Background: One of the most frequent causes of death is poisoning worldwide. Investigating the causes of mortality due to poisoning profoundly affects making decisions and improving standards for preventing adverse events. Therefore, to better understand this problem and evaluate the causes, this study aimed to determine the risk of suicide using the SAD PERSONS Scale (SPS) criteria and its relationship with the birth month in poisoned patients.
Methods: This cross-sectional descriptive-analytic study was conducted on poisoned patients admitted to Khorshid Hospital in Isfahan City, Iran, in 2018. First, the patients’ age, gender, and birth month were recorded. Then, their suicide risk was assessed by SPS.
Results: From 2735 referred patients with poisoning, 1839 (67.2%) attempted suicide, and 896(32.8%) cases were poisoned. The Mean±SD SPS score in patients with suicidal attempts was 4.89±1.94, and in the poisoned patients was equal to 2.74±1.46 (P<0.001). There was no significant relationship between suicide and birth month; however, gender (male), age, depression, previous suicidal attempts, ethanol abuse, rational thinking loss, social support lacking, and being unmarried significantly increased the risk of suicide (P<0.01). In addition, the SPS scores ≥5 with a sensitivity of 43.77%, and specificity of 98.44% had an acceptable diagnostic value in identifying the risk of suicide (P<0.0001).
Conclusion: As SPS criteria have an appropriate diagnostic value for suicide prediction, it is recommended that these criteria be assessed among individuals with susceptible suicide characteristics (e.g. males, elders, depression, the lack of social support, etc.), to prevent future suicide attempts and appropriate medical-psychological measures.
1. World Health Organization. Preventing suicide-a global imperative. Geneva: World Health Organization; 2014.
2. World Health Organization. Global Health Estimates. Geneva: World Health Organization; 2014.
3. Hassanian-Moghaddam H, Zamani N. Suicide in Iran: The facts and the figures from nationwide reports. Iranian Journal of Psychiatry. 2017; 12(1):73-7. [PMID] [PMCID]
4. Katz C, Randall JR, Sareen J, Chateau D, Walld R, Leslie WD, et al. Predicting suicide with the SAD PERSONS scale. Depression and Anxiety. 2017; 34(9):809-16. [DOI:10.1002/da.22632] [PMID]
5. Sharif-Alhoseini M, Rasouli MR, Saadat S, Haddadi M, Gooya MM, Afsari M, et al. Suicide attempts and suicide in Iran: results of national hospital surveillance data. Public Health. 2012; 126(11):990-2. [DOI:10.1016/j.puhe.2012.06.006] [PMID]
6. Berman AL. Estimating the population of survivors of suicide: seeking an evidence base. Suicide and Life-Threatening Behavior. 2011; 41(1):110-6. [DOI:10.1111/j.1943-278X.2010.00009.x] [PMID]
7. Bolton JM, Au W, Leslie WD, Martens PJ, Enns MW, Roos LL, et al. Parents bereaved by offspring suicide: A population-based longitudinal case-control study. JAMA Psychiatry. 2013; 70(2):158-67. [DOI:10.1001/jamapsychiatry.2013.275] [PMID]
8. Rostila M, Saarela J, Kawachi I. Suicide following the death of a sibling: A nationwide follow-up study from Sweden. BMJ Open. 2013; 3(4):e002618. [DOI:10.1136/bmjopen-2013-002618] [PMID] [PMCID]
9. Office of the Surgeon General, National Action Alliance for Suicide Prevention. 2012 national strategy for suicide prevention: Goals and objectives for action: A report of the US Surgeon General and of the National Action Alliance for Suicide Prevention. Washington: US Department of Health & Human Services; 2012.
