonclinical suicide, to be a woman, to be young, to have no income, to experience feelings of depression, loneliness, and hopelessness, and to have fewer reasons for living can be seen as important risk factors. In this study, a series of analyses were conducted to examine the suicide probability and associated factors of the patients hospitalized at the psychiatric clinic.
According to the findings obtained from this study, the suicide probabilities of the university graduates are lower than the other education level individuals. Previous studies in the literature show that low education level is a risk for suicide and that individuals with low education level have high suicide probability., It can be said that individuals with low educational level are inadequate in the problems they face and the ability to cope with stress. As the level of education of the individual increases, the self-esteem also increases and it is thought that individuals with high self-esteem have more control over life situations and solve their problems with effective coping methods.
There are also studies showing that suicide attempts are most frequent in the working group as well as studies ,, that indicate that individuals who do not work in any way have a high probability of suicide. In this study, it was found that individuals with low income are more likely to commit suicide. Unemployment and low-income levels are said to increase the probability of suicide., In addition to determining the standard of life for the individuals, the level of financial income provides financial resources for solving many problems. Job loss with financial losses, loss of housing, and loss of interpersonal relationships can cause emotional stress. In the relationship between unemployment and income level and suicide, it is thought that a number of factors, such as physical or mental illnesses, harmonious personality traits, and bad childhood experiences have a role.
In this study, suicide probability of individuals with depression was found to be higher than those of the other diagnostic groups, and the reasons for living were lower. In other words, the probability of suicide increases as their depression level increases and reasons for living decreases. Similar studies made in clinical and nonclinical settings have also shown that the reasons for living reduce the power of suicidal thoughts, depression, and hopelessness and protect individuals from negative effects of despair.,,,,, Suicide is reported to be more common in psychiatric patients according to the general population and especially patients who have hospitalized in psychiatric clinics have higher risk for suicide., In previous studies, individuals who were diagnosed with depression and undergoing inpatient treatment were found to have high suicide probability and low reasons for living. It is thought that the results obtained from this study are consistent with the literature, and it is considered that the risk of suicide is increased by adding negative expectations about hopelessness, pessimism, and future to the symptoms of depression.,,,,,,, Factors such as social isolation, job loss, loss of family members, loss of interpersonal relationships, hopelessness, use of substance or alcohol, ineffective problem-solving skills, and loss of ability can lead to an increase in suicide probability in individuals with any psychiatric disorder. It is believed that the ability to cope with hopelessness and pessimism will be a contribution to the development of reasons for living and will protect against the risk of suicide by ensuring that sick individuals focus on positive thinking and what they have in their lives such as family and children.
In the literature, it is stated that suicidal thoughts and suicide attempts are a strong factor in increasing the probability of suicide in hospitalized patients.,, Similar studies have also shown that suicide ideation and story of suicide attempt increase suicide risk.,,,, Individuals with suicide ideation and story of suicide attempt have fewer reasons for living and high suicide probability and depression levels.,,, In this study, it was found that individuals with suicidal thoughts and story of suicide have higher probability of suicide and fewer reasons for living in accordance with the literature. Individuals with suicide attempts have high levels of depression and are accompanied by psychiatric disorders such as substance use disorders and anxiety and mood disorders. Depression and hopelessness are strong risk factors for suicidal thoughts and behaviors, and reasons for living seem to be a protective cognitive factor against the possibility of suicide. Treatment of psychiatric disorders and evaluation of suicidal ideation are thought to be helpful in preventing suicide attempts.
In this study, it has been found that individuals who overcoming a life-threatening situation, being treated badly, losing a relative from suicide, experiencing suicide attempt by a relative, and losing a relative due to an accident have higher suicide probability and individuals who lose his/her relative because of suicide have more reasons for living. In traumatic life events, it is stated that the reasons for living related to determining the probability of suicide have not any effect alone. Lizardi et al. found that individuals who have suicide stories in their families had high levels of anger and fewer reasons for living. In the study performed with individuals who have previously attempted suicide and who have not attempted suicide, Jokinen et al. have concluded that individuals who have previously attempted suicide have subjected to ill treatment during their childhood or adulthood. In a study conducted by Ajdacic-Gross et al. to determine the probability of suicide of patients hospitalized at psychiatry clinics, 74% of individuals who applied to the hospital for suicide were found to experience stressful life events. Negative life events disrupt the mental balance of the individual, reducing their vulnerability and making them more susceptible to psychiatric disorders. It is thought that because depressive individuals with story of suicide in their families are more impulsive and angry, they have high probability of suicide and model suicidal behavior as coping skills.
