Research Journal of Recent Sciences _________________________________________________ ISSN 2277-2502 Vol. 4(8), 30-36, August (2015) Res.J.Recent Sci. International Science Congress Association 30 Prevalence of Suicide Attempts by Patients and Its Related Factors in Emergency Rooms of Kerman Medical HospitalsMahin Eslami Shahrbabaki*, Hassan Ziaaddini, Hamed Saeedi and Farshid Khorasani4 Psychiatry Department, Shahid Beheshti hospital, Kerman University of Medical Sciences, Kerman, IRAN Institue of Neuropharmachology, Psychiatry Department, Shahid Beheshti hospital, Kerman University of Medical Sciences, Kerman, IRAN Neurology Research Center, Kerman University of Medical Sciences, Kerman, IRAN Neuroscience Research Center, Institue of Neuropharmachology, Kerman University of Medical Sciences, Kerman, IRAN Available online at: www.isca.in , www.isca.me Received 21st January 2014, revised 15th March 2014, accepted 5th August 2014Abstract Today, suicide is known as a social problem in different countries and this problem has different reasons depending on cultural and social fabric of countries. So exploration of these reasons is essential for taking action to prevent further suicide attempts. This study was designed to determine the frequency of suicide attempts referred to emergency room of educational hospital of Kerman. In this cross sectional study, all suicide attempts referred to emergency room of educational hospital of Kerman were evaluated by 2 separate questionnaires related to demographic variables and suicide characteristics and “Beck Depression Inventory”. Data were analyzed by SPSS and descriptive statistic and Chi square test and T-test. 72% of 100 cases were female. 16 cases have moderate and 16 have severe depression and others have mild or minimal depression. The most frequent age group was 20-40 year old and the most frequent method was abusing drugs. Among drugs, NSAIDs have higher frequency. The frequency of suicide was higher among low educated (43%), history of suicide and psychiatric disorder (p=0.02) and history of psychiatric hospitalization (p=0.00001). Single people were significantly more depressed (P=0.04). The most frequent suicide triggers were family dispute, love failure and unemployment.It seems that the risk of suicide attempt in low educated single women was higher in comparison with others and single people have higher risk of depression and suicide so that more attention should be directed at theses populations. Keywords: Suicide attempt, depression, beck depression inventory. IntroductionSuicide is a kind of intentional death done mostly by individuals themselves aiming to deliberately or partly deliberately kill themselves. It is in no way a meaningless act and is closely related to one’s unfulfilled needs, feeling of despair and hopelessness. It is estimated that 650000 people attempt suicide every year. Around 80 American people are reported to attempt suicide each day; i.e. one suicide in each 20 minutes. Out of 100000 cases of suicides, 12 cases are completed. In Scandinavian countries, Switzerland, Germany, Japan, Austria and Western Europe countries, known as suicide belt, 25 people out of 100000 die of suicide. Based on a report released by World Health Organization (WHO), suicide is the thirteenth leading cause of death in the world; it is also the third cause of death among people aged 15-34 years. Many studies have been undertaken in European countries concerning the Epidemiology of suicide and It’s related risk factors. A research done by Alvaro Meca is one of such studies which has addressed suicide attempts from 1981 to 2008. The result of his study showed that males were more inclined to attempt suicide, though in recent years the number of fatal suicide attempts by females has increased. In addition, suicide rate was higher in over-populated regions compared with under-populated ones4-8. The number of studies on suicidal behavior is relatively few in Middle East. A study done in Turkey showed that the rate of suicide attempts among males and females is 85.6 and 31.9 in 100000, respectively. Completed suicides have also been rated as 9.9 for males and 5.6 for females. Suicide attempts in Iran are lower than in rest of the world, especially Compared with western communities. This rate is, however, higher in comparison with Middle Eastern countries. Investigating suicide attempts is important because 30-60% of those who have actually committed suicide are reported to have tried it before and also 10-40% of these suicide attempts has been fatal10. Three main factors have been identified in suicidal etiology: sociological, psychological and physiological factors. Mood disorders have been the leading cause of suicides. Furthermore, 60% of those suffering from depression have attempted suicide 15-20% of them have died11. Suicide attempt is related to such factors like age, sex, religion, marital condition, physical and mental health, occupation status, and geographical, temporal and regional conditions. It is rather Research Journal of Recent Sciences ______ ______________________________ Vol. 4(8), 30-36, August (2015) International Science Congress Association scarce prior to puberty but increases significantly from the age 20 to 30. Moreover, it is twice more