Clinical feature of suicidal behavior in patients with depression
Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
CLINICAL FEATURE OF SUICIDAL BEHAVIOR
IN PATIENTS WITH DEPRESSION
Dinh Viet Hung1, Nguyen Van Linh1
Nguyen Dinh Khanh1, Ngo Dac Sang2
SUMMARY
Objectives: To study clinical features of suicidal behaviors in patients with depression.
Subjects and methods: Thirty-six patients with depression were treated at the Department of
Psychiatry, Military Hospital 103. Results: The patients with disease duration from 1 - 3 years
accounted for the highest rate (69.45%); Patients with recurrences of two and three times
accounted for 58.32%, and severe depression accounted for 61.11%. Prominent symptoms
include depressed mood, anhedonia, a feeling of sadness, suicidal idea. In terms of thought
form, slow rhythm accounted for 88.89%, and alogia accounted for 80.56%. Most patients with
severe depression experiencing only one time of suicidal behavior accounted for 58.34%; the
suicidal methods were varied, in which overdosing psychotic and sedative medications were the
most frequent (30.55%), time of suicidal behavior being at day accounted for 72.22%, and
suicidal accommodation being at home accounted for 69.45%. Conclusion: Suicidal behaviors
in patients with depression were varied and directly threatened patients’ lives.
* Keywords: Depression; Suicidal behaviors.
INTRODUCTION
attempted suicide and approximately 5 - 6%
of death is originated from suicide. Threat
factors of attempted suicide in such
patients include depression, loss of hope,
unemployment, psychosis and post-
discharge. In Vietnam, there are some
studies on attempted suicide. However,
they only stop at psychotic patients in
general. No study on attempted suicide in
heavy depression cases is launched. That
is why the topic of “A study on clinical
characteristics of suicide in depressed
patients” is launched by the authors.
Currently, approximately 10 - 20 million
attempted suicide persons are found in
the world. Suicide is the 13th cause of
death in the world. In USA, suicide is the
6th death cause, male/female ratio of
attempted suicide is 2:1. In Vietnam,
suicide is the 2nd death cause in young
people, just behind traffic accidents.
Attempted suicide due to depression
makes up the highest rate. Approximately
20 - 30% of depression patients have
1Military Hospital 103, Vietnam Military Medical University
2Vietnam Military Medical University
Corresponding author: Dinh Viet Hung (bshunga6@gmail.com)
Date received: 26/02/2021
Date accepted: 16/3/2021
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
SUBJECTS AND METHODS
1. Subjects
Thirty-six patients diagnosed with the depressive disorder according to ICD-10 were
treated at the Department of Psychiatry, Military Hospital 103 from May 2016 to May 2020.
2. Research method
Using the retrospective sectional method and analyzing each case. The clinical
symptoms were consulted when patients were hospitalized. The consultation was
performed by two independent psychiatrists.
3. Data analysis
Data analysis was performed base on SPSS 20.0. A statistically significant difference
was determined for tests (p < 0.05).
RESULTS AND DISCUSSION
1. Features of depression disorder symptoms
Table 1: The onset age in patient with depressive disorder.
Statistics index
Number (n)
Percent (%)
Age group
< 20
20 - 29
30 - 39
40 - 49
50 - 59
> 60
2
6
5.56
16.67
27.78
33.32
11.11
5.56
10
12
4
2
Mean age
33.27 11.48
Our main findings unveiled that the onset age making up the highest prevalence
was 20 - 49 (77.77%); it is equivalent to the results from previous studies. Depression
often onset at the early stage of growth and start of self-independence life. This was
also a phase that a series of problems are faced by people, especially difficulties in life,
strengths and weaknesses of the body are also demonstrated, socio-economic conditions
affecting the personal life cause stress to the body. As a result, the disease may start.
Indicator signs of depression disorders were often shown by fatigue, sleep disorders,
and impaired work performance [1].
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
Table 2: The disease duration in patients with depressive disorder.
Statistics index
Number (n)
Percent (%)
Disease duration
< 1 year
7
10
15
4
19.44
27.78
41.67
11.11
1 - 2 years
2 - 3 years
> 3 years
Table 2 unveiled that the patients with 1 - 3 years disease made up the highest
percentage (69.45%), the number of patients with a disease period of over 3 years
made up the lowest percentage (11.11%). Depression may be prolonged for years and
become chronic. Hence, the disease period was generally prolonged. Due to unclear
understanding about the disease, many patients became serious before the
examination at the psychotic department [1].
Table 3: The number of recurrences of depressive disorder.