In this study, independent variables that were predicted to have a significant effect on the probability of suicide were depression, suicidal ideation, reasons for living, being treated badly, education level, income status and age, all of which were found to have significant effects in consequence of stepwise regression analysis. In similar studies, it was found that depression, suicidal ideation, reasons for living, being treated badly, education level, income status, and age are significant predictors of suicide probability.,,,,, It was determined that in the study by Mohammadkhani et al., reasons for living; in the study by Edelstein et al., depression, age, and reasons for living; in the study by O'Connor et al., suicidal ideation and reasons for living; in the study by Qin et al., low-income level; in the study by Oquendo et al., depression, life situations, suicidal ideation, and reasons for living are predictor factors of suicide probability.
Limitations of the study
The most important limitation of our study was the number of sample group. It is thought that it would be useful to expand the sample and work with the control group in future studies. The study is an opportunity to determine the risk factors of suicide as well as the protective factors in the clinical practice and to monitor the patient in this context.
| Conclusions|| |
According to the results of the study, the evaluation of age, education level, income status, traumatic life story, depression level, suicide ideation, suicide attempt, and reasons for living of the patients hospitalized at psychiatry clinics were found to be effective in preventing suicide. It is thought that the nurses who are in the mental health personnel in psychiatry clinics can contribute to the safety of the patients and the therapeutic environment by observing these results during patient observation, patient interviews, and patient treatment within the mental health service. It is considered necessary to know and monitor the protective factors as well as the factors that increase the risk of suicide in the prevention of suicide.
Financial support and sponsorship
3128 projects were supported by the project by Ankara Yildirim Beyazit University Scientific Research Projects Unit.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Van Bogaert P, Clarke S, Willems R, Mondelaers M. Staff engagement as a target for managing work environments in psychiatric hospitals: Implications for workforce stability and quality of care. J Clin Nurs 2013;22:1717-28.
Sakinofsky I. Preventing suicide among inpatients. Can J Psychiatry 2014;59:131-40.
Halter MJ, Varcarolis EM. Varcarolis' Foundations of Psychiatric Mental Health Nursing. 7th
ed. New York: Elsevier Health Sciences; 2013. p. 73-4.
Simon RI, Shuman DW. Psychiatry and the law. In: Hales RE, Yudofsky SC, Gabbard GO, editors. The American Psychiatric Publishing Textbook of Psychiatry. 5th
ed. Washington, DC: American Psychiatric Publishing; 2008.
Walsh G, Sara G, Ryan CJ, Large M. Meta-analysis of suicide rates among psychiatric in-patients. Acta Psychiatr Scand 2015;131:174-84.
Dong JY, Ho TP, Kan CK. A case-control study of 92 cases of in-patient suicides. J Affect Disord 2005;87:91-9.
Madsen T, Agerbo E, Mortensen PB, Nordentoft M. Predictors of psychiatric inpatient suicide: A national prospective register-based study. J Clin Psychiatry 2012;73:144-51.
Zincir SB, Zincir S, Kosker SD, Sunbul EA, Aksoy AE, Elbay RY, et al.
Suicide attempt and its relationships with clinical features and sociodemographic variables in psychiatric inpatients. J Mood Disord 2014;4 Suppl 2:53-8.
Radhakrishnan R, Andrade C. Suicide: An Indian perspective. Indian J Psychiatry 2012;54:304-19.
] [Full text]
Dong X, Chang ES, Zeng P, Simon MA. Suicide in the global Chinese aging population: A review of risk and protective factors, consequences, and interventions. Aging Dis 2015;6:121-30.
Sayil I, Berksun OE, Palabiyikoglu R, Ozguven HD, Soykan C, Haran S. Crisis and crime intervention. Ankara University Psychiatric Crisis Application and Research Center Publications; 2000. p. 6.
World Health Organization. Preventing Suicide: A Global İmperative. World Health Organization; 2014.
Ahmedani BK, Simon GE, Stewart C, Beck A, Waitzfelder BE, Rossom R, et al.
Health care contacts in the year before suicide death. J Gen Intern Med 2014;29:870-7.
Beck AT, Brown G, Berchick RJ, Stewart BL, Steer RA. Relationship between hopelessness and ultimate suicide: A replication with psychiatric outpatients. Am J Psychiatry 1990;147:190-5.
Holma KM, Melartin TK, Haukka J, Holma IA, Sokero TP, Isometsä ET, et al.
Incidence and predictors of suicide attempts in DSM-IV major depressive disorder: A five-year prospective study. Am J Psychiatry 2010;167:801-8.
Johnson J, Wood AM, Gooding P, Taylor PJ, Tarrier N. Resilience to suicidality: The buffering hypothesis. Clin Psychol Rev 2011;31:563-91.
Linehan MM, Goodstein JL, Nielsen SL, Chiles JA. Reasons for staying alive when you are thinking of killing yourself: The reasons for living inventory. J Consult Clin Psychol 1983;51:276-86.
Britton PC, Duberstein PR, Conner KR, Heisel MJ, Hirsch JK, Conwell Y, et al.