frequent among unmarried people. Religion adherence is said to be an preventive factor In a review study by Ghoreishi et al. 3477 persons were examined including men aged 30- 39 years and women aged 30 years. From among this population, 71.8% Were reported as having mood disorders and 53.3% had overdosed. Frequency of suicide attempts in Ir an was found to be 9.4 in every 100000. It shows that, compared with world statistics, frequency of suicide attempts is lower in Iran and that self- poisoning with drugs has been the frequent method of suicides. The results of the aforementioned study also showed that the number of suicide attempts by women has been twice this number in men. Self burning has been the commonest method used by women and hanging has been the commonest method used by men The results of a study by Zafar- Ghandi et al. Shows th suicide attempters have been below 30 years old and 99% of these attempts have not been completed suicides carried out by Iranian Legal Medicine Organization have concerned itself with the effect of factors such as age, sex, marital condition, income rate and literacy on suicide attempts Still in another study by Salari et al. it is shown that there is a meaningful relationship between attempting suicide and features like age, sex, occupation status, marital condition and t selected method16. The results of a study done in Qazvin showed that suicide attempters were from age group of 15- 24 years old. Drug abuse was reported to be the main cause of suicides in both males and females living in rural and urban areas. Pesticid specifically been the leading method of suicide attempts in rural areas. Couples’ disagreements, quarreling with parents, emotional breakdown and mental disorders were cited as the main factors predisposing individuals to attempt suicide The findings of another study undertaken in Hamedan introduced youths and housewives as two major groups of suicide attempters. It suggests that protective measures be directed mostly on these two groups18. Alizadeh et al. showed in their study a high ra te of suicide attempts among young females. Furthermore, they highlight the meaningful relationship between the number of family members and traumatic events and the tendency to attempt suicide19. Another research has addressed the relationship between sui cide attempts and divorce, asperity, inappropriate verbal communication, disagreements between parents, experience of physical, verbal or sexual abuse, positive family history of suicide attempts, drug use and visiting psychiatrist20, 21. Methodology In this descriptive and cross- sectional study, all suicide attempts referred to Afzali Pour, Shahid Bahonar and Kerman Accidents and Burnings hospitals from March to January, 2012 were ______________________________ __________ _______________ International Science Congress Association scarce prior to puberty but increases significantly from the age 20 to 30. Moreover, it is twice more frequent among unmarried people. Religion adherence is said to be an preventive factor 12. In a review study by Ghoreishi et al. 3477 persons were 39 years and women aged 30 years. From among this population, 71.8% Were reported as having mood disorders and 53.3% had overdosed. Frequency of an was found to be 9.4 in every 100000. It shows that, compared with world statistics, frequency of suicide poisoning with drugs has been the frequent method of suicides. The results of the showed that the number of suicide attempts by women has been twice this number in men. Self - burning has been the commonest method used by women and hanging has been the commonest method used by men 13. Ghandi et al. Shows th at 78% of suicide attempters have been below 30 years old and 99% of these attempts have not been completed suicides 14. A research carried out by Iranian Legal Medicine Organization have concerned itself with the effect of factors such as age, sex, marital condition, income rate and literacy on suicide attempts 15. Still in another study by Salari et al. it is shown that there is a meaningful relationship between attempting suicide and features like age, sex, occupation status, marital condition and t he The results of a study done in Qazvin showed that suicide 24 years old. Drug abuse was reported to be the main cause of suicides in both males and females living in rural and urban areas. Pesticid e poisoning has specifically been the leading method of suicide attempts in rural areas. Couples’ disagreements, quarreling with parents, emotional breakdown and mental disorders were cited as the main factors predisposing individuals to attempt suicide 17. The findings of another study undertaken in Hamedan introduced youths and housewives as two major groups of suicide attempters. It suggests that protective measures be Alizadeh et al. showed in te of suicide attempts among young females. Furthermore, they highlight the meaningful relationship between the number of family members and traumatic events Another research has cide attempts and divorce, asperity, inappropriate verbal communication, disagreements between parents, experience of physical, verbal or sexual abuse, positive family history of suicide attempts, drug use and visiting sectional study, all suicide attempts referred to Afzali Pour, Shahid