Identification of risk factors for attempted suicide by self-poisoning and a nomogram to predict self-poisoning suicide

Abstract

PurposeSuicide is a global concern, especially among young people. Suicide prediction models have the potential to make it easier to identify patients who are at a high risk of suicide, but they have very little predictive power when there is a positive value for suicide mortality. Therefore, the aim of the study is to uncover potential risk factors associated with suicide by self-poisoning and further to provide a trustworthy nomogram to predict self-poisoning suicide among poisoned patients.MethodsThis study prospectively enrolled 237 patients who were treated for poisoning at the Fifth Medical Center of PLA General Hospital (Beijing) between May 2021 and May 2022. Patient's basic characteristics, daily activities, mental health status, and history of psychological illnesses were gathered to examine their predictive power for self-poisoning suicide. On developing a prediction model, patients were split 8:2 into a training (n = 196) group and a validation (n = 41) group at random via computer. The training group worked on model development, while the validation group worked on model validation. In this study, the Hosmer and Lemeshow test, accuracy, and area under the curve were the primary evaluation criteria. Shapley Additive exPlanations (SHAP) was determined to evaluate feature importance. To make the prediction model easy for researchers to utilize, it was presented in nomogram format. Two risk groups of patients were identified based on the ideal cut-off value.ResultsOf all poisoned patients, 64.6% committed suicide by self-poisoning. With regard to self-poisoning attempted suicide, multivariate analysis demonstrated that female gender, smoking, generalized anxiety disorder-7 (GAD-7), and beck hopelessness scale-20 (BHS-20) were significant risk factors, whereas married status, relatively higher education level, a sedentary time of 1–3 h per day, higher sport frequency per week, higher monthly income were significant protective features. The nomogram contained each of the aforementioned nine features. In the training group, the area under curve (AUC) of the nomogram was up to 0.938 (0.904–0.972), whereas in the validation group, it reached a maximum of 0.974 (0.937–1.000). Corresponding accuracy rates were up to 0.883 and 0.927, respectively, and the P-values for the Hosmer and Lemeshow test were 0.178 and 0.346, respectively. SHAP demonstrated that the top three most important features were BHS-20, GAD-7, and marital status. Based on the best cut-off value of the nomogram (40%), patients in the high-risk group had a nearly six-time larger likelihood of committing suicide by self-poisoning than patients in the low-risk group (88.68 vs. 15.38%, P < 0.001). The dynamic nomogram was made available at the following address: https://xiaobo.shinyapps.io/Nomogramselfpoisoningsuicide/.ConclusionsThis study proposes a prediction model to stratify patients at a high risk of suicide by self-poisoning and to guide individual preventive strategies. Patients in the high-risk group require further mental health counseling to alleviate anxiety and hopelessness, healthy lifestyle like quitting smoking and exercising more, and restriction of access to poison and psychiatric drugs.

Trends and profiles of acute poisoning cases: a retrospective analysis

“…In the Chinese population, women are also identified as a significant risk factor for suicide. In a more recent study, Zheng et al (26) prospectively included 237 patients treated for poisoning between May 2021 and May 2022, and their findings supported our results, with being female and anxious being significant risk factors for suicide. Thus, understanding these gender differences is essential for the development of gender-specific prevention and intervention strategies.…”

Epidemiological Aspects of Suicide in the East Kazakhstan Region

“…In order to reduce the number of suicidal attempts, it is very useful to promote a healthy lifestyle, treat mental illnesses and establish strong relationships with family and social communities [23]. These steps should be taken from a sociocultural point of view, including removing obstacles to psychiatric care and rehabilitation of drug addicts, reducing the impact of the media on suicidal behavior and the influence of those who committed suicide [24].…”

An analysis of the mediating factors of suicide risk in adolescents with depressive disorder based on machine learning

“…Consequently, NSSI is a coping mechanism for people with depression to alleviate negative thoughts and feelings. Domestic and foreign studies have found that patients with depressive disorder, who deliberately engage in negative behaviors such as self-harm and self-injury to deal with unpleasant emotions, are more prone to active or passive suicide [9,13] .However, the role of NSSI in the suicide process of patients with depressive disorder remains controversial [14] .…”