Psychological,Structural,Social and Economic Determinants of Suicide Attempt: Risk Assessment and Decision Making Strategies

Abstract

The aim of this research was to conduct a risk assessment and management of psychological, structural, social and economic determinants (PSSED) in a suicide attempt. The sample consisted of 353 individuals who had a recorded history of suicidal attempt; and 20 professional individuals by purposive sampling method within a descriptive cross-sectional design. Worksheets for RAM and AHP were used for data collection in this study. The rate of suicide attempt was 7.21 per 100,000 population in this study. Analysis showed that depression and mental disorders; personality disorders; family problems; socio-cultural and economic problems; lack of awareness; and low level of education have a high level of risk for suicide attempts. Psychiatric and psychological services; awareness and knowledge of life skills; medical services to dysfunctional families; development of community-based planning for PSSED of suicide; and employment and entrepreneurship services may lower suicide attempt risk.

Keywords

risk assessment model suicide attempt analytical hierarchy process

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References

Arya

Page

River

Armstrong

Mayer

(2018). Trends and socio-economic determinants of suicide in India: 2001–2013. Social Psychiatry and Psychiatric Epidemiology, 53(3), 269–278.

Awenat

Y. F.

Peters

Gooding

P. A.

Pratt

Shaw-Núñez

Harris

Haddock

(2018). A qualitative analysis of suicidal psychiatric inpatients views and expectations of psychological therapy to counter suicidal thoughts, acts and deaths. BMC Psychiatry, 18(1), 334. https://doi.org/10.1186/s12888-018-1921-6

Blakely

T. A.

Collings

S. C.

Atkinson

(2003). Unemployment and suicide. Evidence for a causal association? Journal of Epidemiology and Community Health, 57(8), 594–600. https://doi.org/10.1136/jech.57.8.594

Bakhtar

Rezaeian

(2017). The prevalence of suicide thoughts and attempted suicide plus their risk factors among Iranian students: A systematic review study. Journal of Rafsanjan University of Medical Sciences, 15(11), 1061–1076.

Bantjes

Iemmi

Coast

Channer

Leone

McDaid

Palfreyman

Stephens

Lund

(2016). Poverty and suicide research in low-and middle-income countries: Systematic mapping of literature published in English and a proposed research agenda. Global Mental Health, 3(32), 1–18.

Barr

Taylor-Robinson

Scott-Samuel

McKee

Stuckler

(2012). Suicides associated with the 2008-10 economic recession in England: Time trend analysis. BMJ (Clinical Research ed.), 345, e5142.

Batic-Mujanovic

Poric

Pranjic

Ramic

Alibasic

Karic

(2017). Influence of unemployment on mental health of the working age population. Materia Socio-Medica, 29(2), 92–96. https://doi.org/10.5455/msm.2017.29.92-96

Bean

Baber

K. M.

(2011). Connect: An effective community-based youth suicide prevention program. Suicide & Life-Threatening Behavior, 41(1), 87–97. https://doi.org/10.1111/j.1943-278X.2010.00006.x

Berríos-Torres

S. I.

Umscheid

C. A.

Bratzler

D. W.

Leas

Stone

E. C.

Kelz

R. R.

Reinke

C. E.

Morgan

Solomkin

J. S.

Mazuski

J. E.

Dellinger

E. P.

Itani

K. M. F.

Berbari

E. F.

Segreti

Parvizi

Blanchard

Allen

Kluytmans

J. A. J. W.

Donlan

Schecter

W. P.

(2017). Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surgery, 152(8), 784–791.

10.

Brunelli

(2014). Introduction to the analytic hierarchy process. Springer.

11.

Bunkley

(2008). Joseph Juran, 103, pioneer in quality control, dies. New York Times, 3, 50–55.

12.

Changizi

Kazemi

Farokhian

(2014). Applying analysis hierarchical process (AHP) technique for prioritization of management’s criteria of health, safety and environment of urban parks. Journal of Middle East Applied Science and Technology (JMEAST), 19, 666–674.