Bahonar and Kerman Accidents and Burnings hospitals from March to January, 2012 were analyzed. All cases of suicide attempts in the above hospitals w ere selected to be investigated. Two separate questionnaires were used for data gathering. The first concerned with demographic variables and suicide characteristics reviewed in previous studies one was “Beck Depression Inventory”. inventory is a 21- question multiple which is used a tool to measure the severity and symptoms of depression. The contents of this questionnaire are prepared based on observation and a summary of common attitudes symptoms among individuals suffering from depression. In other words, the items are selected wisely and in a way to shed light on the symptoms of depression but with a deeper focus on cognitive nature of it. By summing up the scores of individuals score is gained. The following scores are used to show the severity of depression: 0- 9: indicates minimal depression 18: indicates mild depression , depression, 30- 64: indicates severe depression At t he end, data were analyzed by SPSS Version 17; afterward they were statistically analyzed using descriptive statistics and statistical tests including Chi square, T Results and Discussion Out of 236 cases of suicide attempts referred to ho Kerman from March to January, 2012, only 100 cases were chosen to be analyzed. 72 cases (72%) were females and 28 cases (28%) were males (figure-1). Figure - Frequency of suicide attempts based on sex In this study, there was no meaningful and severity of depression (P=0.7). 31 cases of suicide attempters (31%) were below 20 years old, 60 of them (60%) were aged 20- 40 years and 9 cases (9%) were _______________ ISSN 2277-2502 Res.J.Recent Sci. 31 analyzed. All cases of suicide attempts in the above -mentioned ere selected to be investigated. Two separate questionnaires were used for data gathering. The first concerned with demographic variables and suicide characteristics reviewed in previous studies 16,20,27,36. The second one was “Beck Depression Inventory”. Beck depression question multiple -choice self-report inventory which is used a tool to measure the severity and symptoms of depression. The contents of this questionnaire are prepared based on observation and a summary of common attitudes and symptoms among individuals suffering from depression. In other words, the items are selected wisely and in a way to shed light on the symptoms of depression but with a deeper focus on By summing up the scores of individuals in each item, the total score is gained. The following scores are used to show the 9: indicates minimal depression , 10- , 19-29: indicates moderate 64: indicates severe depression . he end, data were analyzed by SPSS Version 17; afterward they were statistically analyzed using descriptive statistics and statistical tests including Chi square, T -test and ANOVA. Out of 236 cases of suicide attempts referred to ho spitals in Kerman from March to January, 2012, only 100 cases were chosen to be analyzed. 72 cases (72%) were females and 28 - 1 Frequency of suicide attempts based on sex In this study, there was no meaningful relationship between sex 31 cases of suicide attempters (31%) were below 20 years old, 40 years and 9 cases (9%) were Research Journal of Recent Sciences ______ ______________________________ Vol. 4(8), 30-36, August (2015) International Science Congress Association above 40 years old. There was no meaningful relationship between differ ent age groups and high severity of depression (P= 0.08) (figure 2). Figure-2 Frequency of suicide attempts based on severity of depression In terms of level of education, 43 cases (43%) did not have high school diploma, 32 cases (32%) were holding hig diploma, 22 cases (22%) had bachelor’s degrees, 1 person (1%) held a master’s degree and 2 of them (2%) had PhD. There was no significant relationship between education levels and severity of depression (P= 0.11). The most frequent suicide attemp ters were housewives (28 persons; 28%) and the unemployed (24 persons; 24 %) and the less frequent ones were doctors (2 persons; 2%). There was no significant relationship between occupation status and high severity of depression (P= 0.48) (table-1 ) (figur Based on data gathered in this study, the number of unmarried suicide attempters (62 persons; 62%) was higher than married ones (38 persons; 38%). There was significant relationship between marital condition and high severity of depression (P= 0.04) . 79% of studied cases live in cities and 21% were from villages. It was shown that there is no significant relationship between living in rural or urban areas and severity of depression (P= 0.58). Of the types of suicide attempts made, 72 were by drug ove rdose among which 73.6% used one drug type, 23.6% used two drug types and 2.8% used three drug types. 