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)].


METHODS
Subjects seen for suicide 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.


RESULTS
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.


CONCLUSIONS
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.
Fleischmann
Alexandra
A
Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
Bertolote
José M
JM
De Leo
Diego
D
Botega
Neury
N
Phillips
Michael
M
Sisask
Merike
M
Vijayakumar
Lakshmi
L
Malakouti
Kazem
K
Schlebusch
Lourens
L
De Silva
Damani
D
Nguyen
Van Tuong
VT
Wasserman
Danuta
D
D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D003469:Culture; D004637:Emergency Services, Psychiatric; D004957:Estonia / Q000453:epidemiology; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007182:Income; D007194:India / Q000453:epidemiology; D007492:Iran / Q000453:epidemiology; D008297:Male; D011041:Poisoning / Q000453:epidemiology; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D013188:Sri Lanka / Q000453:epidemiology; D013406:Suicide, Attempted / Q000208:ethnology / Q000517:prevention & control / Q000523:psychology; D011795:Surveys and Questionnaires; D014744:Vietnam / Q000453:epidemiology