13.

Delbari

Davoodi

(2012). Applying analysis hierarchical process technique (AHP) in ranking tourism attraction evaluation indices. Journal of Research in Operations and Its Applications, 9(2), 57–79.

14.

Doost Mohammadi

Rezaeian

(2020). The steps to develop a comprehensive suicide prevention strategy: A narrative review. Journal of Rafsanjan University of Medical Sciences, 18(11), 1155–1182.

15.

Ebrahimzadih

Halvani

Darvishi

Froghinasab

(2015). Application of job safety analysis and William fine methods to identify and control hazards in a uranium mine in Central area of Iran. Journal of Health, 6(3), 313–324.

16.

Eghbali

Mastyani

(2015). Factors leading to suicide in Alborz province. Quarterly Journal of Alborz Police Science, 6(18), 29–58.

17.

Erdogan

S. A.

Šaparauskas

Turskis

(2017). Decision making in construction management: AHP and expert choice approach. Procedia Engineering, 172, 270–276.

18.

Evans

White

Turley

Slater

Morgan

Strange

Scourfield

(2017). Comparison of suicidal ideation, suicide attempt and suicide in children and young people in care and non-care populations: Systematic review and meta-analysis of prevalence. Children and Youth Services Review, 82, 122–129.

19.

Feizpour

Lotfi

(2015). Economical distinctions and social problems of Iran: Rates of unemployment and suicide. Strategic Research on Social Problems in Iran, 4(1), 153–166.

20.

Fine

W. T.

(1971). Mathematical evaluations for controlling hazards. Journal of Safety Research, 3, 157–166.

21.

Frey

L. M.

Cerel

(2015). Risk for suicide and the role of family: A narrative review. Journal of Family Issues, 36(6), 716–736. https://doi.org/10.1177/0192513X13515885

22.

Ghodsipoor

(2016). Analytical hierarchy process (AHP). Amirkabir University of Technology.

23.

Goldston

D. B.

Molock

S. D.

Whitbeck

L. B.

Murakami

J. L.

Zayas

L. H.

Hall

G. C.

(2008). Cultural considerations in adolescent suicide prevention and psychosocial treatment. The American Psychologist, 63(1), 14–31. https://doi.org/10.1037/0003-066X.63.1.14

24.

Gul

Guven

Guneri

A. F.

(2018). A new Fine-Kinney-based risk assessment framework using FAHP-FVIKOR incorporation. Journal of Loss Prevention in the Process Industries, 53, 3–16. https://doi.org/10.1016/j.jlp.2017.08.014

25.

Halvani

Ehrampoush

M. H.

Ghaneian

M. T.

Dehghani

Arani

M. H.

(2017). Applying job hazard analysis and William fine methods on risks identification and assessment of jobs in hot rolling steel, Iran. Journal of Mazandaran University of Medical Sciences, 26(145), 293–303.

26.

Hassanian-Moghaddam

Zamani

(2017). Suicide in Iran: The facts and the figures from nationwide reports. Iranian Journal of Psychiatry, 12(1), 73–77.

27.

Hashemifard

Saffari

Ghasemi-Hosseinabadi

Hashemifard

(2015). A determination of the effective factors on suicide attempt among patients of Vasei hospital of Sabzevar in 2013. Journal of Sabzevar University of Medical Sciences (JSUMS), 22(1), 84–92.

28.

Huertas

Moreno-Küstner

Gutiérrez

Cervilla

J. A.

(2020). Prevalence and correlates of suicidality in Andalusia (Spain): Results of the epidemiological study PISMA-ep. Journal of Affective Disorders, 266, 503–511.

29.

Iemmi

Bantjes

Coast

Channer

Leone

McDaid

Palfreyman

Stephens

Lund

(2016). Suicide and poverty in low-income and middle-income countries: A systematic review. The Lancet Psychiatry, 3(8), 774–783.

