A Study on Psycho-Social Factors Related to Children’s Suicide

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Article Information:


Group: 2010
Subgroup: Volume 12, Issue 6
Date: November 2010
Type: Short Communication
Start Page: 660
End Page: 663

Authors:

  • T Seghatoleslam
  • Shahid Beheshti University of Medical Sciences, Loghmon Hakim Medical Center, Tehran, Tehran, Iran
  • O Rezaee Mirghaed
  • Shahid Beheshti University of Medical Sciences, Tehran, Tehran, Iran
  • F Sajadfar
  • Shahid Beheshti University of Medical Sciences, Tehran, Tehran, Iran
  • S Sadr
  • Shahid Beheshti University of Medical Sciences, Tehran, Tehran, Iran
  • A Zahiroddine
  • Shahid Beheshti University of Medical Sciences, Tehran, Tehran, Iran

      Correspondence:

      Affiliation: Shahid Beheshti University of Medical Sciences, Loghmon Hakim Medical Center
      City, Province: Tehran, Tehran
      Country: Iran
      Tel: +98-21-55414322
      Fax: +98-21-55416170
      E-mail: tbseghatoleslam2001@yahoo.co.uk

Abstract:


Background: Over the last 45 years, mortality due to suicide has increased in some developed and developing countries, among both children and adults. This study was undertaken to determine the cases suicide in 6-15 years old children.

 

Methods: Between Jan. 2005 and Jan. 2008, data from  292 children  (239 girls and 53 boys) aged 6-15 years who attempted suicide and were referred to the Loghman Hakim Medical  Poison Centre affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran  were enrolled. The Children Suicide Questionnaire (CSQ) was applied.

 

Results: The percentage of girls who attempted suicide was 81.8% against 18.2% for boys. Most of them were from 12 to 14 years old. 43.8% of the children were in a poor socio-economic class. 55.5% of the study period was between 6.00 pm and 12.00 pm. 41% of the respondents reported cases of mental illness in their family. 41.6% of the children had previously attempted suicide while 95% of suicide attempts took place at home and in 36.6% of suicides, there was a family argument. Depression (28%) and epilepsy (27.1%) were the most cited cases of personal problems using antiepileptic drugs (23%), benzodiazepine (23%), and antidepressants (20%).

 

Conclusion: This study suggests a collaboration between pediatricians, psychiatrists and psychologists.

Keywords: Children; Suicide; Iran; Children’s Suicide Questionnaire

Manuscript Body:


Introduction

 

Over the last 45 years, mortality due to suicide has increased in some developed and developing countries among both children and adults in all ages and both genders. Suicide attempts occur 10-40 times more frequent than the completed ones.1 Suicidal tendencies and attempts mainly happen among children who suffer from mental diseases, even in mild form, although these attempts are rarely fatal. Few studies were performed on suicide in children in Iran. Even in Western Europe and the United States, systematic studies on suicide in children were few until the late 70’s. Jackson and Nuttall (2001) studied on suicidal behaviours among children, throughout the 1980’s.2 Suicide is still a taboo in most societies and particularly in Islamic countries.  Therefore, lots of deaths were described as accidentals rather than suicides.  Psychological assessment is usually rare and early behavioural evaluation leading to a suicide is problematic.3 In the United States, a study in a group of randomly selected healthy children showed that 13% of children occasionally thought about suicide or had the intention of suicide. While many of them do not actually take place, several sociological factors may also contribute suicidal behaviours. Barker reported that in United States, suicide was the main cause of death in children younger than 14 years4 and is the 11th cause of death in the country (30,000/year).

The main factors related to children suicide are age, gender, personal and family problems and family conflicts. A previous suicide attempt can be one of the strongest predictive factors for an intended suicide in future.5 Seghatoleslam et al. (2006) showed that factors related to children’s suicide in Iran were gender (more in girls), the area of residence (mostly in south of Tehran as a poor area of the country), and the time period (mostly between 6.00 pm and 12.00 midnight).  Prescription drugs were used in most cases. The majority of the children reported an attempt after a family argument.6 The present study was designed to determine the factor related to attempted suicides in children in Tehran, Capital of Iran.

 

 

Materials and Methods

 

292 files of children aged between 6 and 15 years old (239 girls, 53 boys) were enrolled.  The children who had attempted suicide were referred to Loghman Hakim Poison Centre affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran between 2005-2008.

All relevant information from data files of the hospital were collected. The Children's Suicide Questionnaire (CSQ) had personal information such as: age, sex, economical class and family history.6 The questionnaires were completed by 2 psychiatrists and 2 psychologists covering a list of psycho-social factors associated with the children’s suicide attempts. The questionnaire compromised the reasons for the suicide attempts, area of residence, the time of suicide, the means and location of the attempts, previous history of suicide attempts, mental and physical history and general psychological information such as family problems, type of drug and dosage, history of psychiatric and physical status as well as mental disorders in children and their family. Table 1 shows the psychological characteristic of the sample population.

 

 

Table 1: The psychosocial  characteristics of the sample according to attempt suicide status, sex, age, and living areas 

Variables

Attempted suicide No. (%)  

Sex

Male

Female

 

  53 (18.2)

239 (81.8)

Age

Mean

Group age

6-8

9-11

12-14

15-

 

  12

 

  50 (17)

  71 (24.3)

105 (36)

  66 (22.6)

Tehran Living Area(TLA)*

West

North

South

East

Centre

Unknown

 

  13 (4.6)

  35 (12.0)

128 (43.8)

  34 (11.6)

  81 (27.7)

    1 (0.3)

TLA*, It was classified according to Iran Map of Tehran living areas (condensed into 5 categories).