Statistics index
Number (n)
Percent (%)
Number of recurrences
1 time
2 times
3 times
4 times
5 times
> 5 times
4
9
11.11
25.00
33.32
16.67
8.34
12
6
3
2
5.56
Table 3 unveiled that the number of disease re-occurrence two times and three
times accounted for the highest percentage (58.32%), and the lowest one was the case
with five times of occurrence (5.56%). The development of depression was to re-occur.
Between the stable phases, the depressed patients were still found with disease
persistence. In comparison, the patients’ post-discharging monitoring and maintenance
treatment was not paid with special concerns. Many patients omitted medicine as they
denied the disease and incorrect recognition. That is why the high rate of re-occurrence
patients for 2nd time or more account is recorded. Moreover, Vietnamese awareness
about mental health is still restricted, resulting in prolong disease time and low
treatment efficiency [1].
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
Table 4: Clinical types of depressive disorder.
Statistics index
Number (n)
Percent (%)
Clinical types
Bipolar disorder with current depressive phage
Depressive disorder
4
11.11
61.11
27.78
22
10
Recurrent phage
Among study patients, most of them in the depression phase included 22 persons,
accounting for 61.11%; ten patients with re-occurrence of depression account for
27.78%, and the lower rate of bipolar emotional disorder was found in 4 patients,
accounting for 11.11%. Our study is consistent with the study of Viswanath B. (2012)
that assumed that the depression phase is ranked at the top, next is the depression
re-occurrence and bipolar emotional disorder. The study indicated that bipolar emotional
disorder generally onset at a young age. However, when it was in the depression phase,
it related to a series of factors such as disease time, living quality, and discrimination,
the attempted suicide was partially explained in the depression phase [2].
Table 5: Symptoms of mood disorder in the patient.
Statistics index
Number (n)
Percent (%)
Symptoms
Depressed mood
Anhedonia
36
36
36
35
34
32
100.00
100.00
100.00
97.22
Feeling of sadness
Reduced energy
Loss of confidence
Loss of concentration
94.44
88.89
Table 5 unveiled that the outstanding emotion symptoms included reduced complexion,
loss of interest/concern, and bored feelings with 100%. The study of Lin C (2019)
indicated that these are core symptoms of depressive disorder and obligatory
appearance of emotional symptoms in acutely psychotic patients, i.e., reduced complexion
and loss of interest/concern. In addition, other symptoms of depression were emphasized,
for example, anxiety, reduced energy and discouragement [3].
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
Table 6: Symptoms of dyskinesia in the patient.
Statistics index
Number (n)
Percent (%)
Symptoms
Sucidal ideation
36
34
32
31
29
11
100.00
94.44
88.89
86.11
80.55
30.56
Psychomotor retardation
Anxiety
Ignore social activities
None of co-operation in treatment
Food refusal
Table 6 unveiled that the restricted affect disorders were mostly found in symptoms
with intentional suicide (100%), next was delayed movements and anxiety (94.44%);
88.89% and especially 30.56% patients refused food. These specific symptoms were
often found in depression disorder patients under ICD 10-1992. A study on restricted
affect disorders in depression patients launched by Pettersson A. (2015) realized that
in addition to the specific signs (i.e., attempted suicide, restricted affect), other diversified
movement disorders were also recorded in the patients with depression, including
anxiety, social activity omission and non-cooperation with treatment. An important
characteristic of restricted affect disorders of patients with depression was suicide
attempt. Hence, such disorders must be especially concerned during the treatment of
patients with depression. The close and inevitable gap was found from depression to
suicide behavior [4].
Table 7: Disorders of the form of thought in the patient.
Statistics index
Number (n)
Percent (%)
Symptoms
Poor language
Sluggish language
Interruption answer
Whispering
32
29
23
12
6
88.89
80.56
63.89
33.33
16.67
Don't speak
As a result, thinking disorders in patients with depression showed poor, sluggish
language and interruption answer accounted for a large percentage, i.e., 88.89%,
80.56%, and 63.89%, respectively. Through such symptoms, patients were realized
with mental health problems. Patients were found with anxiety, silence, or even they
did not want to talk. This result is well-matched with the main findings of Riga D (2017),
where conclusions were drawn that the thinking disorders in elderly patients with
depression are generally found [5].
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
2. Clinical characteristics of attempted suicide in depression patients
Table 8: Number of suicide attempts in study patients.
Statistics index
Number (n)
Percent (%)
Number of suicide
Once time
21
7
58.34
19.44
11.11
8.33
Two times
Three times
Four times
4
3
Five times
1
2.78
Table 8 specified that majority of patients having at least once attempted suicide
accounts for 58.34%; next was those having two and three attempted suicide times,
accounted for 19.44% and 11.11%, respectively. This result is well-matched with the
main findings of Park S (2018), where it is assumed that the majority of depression
patients with suicide to be treated in the Department of Psychiatry has just only one
suicide time. The author further emphasized that the number of attempted suicide
would be repeated if patients are not well treated, managed, and not applied with
electrical cardioversion [6].