Reasons for living, hopelessness, and suicide ideation among depressed adults 50 years or older. Am J Geriatr Psychiatry 2008;16:736-41.
Malone KM, Oquendo MA, Haas GL, Ellis SP, Li S, Mann JJ, et al.
Protective factors against suicidal acts in major depression: Reasons for living. Am J Psychiatry 2000;157:1084-8.
Bagge CL, Lamis DA, Nadorff M, Osman A. Relations between hopelessness, depressive symptoms and suicidality: Mediation by reasons for living. J Clin Psychol 2014;70:18-31.
Edelstein BA, Heisel MJ, McKee DR, Martin RR, Koven LP, Duberstein PR, et al.
Development and psychometric evaluation of the reasons for living – Older adults scale: A suicide risk assessment inventory. Gerontologist 2009;49:736-45.
Mohammadkhani P, Khanipour H, Azadmehr H, Mobramm A, Naseri E. Trait mindfulness, reasons for living and general symptom severity as predictors of suicide probability in males with substance abuse or dependence. Iran J Psychiatry 2015;10:56-63.
O'Connor SS, Comtois KA, Wang J, Russo J, Peterson R, Lapping-Carr L, et al.
The development and implementation of a brief intervention for medically admitted suicide attempt survivors. Gen Hosp Psychiatry 2015;37:427-33.
Oquendo MA, Waternaux C, Brodsky B, Parsons B, Haas GL, Malone KM, et al.
Suicidal behavior in bipolar mood disorder: Clinical characteristics of attempters and nonattempters. J Affect Disord 2000;59:107-17.
Sezer S. A look at the theoretical and psychometric studies on the meaning of life. J Fac Educ Sci 2012;45 Suppl 1:209-27.
Sahin NH, Batigun AD. Reasons for Surviving and the Possibility of Suicide. Unpublished Work; 2000.
Durak A, Yasak GY, Sahin NH. What are the reasons connecting people to life? The reasons for the sustainment of life the validity and reliability of the inventory. J Turk Psychol 1993;8 Suppl 30:7-19.
Hisli N. A study on the validity of the Beck Depression Inventory. J Psychol 1988;6 Suppl 22:118-22.
Sevik AE, Ozcan H, Uysal E. Investigation of suicide attempts: Risk factors and follow-up. Clin Psychiatry 2012;15:218-25.
Batigun AD. Juniors and Suicide: Differentiating Characteristics with Other Age Groups. Ankara University Social Sciences Institute, Unpublished PhD thesis, Ankara: Ankara University; 2002.
Cull JG, Gill WS. Suicide Probability Scale (SPS) Manual. Los Angeles: Western Psychological Services; 1988.
Sahin NH, Batigun AD, Sahin N. Reasons for living and their protective value: A Turkish sample. Arch Suicide Res 1998;4:157-68.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-71.
Sabanciogullari S, Avci D, Dogan S, Kelleci M, Ata E. Suicide probability and affecting factors in psychiatric inpatients. Anatol J Psychiatry 2015;16 Suppl 3:164-72. [doi: 10.5455/apd. 1402480271].
Kõlves K, Ide N, De Leo D. Suicidal ideation and behaviour in the aftermath of marital separation: Gender differences. J Affect Disord 2010;120:48-53.
Lim AY, Lee AR, Hatim A, Tian-Mei S, Liu CY, Jeon HJ, et al.
Clinical and sociodemographic correlates of suicidality in patients with major depressive disorder from six Asian countries. BMC Psychiatry 2014;14:37.
Platt S, Hawton K. Suicidal behaviour and the labour market. The İnternational Handbook of Suicide and Attempted Suicide. Ch. 20. England: John Wiley; 2000. p. 309-84.
Chang SS, Stuckler D, Yip P, Gunnell D. Impact of 2008 global economic crisis on suicide: Time trend study in 54 countries. BMJ 2013;347:f5239.
Alberdi-Sudupe J, Pita-Fernández S, Gómez-Pardiñas SM, Iglesias-Gil-de-Bernabé F, García-Fernández J, Martínez-Sande G, et al.
Suicide attempts and related factors in patients admitted to a general hospital: A ten-year cross-sectional study (1997-2007). BMC Psychiatry 2011;11:51.
Agerbo E, Nordentoft M, Mortensen PB. Familial, psychiatric, and socioeconomic risk factors for suicide in young people: Nested case-control study. BMJ 2002;325:74.
Caykoylu A, Coskun I, Kirkpinar I, Ozer H. Sociodemographic characteristics and distribution of diagnoses in suicide attempt. J Crisis 1997;5 Suppl 1:37-42.
Batigun AD. Some variables related to suicide: Anger/aggression, impulsive behaviors, problem solving skills, causes of survival. J Crisis 2004;12 Suppl 2:49-61.