30.

Indu

P. S.

Anilkumar

T. V.

Pisharody

Russell

P. S. S.

Raju

Sarma

P. S.

Remadevi

Amma

K. R. L. I.

Sheelamoni

Andrade

(2017). Prevalence of depression and past suicide attempt in primary care. Asian Journal of Psychiatry, 27, 48–52.

31.

Ishizaka

Labib

(2009). Analytic hierarchy process and expert choice: Benefits and limitations. OR Insight, 22(4), 201–220.

32.

Jozi

Atabi

Honarmand

(2015). Health, safety and environmental risk management in Shomal cement plant by using William fine technique. Environmental Research, 5(10), 23–34.

33.

Kerr

W. C.

Kaplan

M. S.

Huguet

Caetano

Giesbrecht

McFarland

B. H.

(2017). Economic recession, alcohol, and suicide rates: Comparative effects of poverty, foreclosure, and job loss. American Journal of Preventive Medicine, 52(4), 469–475.

34.

Khadem Rezaiyan

Jarahi

Moharreri

Afshari

Motamedalshariati

Okhravi

Khajedaluee

(2017). Epidemiology of suicide attempts in Khorasan Razavi province. Iranian Journal of Epidemiology, 13(2), 128–135.

35.

Kiadaliri

A. A.

Saadat

Shahnavazi

Haghparast-Bidgoli

(2014). Overall, gender and social inequalities in suicide mortality in Iran, 2006-2010: A time trend province-level study. BMJ Open, 4(8), e005227. https://doi.org/10.1136/bmjopen-2014-005227

36.

Lafromboise

T. D.

Lewis

H. A.

(2008). The Zuni life skills development program: A school/community-based suicide prevention intervention. Suicide & Life-Threatening Behavior, 38(3), 343–353. https://doi.org/10.1521/suli.2008.38.3.343

37.

Lapponi

J. C.

(2005). Estatística usando excel. Elsevier Brasil.

38.

Lee

Kim

Woo

Chang

S. M.

Hong

J. P.

Lee

D. W.

Hahm

B. J.

Cho

S. J.

Park

J. I.

Jeon

H. J.

Seong

S. J.

Park

J. E.

Kim

B. S.

(2020). Impacts of remaining single above the mean marriage age on mental disorders and suicidality: A nationwide study in Korea. Journal of Korean Medical Science, 35(37), e319. https://doi.org/10.3346/jkms.2020.35.e319

39.

Chau

Zeng

(2019). Ranking of risks for existing and new building works. Sustainability, 11(10), 2863.

40.

Martelli

de Barros

M. S. M.

(2018). Excel 2013. Avançado: Senac.

41.

McKinnon

Gariépy

Sentenac

Elgar

F. J.

(2016). Adolescent suicidal behaviours in 32 low-and middle-income countries. Bulletin of the World Health Organization, 94(5), 340–350.

42.

Mehrabi

Sheikh Darani

(2013). The role of effective factors on suicidal tendency in female high school students. Knowledge and Research in Applied Psychology, 14(3), 91–100.

43.

Milner

Hjelmeland

H. M.

Arensman

De Leo

(2013). Social-environmental factors and suicide mortality: A narrative review of over 200 articles. Sociology Mind, 3(2), 137–148. https://doi.org/10.4236/sm.2013.32021.

44.

Milner

Page

LaMontagne

A. D.

(2013). Long-term unemployment and suicide: A systematic review and meta-analysis. PLoS One, 8(1), e51333.

45.

Milner

Page

Spencer-Thomas

Lamotagne

A. D.

(2015). Workplace suicide prevention: A systematic review of published and unpublished activities. Health Promotion International, 30(1), 29–37. https://doi.org/10.1093/heapro/dau085

46.

Mirahmadizadeh

Rezaei

Mokhtari

A. M.

Gholamzadeh

Baseri

(2020). Epidemiology of suicide attempts and deaths: A population-based study in Fars, Iran (2011–16). Journal of Public Health, 42(1), e1–e11.