10. Bolton JM, Gunnell D, Turecki G. Suicide risk assessment and intervention in people with mental illness. British Journal of Medical Education. 2015; 351:h4978. [DOI:10.1136/bmj.h4978] [PMID]
11. Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, et al. Suicide prevention strategies: A systematic review. The Journal of the American Medical Association. 2005; 294(16):2064-74. [DOI:10.1001/jama.294.16.2064] [PMID]
12. Hawton K, van Heeringen K. Suicide. Lancet. 2009; 373(9672):1372-81. [DOI:10.1016/S0140-6736(09)60372-X]
13. Kovacs M, Garrison B. Hopelessness and eventual suicide: A 10-year prospective study of patients hospitalized with suicidal ideation. American Journal of Psychiatry. 1985; 1(42):559-63. [DOI:10.1176/ajp.142.5.559] [PMID]
14. Brown GK, Beck AT, Steer RA, Grisham JR. Risk factors for suicide in psychiatric outpatients: A 20-year prospective study. Journal of Consulting and Clinical Psychology. 2000; 68(3):371-7. [DOI:10.1037/0022-006X.68.3.371]
15. Niméus A, én M, Träskman-Bendz L. High suicidal intent scores indicate future suicide. Archives of Suicide Research. 2002; 6(3):211-9. [DOI:10.1080/13811110214142]
16. Patterson WM, Dohn HH, Bird J, Patterson GA. Evaluation of suicidal patients: The SAD PERSONS scale. Psychosomatics. 1983; 24(4):343-9. [DOI:10.1016/S0033-3182(83)73213-5]
17. Warden S, Spiwak R, Sareen J, Bolton JM. The SAD PERSONS scale for suicide risk assessment: A systematic review. Archives of Suicide Research. 2014; 18(4):313-26. [DOI:10.1080/13811118.2013.824829] [PMID]
18. Kurz A, Möller HJ, Torhorst A, Lauter H. Validation of six risk scales for suicide attempters. Berlin: Springer; 1988. [DOI:10.1007/978-3-642-73358-1_25]
19. Bolton JM, Spiwak R, Sareen J. Predicting suicide attempts with the SAD PERSONS scale: A longitudinal analysis. The Journal of Clinical Psychiatry. 2012; 73(6):3-735-41. [DOI:10.4088/JCP.11m07362] [PMID]
20. Castrogiovanni P, Iapichino S, Pacchierotti C, Pieraccini F. Season of birth in panic disorder. Neuropsychobiology. 1999; 40(4):177-82. [DOI:10.1159/000026616] [PMID]
21. Kettl PA, Collins T, Sredy M, Bixler EO. Seasonal differences in suicide birth rate in Alaska natives compared to other populations. American Indian and Alaska Native Mental Health Research. 1997; 8(1):1-0. [DOI:10.5820/aian.0801.1997.1] [PMID]
22. Salib E, Cortina-Borja M. Effect of month of birth on the risk of suicide. The British Journal of Psychiatry. 2006; 188(5):416-22. [DOI:10.1192/bjp.bp.105.009118] [PMID]
23. Åsberg M. Neurotransmitters and suicidal behavior. Annals of the New York Academy of Sciences. 1997; 836(1):158-81. [DOI:10.1111/j.1749-6632.1997.tb52359.x] [PMID]
24. Juhnke GA. The adapted-SAD PERSONS: A suicide assessment scale designed for use with children. Elementary School Guidance & Counseling. 1996; 30(4):252-8.
25. Abdollahi M, Jalali N, Sabzevari O, Hoseini R, Ghanea T. A restrospective study of poisoning in Tehran. Journal of Toxicology: Clinical Toxicology. 1997; 35(4):387-93. [DOI:10.3109/15563659709043371] [PMID]
26. Srivastava A, Peshin SS, Kaleekal T, Gupta SK. An epidemiological study of poisoning cases reported to the national poisons information centre, All India Institute of Medical Sciences, New Delhi. Human & Experimental Toxicology. 2005; 24(6):279-85. [DOI:10.1191/0960327105ht527oa] [PMID]
27. Presgrave RD, Camacho LA, Villas Boas MH. A profile of unintentional poisoning caused by household cleaning products, disinfectants and pesticides. Cadernos de Saudepublica. 2008; 24(12):2901-8. [DOI:10.1590/S0102-311X2008001200019] [PMID]
28. Williams H, Moyns E, Bateman DN, Thomas SH, Thompson JP, Vale JA. Hazard of household cleaning products: a study undertaken by the UK National Poisons Information Service. Clinical Toxicology. 2012; 50(8):770-5. [DOI:10.3109/15563650.2012.709937] [PMID]
29. Bronstein, Alvin C, Daniel A. Spyker, Louis R. Cantilena Jr, Barry H. Rumack, and Richard C. Dart. 2011 annual report of the American Association of Poison Control Centers’ National Poison data system (NPDS): 29th annual report. 2012; 50(10): 911-64. [DOI:10.3109/15563650.2012.746424] [PMID]
30. Peshin SS, Gupta YK. Poisoning due to household products: A ten years retrospective analysis of telephone calls to the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi, India. Journal of Forensic and Legal Medicine. 2018; 58:205-11. [DOI:10.1016/j.jflm.2018.07.005] [PMID]
31. Herman SM. Is the SADPERSONS scale accurate for the veterans affairs population? Psychological Services. 2006; 3(2):137-141. [DOI:10.1037/1541-15188.8.131.52]
32. Kripalani M, Nag S, Nag S, Gash A. Integrated care pathway for self-harm: Our way forward. Emergency Medicine Journal. 2010; 27(7):544-6. [DOI:10.1136/emj.2009.074054] [PMID]
33. Hockberger RS, Rothstein RJ. Assessment of suicide potential by nonpsychiatrists using the SAD PERSONS score. Journal of Emergency Medicine. 1988; 6(2):99-107. [DOI:10.1016/0736-4679(88)90147-3]