Lizardi D, Sher L, Sullivan GM, Stanley B, Burke A, Oquendo MA, et al.
Association between familial suicidal behavior and frequency of attempts among depressed suicide attempters. Acta Psychiatr Scand 2009;119:406-10.
Wang MC, Joel Wong Y, Tran KK, Nyutu PN, Spears A. Reasons for living, social support, and Afrocentric worldview: Assessing buffering factors related to Black Americans' suicidal behavior. Arch Suicide Res 2013;17:136-47.
Lee SY. Reasons for living and their moderating effects on korean adolescents' suicidal ideation. Death Stud 2011;35:711-28.
Nordentoft M, Mortensen PB, Pedersen CB. Absolute risk of suicide after first hospital contact in mental disorder. Arch Gen Psychiatry 2011;68:1058-64.
Qin P, Nordentoft M. Suicide risk in relation to psychiatric hospitalization: Evidence based on longitudinal registers. Arch Gen Psychiatry 2005;62:427-32.
Saginc H, Kugu N, Akyuz G, Dogan O. Investigation of suicide story in hospitalized patients. Anatol J Psychiatry 2000;1 Suppl 2:83-8.
Lin SK, Hung TM, Liao YT, Lee WC, Tsai SY, Chen CC, et al.
Protective and risk factors for inpatient suicides: A nested case-control study. Psychiatry Res 2014;217:54-9.
Scott EM, Hermens DF, Naismith SL, White D, Whitwell B, Guastella AJ, et al.
Thoughts of death or suicidal ideation are common in young people aged 12 to 30-years presenting for mental health care. BMC Psychiatry 2012;12:234.
Aishvarya S, Maniam T, Karuthan C, Sidi H, Ruzyanei N, Oei TP. Psychometric properties and validation of the Reasons for Living Inventory in an outpatient clinical population in Malaysia. Compr Psychiatry 2014;55 Suppl 1:S107-13.
Maree EG. Hospital-based psychiatric nursing care. In: Stuart GW, Laraia MT, editors. Principles and Practices of Psychiatric Nursing. 7th
ed. St. Louis: Mosby; 2001. p. 712-27.
Neuner T, Schmid R, Wolfersdorf M, Spiessl H. Predicting inpatient suicides and suicide attempts by using clinical routine data? Gen Hosp Psychiatry 2008;30:324-30.
Bowers L, Banda T, Nijman H. Suicide inside: A systematic review of inpatient suicides. J Nerv Ment Dis 2010;198:315-28.
Coryell W, Kriener A, Butcher B, Nurnberger J, McMahon F, Berrettini W, et al.
Risk factors for suicide in bipolar I disorder in two prospectively studied cohorts. J Affect Disord 2016;190:1-5.
Britton PC, Stephens B, Wu J, Kane C, Gallegos A, Ashrafioun L, et al.
Comorbid depression and alcohol use disorders and prospective risk for suicide attempt in the year following inpatient hospitalization. J Affect Disord 2015;187:151-5.
Chan LF, Shamsul AS, Maniam T. Are predictors of future suicide attempts and the transition from suicidal ideation to suicide attempts shared or distinct: A 12-month prospective study among patients with depressive disorders. Psychiatry Res 2014;220:867-73.
Mendez-Bustos P, de Leon-Martinez V, Miret M, Baca-Garcia E, Lopez-Castroman J. Suicide reattempters: A systematic review. Harv Rev Psychiatry 2013;21:281-95.
Mann JJ, Waternaux C, Haas GL, Malone KM. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry 1999;156:181-9.
Lizardi D, Currier D, Galfalvy H, Sher L, Burke A, Mann J, et al.
Perceived reasons for living at index hospitalization and future suicide attempt. J Nerv Ment Dis 2007;195:451-5.
Conner KR. A call for research on planned vs. Unplanned suicidal behavior. Suicide Life Threat Behav 2004;34:89-98.
Jokinen J, Forslund K, Ahnemark E, Gustavsson JP, Nordström P, Asberg M, et al.
Karolinska interpersonal violence scale predicts suicide in suicide attempters. J Clin Psychiatry 2010;71:1025-32.
Ajdacic-Gross V, Lauber C, Baumgartner M, Malti T, Rössler W. In-patient suicide – A 13-year assessment. Acta Psychiatr Scand 2009;120:71-5.
Batigun AD. Likelihood of suicide: A review of causes of survival, hopelessness and loneliness. J Turk Psychiatry 2005;16 Suppl 1:29-39.
Qin P, Agerbo E, Mortensen PB. Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: A national register-based study of all suicides in Denmark, 1981-1997. Am J Psychiatry 2003;160:765-72.
Dr. Reyhan Eskiyurt
Mental Health Nursing, Faculty of Health Sciences, University of Ankara Yildirim Beyazit, Ankara
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]