Prevalence and characteristics of suicide attempters and ideators among acutely admitted psychiatric hospital patients in northwest Russia and northern Norway

Abstract

BackgroundMore knowledge about suicidality and suicide risk profiles in acute psychiatric hospital patients (both first-time and chronic patients) is needed. While numerous factors are associated with suicidality in such populations, these may differ across cultures. Better understanding of factors underlying suicide risk can be informed by cross-cultural studies, and can aid development of therapeutic and preventive measures.MethodsAn explorative, cross-sectional cohort study was carried out. Acutely admitted patients at one psychiatric hospital in northwest Russia and two in northern Norway were included. At admission, demographic, clinical, and service use data were collected, in addition to an assessment of suicidal ideation and attempts, comprising five dichotomic questions. Data from 358 Norwegian and 465 Russian patients were analyzed with univariate and multivariate statistics. Within each cohort, attempters and ideators were compared with patients not reporting any suicidality.ResultsThe observed prevalence of suicidal ideation and attempts was significantly higher in the Norwegian cohort than in the Russian cohort (χ2 = 168.1, p < 0,001). Norwegian suicidal ideators and attempters had more depressed moods, more personality disorders, and greater problems with alcohol/drugs, but fewer psychotic disorders, cognitive problems or overactivity than non-suicidal patients. Russian suicidal ideators and attempters were younger, more often unemployed, had more depressed mood and adjustment disorders, but had fewer psychotic disorders and less alcohol/drug use than the non-suicidal patients.ConclusionsRates of suicidal ideation and non-fatal attempts in Norwegian patients were intermediate between those previously reported for patients admitted for the first time and those typical of chronic patients. However, the significantly lower rates of suicidal ideation and non-fatal attempts in our Russian cohort as compared with the Norwegian, contrasted with what might be expected in a region with much higher suicide rates than in northern Norway. We suggest that suicide-related stigma in Russia may reduce both patient reporting and clinicians’ recognition of suicidality. In both cohorts, overlapping risk profiles of ideators and attempters may indicate that ideators should be carefully evaluated and monitored, particularly those with depressed moods, alcohol/substance abuse disorders, and inadequate treatment continuity.

Attitudes toward suicidal behaviour among professionals at mental health outpatient clinics in Stavropol, Russia and Oslo, Norway

“…Findings from the Northern Russia and Northern Norway show less reported suicidal ideation among patients and professionals in Northern Russia, especial among men, despite the higher suicidal rates, particular in men. Failure to acknowledge and communicate suicidal ideation is suspected to be a risk factor for suicide [ 18 , 20 ]. Stigmatic attitudes and little awareness of suicidal ideation might hinder patients to get help to be aware needed changes to get a better life.…”

“…Psychiatric disorders were considered the most important causes of suicide in both cities in line with previous studies that highlights mental illness as main reason for suicide [ 10 ]. But suicides have many causes, and a study from Northern Russia and Northern Norway found that suicide were less associated with severe mental illness in Russia than Norway [ 18 ]. The World Health Organization has stated that mental disorder and harmful use of alcohol contribute to many suicides worldwide [ 1 ], also described in several studies [ 38 – 40 ].…”

“…Awareness of own attitudes and its impact on decision-making and treatment contribute to understand the patients situation better and improve treatment, education and strategies to prevent suicide as well as cross cultural cooperation. Our study is built on knowledge about risk factors for suicide [ 10 – 14 ], and effective treatment [ 15 – 17 ], all though suicidology is complex and causes might differ within, and between cultures like Norway and Russia [ 18 – 20 ]. Cross-cultural knowledge of attitudes among mental health professional’s are limited, although understanding, competence and attitudes can be essential to whether the patients seek or obtain help [ 7 ], and essential to improve suicidal prevention.…”

Factors influencing suicidal ideation among Chinese patients with stomach cancer: qualitative study

“…It is possible that the negative perception of suicide given by participants may be relatedeither directly or indirectlyto the teachings of Confucianism. Suicide is considered a violation of Confucian teachings, and a person who expresses suicidal ideation or actively seeks to die by suicide would be at increased risk of becoming marginalized and disenfranchised (Sørlie et al 2015). Based on the cultural theory and model of suicide, suicide behaviours would be reduced if they are defined as unacceptable or unethical in some cultures (Chu et al 2010).…”

Integrating mental health into primary care in Arkhangelsk County, Russia: the Pomor model in psychiatry

“…During the period 1993–2010, the total population decrease was about 13 million people [ 1 ]. Non-communicable diseases such as high rates of mental illness, suicide, and alcohol abuse strongly contributed [ 2 – 4 ]. In a Russian cultural context, alcohol abuse may function more as escape from negative emotions and suicidality than in a Western Norwegian context [ 4 ], with negative implications for self-regulation, help-seeking behaviour and suicide rates.…”