Table 9: Methods of suicide attempt in study patients.
Statistics index
Number (n)
Percent (%)
Methods of suicide
Sedatives
11
5
30.55
13.89
16.67
11.11
8.33
With pesticide, ratsbane
Using sharp objects such as knife, scissors to cutor throw
Hammers, bricks, and stones
Hanged
6
4
3
Jumping from above
By electric shock
3
8.33
2
5.56
Other forms
2
5.56
Table 9 described that the suicide forms taken by patients with depression were
very diversified, the highest percent belonged to patients using sedatives (30.55%),
next was using sharp objects such as knives, scissors to cut or throw (16.67%). This
result is consistent with DSM 5 when it is assumed that the schizophrenic patient’s
suicide methods are diversified, however, the most popular one is the violent ways
such as stab, chopper, shoot, garrotte, etc. Girlanda F (2014) specified that the most
popular attempted suicide form is to drink overdose medicines and toxics, accounting
for 68.25%, next was to use a knife and sharp objects, accounting for 12.15%, jumping
from the height accounted for 11.21% [7].
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
Table 10: Percentage of medicine the (22.9%) and not-defined (4.82%). Among
patient took in.
244 depressed patients with attempted
suicide, the patients were found to carefully
prepare and conduct at an unexpected
times [8].
Statistics index
Number Percent
(n)
(%)
Type of medicine
Paraquat
2
3
5
2
1
3
12.5
18.75
31.25
12.5
Table 12: Location suicide attempt of
Paracetamol
Sedatives
study patient.
Statistics index
Number Percent
Organic phospho
No organic phospho
Other
(n)
(%)
Location suicide
Their home
On road
6.25
25
7
69.45
19.44
11.11
18.25
The medicine group which was mostly
used by the attempted suicide patients
was sedatives (31.25%), next was
paracetamol (18.75%), sharing the same
rate of 12.5% was agricultural pesticides
and organic phosphor. These medicine
groups were available for purchase. The
remaining was widely used in agriculture
and industry. With the data above, it is
alarming that such medicines must be
strictly managed to restrict the attempted
suicide with such drugs and chemicals.
Other
4
Most of the patients with attempted
suicide conducted at home, accounting
for 69.45%; the second was on road
(19.44%). Thus, the majority of patients
with attempted suicide conducted suicide
when no one was at home or when no
attention was paid. This result is well-
matched with the main findings of Bui
Quang Huy (2016) [1].
CONCLUSIONS
Table 11: Time of study patient's
suicide attempt.
Through the study on clinical characteristics
of attempted suicide in depression patients,
we realized that.
Statistics index
Number Percent
Time of
(n)
(%)
Patients with disease of 1 - 3 years,
accounted for the highest percent (69.45%);
second and third time of occurrence
accounted for 58.32% and patients in the
depression phase made up 61.11%.
attempted suicide
Daytime
26
10
72.22
27.78
Nighttime
Table 11 unveiled that the majority of
attempted suicide patients conduct the
behavior during the daytime (72.22%).
This result is well-matched with the main
findings of Wee J H (2016). Accordingly,
it is found that attempted suicide patients
conduct the suicide in the morning (35.14%),
afternoon (21.25%), noon (15.89%), night
The outstanding emotion symptoms
include reduced complexion, loss of
interest/concern, and bored feelings, and
100% of patients with attempted suicide.
Regarding the thinking disorder, delayed
language and alogia account for 88.89%
and 80.56%, respectively.
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
4. Pettersson A, Boström KB, Gustavsson P,
et al. Which instruments to support diagnosis
The majority of depression patients
having one attempted suicide time
accounted for 58.34%; attempted suicide
with relatively diversified methods was
recorded, the highest percent belonged
to patients using depression (30.55%);
and most attempted suicide in daytime
accounts for 72.22% and attempted
suicide location was at home (69.45%).
of depression have
sufficient
accuracy?
A systematic review. Nord J Psychiatry 2015;
69(7):497-508.
5. Riga D, Schmitz LJM, Hoogendijk WJG,
et al. Temporal profiling of depression
vulnerability in a preclinical model of sustained
depression. Sci Rep 2017; 7(1):8570.
6. Park S, Lee Y, Youn T, et al.
Association between level of suicide risk,
characteristics of suicide attempts, and mental
disorders among suicide attempters. BMC Public
Health 2018; 18(1):477.
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