47.

Mohammadinia

Rezaei

Sameizadehtoosi

Darban

(2012). Assessing suicidal ideation frequency in medical students. Quarterly Journal of Nursing Management, 1(1), 83–91.

48.

Mortier

Cuijpers

Kiekens

Auerbach

R. P.

Demyttenaere

Green

J. G.

Kessler

R. C.

Nock

M. K.

Bruffaerts

(2018). The prevalence of suicidal thoughts and behaviours among college students: A meta-analysis. Psychological Medicine, 48(4), 554–565.

49.

Pereyra-Rojas

(2017). Practical decision making using super decisions v3: An introduction to the analytic hierarchy process. Springer.

50.

Mühlbacher

A. C.

Kaczynski

(2013). Der analytic hierarchy process (AHP): eine methode zur entscheidungsunterstützung im gesundheitswesen [The analytic hierarchy process (AHP): A method for decision support in the healthcare sector]. PharmacoEconomics German Research Articles, 11(2), 119–132.

51.

Najafipour

Ahmadinia

Rezaeian

(2019). Evaluation of validity and reliability of Persian version of the international proposal questionnaires on the study of nonfatal suicidal behavior in students of Rafsanjan University of Medical Sciences in 2018: A descriptive study. Journal of Rafsanjan University of Medical Sciences, 18(8), 811–838.

52.

Nazarzadeh, M., Bidel, Z., Ayubi, E., Asadollahi, K., Carson, K. V., & Sayehmiri, K. (2013). Determination of the social related factors of suicide in Iran: A systematic review and meta-analysis. BMC Public Health, 13(1), 4.

53.

Newman

(2005). Power laws, Pareto distributions and Zipf’s law. Contemporary Physics, 46(5), 323–351.

54.

Nock

M. K.

Green

J. G.

Hwang

McLaughlin

K. A.

Sampson

N. A.

Zaslavsky

A. M.

Kessler

R. C.

(2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the national comorbidity survey replication adolescent supplement. JAMA Psychiatry, 70(3), 300–310.

55.

Norström

Grönqvist

(2015). The great recession, unemployment and suicide. Journal of Epidemiology and Community Health, 69(2), 110–116.

56.

Omidvari

(2017). Safety risk assessment in motor vehicle industries by using William fine and ANP-DEMATEL. Iran Occupational Health, 14(1), 57–70.

57.

Ohtaki

Doki

Kaneko

Hirai

Sasahara

Matsuzaki

(2019). Relationship between suicidal ideation and family problems among young callers to the Japanese crisis hotline. PLoS One, 14(7), e0220493. https://doi.org/10.1371/journal.pone.0220493

58.

Paul

K. I.

Moser

(2009). Unemployment impairs mental health: Meta-analyses. Journal of Vocational Behavior, 74(3), 264–282.

59.

Rezaeian

(2013). Suicide prevention in developing countries: A prioritized requirement issue. Journal of Health Systems Research, 9, 441–448.

60.

Rezaeian

(2018). A critical look at the world health organization report for suicide prevention. Journal of Rafsanjan University of Medical Sciences, 16(12), 1169–1174.

61.

Rezaeian

Daneshkohan

Sharifirad

Jahani

Bahmani

Fathollahi

Havasi

(2012). Suicide epidemiological pattern within Ilam province. Iran. Health System Research, 7(6), 819–828.

62.

Saaty

T. L.

Rogers

P. C.

Pell

(1980). Portfolio selection through hierarchies. The Journal of Portfolio Management, 6(3), 16–21.

63.

Sedaghat

Sahebi

ShahabiMoghaddam

(2017). The effectiveness of individualized reality therapy on major depression patients with suicide attempt history. Journal of Police Medicine, 5(5), 371–378.

64.