 

 

All analyses were conducted using SPSS software (version 15, Chicago, IL, USA).

 

 

Results

 

Among 292 enrolled cases, the majority were significantly females (81.8%). 36% of subjects who attempted suicide were between 12 and 14 years old (mean=12 years). 43.8% of participants were from south of Tehran as a poor area of the country. Table 2 shows a higher percentage of history of mental illness in the family (41%). 28% of the cases suffered from depression, at the same time other cases had epileptic seizures. 36.6% of children attempted suicide after a family argument. 55.5% of suicide attempts occured between 6.00 pm and 12.00 pm by taking drugs (85.4%) such as benzodiazepines (23%), anti-epileptics (23%) and antidepressant medication (20%). 41.6% of the children had a previous attempt of suicide and 95% of suicide attempts took place at home.

 

 

Table 2: Measurement of the psycho-social factors in the CSQ

Variables

Frequency

%

Family problems:

Family argument

During divorce

Separated parents

Mother lives with children(alone)

Type of family illness:

Mental

Physical

Type of mental and physical illness in the cases:

Depression

Epilepsy

Other physical and mental illnesses

 

The time of suicide

00.00-6.00 AM

6.00 AM-12.00 PM

12.00 PM-6.00 PM

6.00 PM-12.00 AM

The mean of suicide:

Drugs

Insecticide

Alcohol

The kind of drugs that were used:

Benzodiazepine

Anti-depressant

Anti-epileptic

 

107

  54

  52

 

  46

 

120

  92

 

 

 

  82

  79

 

  66

 

 

  68

  23

  39

162

 

249

  16

    3

 

 

  57

  51

  57

 

36.6

18.5

17.8

 

15.8

 

41

31.5

 

 

 

28

27

 

22.6

 

 

23.2

  7.9

13.4

55.5

 

85.4

  5.5

  1

 

 

23

20

23

 

 

Discussion

 

This study indicated that attempted suicides were more common in girls. Although the sample was comparatively small, this seems to agree with the figures for attempted suicides among adults in Iran.7 Janghorbani and Sharifirad (2005)7 carried out a study in Ilam among adults who attempted suicide and found that 36.9% were in males and 63.1% in females. Stiffman noticed more suicide attempts in girls too. In spite of religious rules that  mention suicide to be a great sin, suicide in Islamic countries is also more common in females due to more embarrassments in females seeking help for solving their problems.8 Seghatoleslam et al. showed that not only suicide attempts among adult females were three times more than males,9 but also  girls attempted suicide more than boys.6 These findings agree with those in southern Delhi, India by Sharma et al. that showed girls were far more likely to attempt suicide than boys.10

Most attempts were in the 6-15 years age group (36%). This may indicate that apart from psycho-social factors, puberty may be an important determinant in suicide attempts among children. These findings are in agreement with McClore’s study showing that behaviour is correlated to suicide and is more prevalent in boys and girls younger than 15 years.11

43.8% of subjects lived southern parts of Tehran, Capital of Iran, which is an economically deprived area with high unemployment rate and poor housing conditions.  Sharma et al. showed that most cases of suicide attempts were among those living in low socio-economical status.10

In our study, 95.5% of suicides took place at home. Western studies showed that most suicide attempts happened at school which is not in agreement with our findings.  Suicide was attempted between 6.00 pm and 12.00 pm; the same time-period reported by Groholt et al.12 It seems the stresses are more within the hours at home rather than school. More than one third of children in our study reported a suicide attempt following family arguments at home. Zhang et al. showed that 34% of causes of suicide attempts among teenagers were due to family arguments.13 Another study demonstrated that stressful  family tension was related to internal anger and hostility because of lacking of a good communication.1

Van der Kolk et al.’s study on mental illnesses in children showed that stress in families and a previous history of mental illness are important causes of a suicide attempt among children.14 Seghatoleslam et al. found out that 26.4% of participants had mental problems such as depression and epilepsy.6 Shaffer et al. (1996) showed that depressed children attempt suicide three times more than healthy children.15 Some of the cases were children suffering from epilepsy, another determinant of suicide attempt. 15 Most of the children in the study used prescription drugs as their method to attempt suicide. From the files, it was apparent that those drugs were dispensed in cases of mental disorders. This is also true of adults9 and therefore, children already undergoing treatment or living with a mentally or physically ill family member had relatively an easy access to prescription drugs that is identical to our findings that prescription drugs were used in 85.4% of cases.  However, the vast majority of people who have access to these drugs do not commit suicide.

Another strong determinant in suicide attempts is gender. In Iran, girls and women are far more likely to attempt suicide. Poverty and lack of social and economical opportunities can play a part in depression and suicide attempts. A WHO study of poverty and mental disorders in developing countries identified income, insecurity, feelings of hopelessness, social change, low educational level and gender as a comorbidity, such as inadequate housing and poor physical health as determinants of mental disorders.16 Dastgiri et al. showed that 98% of women who committed suicide by self-immolation did not have any income17 and most of them had a history of previous suicide. In this study, we found that 41.6% of children admitted to the hospital had tried to attempt suicide on a previous occasion too.

Therefore, a combination of factors can result into suicidal behaviours; stresses such as mental or physical illnesses, living with a mentally ill family member, residing in an economically deprived neighbourhood, with its attendant violence, and lack of access to proper psychiatric care. We suggest a multidisciplinary approach to the problem from psychological, biological and social perspectives. Cooperation between psychiatrists, psychologists, paediatricians and social workers to prevent suicide attempts is recommended.

 

Acknowledgement

 

The authors would like to thank the personnel of the archive of Loghman Hakim Hospital Medical Centre. They also wish to thank Dr. Gachkar for his kind participation.

 

Conflict of interest: None declared.

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