1. ANALYSIS OF COMPLETED SUICIDES IN PLEVEN COUNTY FOR A 6 YEAR PERIOD
Vladimir Nakov1, Kaloyan Stoychev2, Liudmil Tumbev2, Krasimir Ivanov2, Dancho Dekov3
1 National Center of Public Health and Analyses, Department of Mental Health, 2 Medical University Pleven, Department of Psychiatry and Medical Psychology,
3 Medical University Pleven, Department of Forensic medicine
INTRODUCTION
Suicide and suicide behavior were long regarded in Bulgaria as a problem inappropriate for scientific study and public discussion and even after the profound sociopolitical changes in 1989 there is still marked deficit in research and publications on this topic. Nakov & Donchev (2015) estimate annual suicide attempts rate in Bulgaria to be around 3000 cases with about 700 completed suicides. Bulgarian National Statistical Institute ranks suicide as the 10-th leading cause of death in the country (NSI Bulgaria 2016).
AIM OF THE STUDY
The present study aims to identify those socio-demographic and clinical factorsin patients with psychiatric disorders that are associated with higher suicide risk for the purpose of suicide prevention.
METHODS
Based on the national legislation requirement for a post mortal forensic examination report in each case of proven or suspected violent cause of death, we studied all forensic reports issued from January 2009 to December 2014 in the region of Pleven - one of the 28 administrative regions of Bulgaria with population of around people. All 185 suicide cases occurred for the above mentioned period were studied and those subjects who had medical record for acute or chronic mental disorder were subjected to deeper analysis by means of documentary and historical methods (studying personal medical records, forensic reports, interviews with relatives etc.). All relevant socio-demographic and clinical data were extracted from medical records by a specially designed information form.
RESULTS
A total of 42 suicide victims were identified as having mental illness on a lifetime basis. Although mean age of this subgroup was years (52.5 years for males and 58.5 years for females), patients with schizophrenia had significantly lower mean age of 44.0years.The males to females ratio (1.625:1) and urban to non-urban citizens ratio (3:1) in our sample were significantly different fromwhat is reported in nationwide studies in which female to male distribution varies from 2.5 to 3:1 and urban/non-urban dwellers correlation is about 1,30:1 (Lisaev et al 1997). The leading method of suicide was hanging, followed by jumping from a high place, poisoning and firearm shot. All suicide methods were dominated by males except for jumping from a high place where female to male ratio was 5:4.
CONCLUSIONS
Despite having certain limitations (only one of the 28 Bulgarian administrative districts is included which makes regional comparison impossible; for some of the patients there was insufficient information) the present study finds that:
Risk factors that were found to have greatest predictive significance for suicide are:
• Diagnosis of schizophrenia
• 25 % of all suicide committers in the period in Pleven region have documented mental illness.
• Living alone (single, divorced or widowed patients)
• Age < 30 years or > 65 years
• Mean age of suicide victims with mental illness is about 54.0 years and it is much lower in patients with schizophrenia or schizoaffective disorder.
• Employment status: unemployed and retired individuals
• Education level of high-school or lower
• ¼ of all mentally ill suicidal subjects have informed other people in the past about having suicidal thoughts and intents.
• Feeling of hopelessness or active psychotic experiences