Psychiatry Research EG

Suicide is a complex phenomenon that has attracted the attention of philosophers, physician, sociologists, artists, and psychiatrists over the centuries. Suicide has occurred consistently throughout recorded history; however, many researchers have found that attitudes toward suicide vary widely in different ages, cultures, and societies [1]. Surprisingly, people dying from suicide more than all of the several armed conflicts around the world and, in many places, about the same or slightly more than those dying from traffic accidents. In all countries, suicide is now one of the three leading causes of death among individuals aged 15–34 years; until recently, suicide was predominant among the elderly, but now suicide is prevalent among younger individuals in both absolute and relative terms [2]. The WHO has estimated that by the year 2020, B1.53 million individuals will die by suicide, according to current trends. Worldwide, suicide attempts will be about 10–20 times more than deaths by suicide. There will be an average of one suicide every 20 s and a suicide attempt every 1–2 s [2]. Several studies have reported that suicide attempts range in intent and medical severity from mild to very severe. All suicide attempts, irrespective of the extent of injury, are indications of severe emotional distress, unhappiness, and/or mental illness. Goes back to the propositions of the early psychoanalytical psychiatrist who regarded the amount of violence which is implicit in person with a suicidal attempts as a form of failed homicide, the turning of aggression against the self that was formerly directed against another person [3]. Suicide attempts result in major economic losses. Direct costs reflect treatment and hospitalization following suicide attempts and indirect costs represent lost potential lifetime income because of suicide-related disability. Notably, every youth suicide implies a loss of productivity of 50 years or more. The resulting economic burden from suicides and serious attempts was estimated to exceed $16 billion annually in the USA [4]. The definitions of attempted suicide used by many authors differ from those used by psychiatrists. The most likely explanation is that the individuals who responded to anonymous inquiries were using a broader definition of attempted suicide than that by professionals [5]. Schmidtke et al. [6] have provided a definition for suicide attempt as a potentially self-injurious behavior with a nonfatal outcome, for which there is evidence (eitherexplicit or implicit) that the person intended to kill himself or herself. De Leo et al. [7] have stated that endorsement of the evidence-based perspective in public health has led to a shift from an interpretive investigation to an outcomebased practice that has led to a shift in the use of terminology. Consequently, ‘fatal suicidal behavior’ is proposed for those suicidal acts that result in death, whereas ‘nonfatal suicidal behavior’ refers to suicidal behavior that does not result in the person’s death. The intention to die is not always a necessary criterion, but the attempters should be aware that the action he/she initiates might cause death. Interestingly, this new approach seems to be closer to the old definition of Durkheim: ‘all those death cases directly or indirectly resulting from a positive or negative act of the victim, who is aware of the consequences of its behavior’ [8]. More recently and precisely, the WHO defined a suicide attempt as a self-damaging act carried out with some intent to die and distinguished from other self-destructive types of behavior, such as self-mutilation, noncompliance with medical treatment in severely ill individuals, and the use of substances such as alcohol and tobacco [2]. An essential preliminary step in the clinical management of persons who attempt suicide is to consider relevant risk or causal factors. Many researches and investigations are still being carried out worldwide in an attempt to understand and evaluate the risk factors for suicide and attempted suicide, as it will help to predict the protective factors against this phenomenon. Many risk factors are correlated to suicide attempters ranging from cultural and sociodemographic factors, family factors, cognitive style and personality factors, psychiatric disorders, and situational risk factors. Low socioeconomic status, poor education, and unemployment in the family are also risk factors [9]. Individual growth is inter-related to collective culture tradition. Those who lack culture roots have marked identity problems and lack a model for conflict resolution. In some stressful situations, they may resort to selfdestructive behavior such as a suicide attempt or suicide [9]. In Arab countries, there are little available data on suicide. In Egypt, Okasha et al. [10] have reported that the crude rate of suicide attempts in Cairo is 38.5/100 000 per annum. Also, they concluded that individuals who attempted suicide often face interpersonal problems, and that their acts may be interpreted more as an attempt to remedy an intolerable situation than a desire to die. However, in Kuwait, only a few papers have focused on this problem; two of these have examined the psychosocial profile of deliberate self-harm by Al-Sahlawi et al. [11]. They have reported that women attempt deliberate self-harm more than men and the most common method is through an overdose of paracetamol. Common risk factors found were exposure to stressors and also depression. However, these studies were retrospective and were only carried out in one general hospital in Kuwait (Mobarak Hospital) [11]. Hence, this study was carried out to determine different risk factors and psychosocial correlates for suicide attempts in Kuwait. Suicide attempters with cluster B personality disorders who have a history of self-mutilation tend to be more depressed, anxious, and impulsive, and they also tend to underestimate the lethality of their suicide attempts. Therefore, clinicians may be unintentionally misled in assessing the suicide risk of self-mutilators as less serious than it is [12].