Sekhavati

Rahimian Boogar

Abasnia

Namazi

(2017). Explaining the prevalence of suicide cases and suicide attempts in terms of socio-economic determinants of health in Larestan city during the years 2012-2016, Iran [Paper presentation]. The Global Conference on Psychology and Educational Sciences, Law and Social Sciences at the Beginning of Third Millennium, November 10, 2016, Shiraz, Iran.

65.

Shakeri

Jafarizadeh

Zarenezhad

(2014). Epidemiology of suicide deaths in Fars province (2007–2011). Iranian Journal of Epidemiology, 10(1), 56–64.

66.

Shilubane

H. N.

Ruiter

R. A.

Bos

A. E.

van den Borne

James

Reddy

P. S.

(2012). Psychosocial determinants of suicide attempts among black South African adolescents: A qualitative analysis. Journal of Youth Studies, 15(2), 177–189.

67.

Silverman

M. M.

(2011). Challenges to classifying suicidal ideations, communications, and behaviours. International Handbook of Suicide Prevention: Research, Policy and Practice (p. 9–25). Wiley Blackwell. https://doi.org/10.1002/9781119998556.ch1

68.

Smith

Jackson

S. E.

Vancampfort

Jacob

Firth

Grabovac

McDermotti

Yang

López-Sánchez

G. F.

Niederkrotenthaler

Veronese

Koyanagi

(2019). Sexual behavior and suicide attempts among adolescents aged 12–15 years from 38 countries: A global perspective. Psychiatry Research, 287, 112564.

69.

Smith

J. C.

Mercy

J. A.

Conn

J. M.

(1988). Marital status and the risk of suicide. American Journal of Public Health, 78(1), 78–80. https://doi.org/10.2105/ajph.78.1.78

70.

Tang

C.-Y.

Curran

M. A.

(2013). Marital commitment and perceptions of fairness in household chores. Journal of Family Issues, 34(12), 1598–1622. https://doi.org/10.1177/0192513X12463185

71.

Tavakoli

Fazelnia

Ganjali

(2009). Application of hierarchical analysis process in prioritizing economic sectors: A case study of Neyshabour city. Village and Development Quarterly, 12(4), 77–98.

72.

Triantaphyllou

(2000). Multi-criteria decision making methods: A comparative study (pp. 5–21). Springer.

73.

VanderWeele

T. J.

Tsai

A. C.

Kawachi

(2016). Association between religious service attendance and lower suicide rates among US women. JAMA Psychiatry, 73(8), 845–851. https://doi.org/10.1001/jamapsychiatry.2016.1243

74.

World Health Organization. (2019). Suicide in the world: Global health estimates. World Health Organization. License: CC BY-NC-SA 3.0 IGO. https://apps.who.int/iris/handle/10665/326948

75.

World Health Organization. (2017). World health organization: Depression and other common mental disorders: Global health estimates.

76.

World Health Organization. (2014). World health organization: Preventing suicide: A global imperative. World Health Organization.

77.

World Health Organization. (1994). Life skills education for children and adolescents in schools. Pt. 1, introduction to life skills for psychosocial competence. Pt. 2, guidelines to facilitate the development and implementation of life skills programmes (2nd Rev.). World Health Organization, Division of Mental Health. https://apps.who.int/iris/handle/10665/63552

78.

Zalsman

Hawton

Wasserman

van Heeringen

Arensman

Sarchiapone

Ir Carli

Höschl

Barzilay

Balazs

Purebl

Kahn

J. P.

Sáiz

P. A.

Lipsicas

G. B.

Bobes

Cozman

Hegerl

Zohar

(2016). Suicide prevention strategies revisited: 10-year systematic review. The Lancet Psychiatry, 3(7), 646–659.

79.

Zarenezhad

Gorgi

Sheikh Fathollahi

Gholamzadeh

Ghadipasha

Rezaeian

(2015). Epidemiological survey of suicide in Fars province in the South of Iran during 2003 to 2011. Journal of Rafsanjan University of Medical Sciences, 13(12), 1129–1140.