75.4% of those who overdosed did so using NSAIDs, 57.7% used benzodiazepines, 12.7% used antidepressant drugs, 14.1% used opioid drugs and the rest 22.5% used other drugs. The above numbers includes cases of multiple well. As for the dose of the drugs used, 8 cases (11.8%) took less than 5 tablets, 46 cases (67.6%) took 5 to 10 tablets and 14 ______________________________ __________ _______________ International Science Congress Association above 40 years old. There was no meaningful relationship ent age groups and high severity of depression Frequency of suicide attempts based on severity of In terms of level of education, 43 cases (43%) did not have high school diploma, 32 cases (32%) were holding hig h school diploma, 22 cases (22%) had bachelor’s degrees, 1 person (1%) held a master’s degree and 2 of them (2%) had PhD. There was no significant relationship between education levels and severity ters were housewives (28 persons; 28%) and the unemployed (24 persons; 24 %) and the less frequent ones were doctors (2 persons; 2%). There was no significant relationship between occupation status and high ) (figur e 3). Based on data gathered in this study, the number of unmarried suicide attempters (62 persons; 62%) was higher than married ones (38 persons; 38%). There was significant relationship between marital condition and high severity of depression (P= . 79% of studied cases live in cities and 21% were from villages. It was shown that there is no significant relationship between living in rural or urban areas and severity of depression Of the types of suicide attempts made, 72 were by rdose among which 73.6% used one drug type, 23.6% used two drug types and 2.8% used three drug types. 75.4% of those who overdosed did so using NSAIDs, 57.7% used benzodiazepines, 12.7% used antidepressant drugs, 14.1% used used other drugs. The above numbers includes cases of multiple -drug overdose as well. As for the dose of the drugs used, 8 cases (11.8%) took less than 5 tablets, 46 cases (67.6%) took 5 to 10 tablets and 14 cases (20.6%) took more than 10 tablets. Table- 1 The frequency of suicide attempts classed based on occupation Occupation Frequency Housewife 28 Unemployed 24 Pupil 12 Student 7 Worker 6 Housewife 5 Prisoner 5 Self-employed 5 Farmer 2 Militiaman 2 Driver 2 doctor 2 Total 100 Figure - Frequency of suicide attempts based on levels of education There was no significant relationship between different doses and high severity of depression (P= 0.75). 14 cases (14%) of the 100 patients studied in this research had self- poisoned themselves: 3 of them (21.4%) had used herbicides, 4 cases (28.6%) had used pesticides, 4 cases (28.6%) had used detergents and 3 of them (21.4%) had used mouse poison. From among those who self suicide attempters (23.1%) had used a dose of less than 10 cc and 10 cases (76.9%) had used a dose of 10 no significant relationship between deliberate self high severity of depression (P= 0.2). In addi that there is no significant relationship between degrees of doses and high severity of depression (P= 0.66). _______________ ISSN 2277-2502 Res.J.Recent Sci. 32 cases (20.6%) took more than 10 tablets. (figure-4). 1 The frequency of suicide attempts classed based on occupation Frequency Percentage 28% 24% 12% 7% 6% 5% 5% 5% 2% 2% 2% 2% 100 100% - 3 Frequency of suicide attempts based on levels of education There was no significant relationship between different doses and high severity of depression (P= 0.75). the 100 patients studied in this research had poisoned themselves: 3 of them (21.4%) had used herbicides, 4 cases (28.6%) had used pesticides, 4 cases (28.6%) had used detergents and 3 of them (21.4%) had used mouse poison. From among those who self -poisoned themselves, 4 suicide attempters (23.1%) had used a dose of less than 10 cc and 10 cases (76.9%) had used a dose of 10 -100 cc. There was no significant relationship between deliberate self -poisoning and high severity of depression (P= 0.2). In addi tion, it was shown that there is no significant relationship between degrees of doses and high severity of depression (P= 0.66). Research Journal of Recent Sciences ______ ______________________________ Vol. 4(8), 30-36, August (2015) International Science Congress Association Figure-4 Frequency of different kinds of drugs used in suicide attempts Twelve of the 100 suicide attempters (12%) did so u narcotics. 8 cases (66.6%) used opium, 2 cases (16.6%) used marjuana, 1 case (8.3%) used amphetamine and 1 case (8.3%) used other kinds of narcotics. No significant relationship was observed between the kind of narcotics and severity of depression (P= 0.5). Concerning the dose of narcotics, in 3 cases (25%) it was less than 1 gram and in 9 cases (75%) it was a large dose of between 1 to 5 grams. There was no significant statistical relationship between narcotics doses and severity of depression (P= 0. Family disputes (48 cases; 48%) and love failure (20 cases; 20%) were the most frequent factors motivating individuals to attempt suicide, while physical illness was the less frequent factor (only 3 cases; 3%). There was no significant relationship be tween the motivation to attempt suicide and severity of depression (P= 0.12). 19 cases (19%) had previously attempted suicide, 5 cases of which (26.3%) had one suicide attempt, 6 case (31.5%) had two suicide attempts, 5 cases (26.3%) had 3 suicide attempt (10.5%) had 4 suicide attempts and one case (5.25%) had 5 suicide attempts. There was a significant relationship between having previous suicide attempt(s) and a severity of depression (P=0.00001). But no significant relationship was found betwe the number of previous suicide attempts and severity of depression (P= 0.13). Out of 100 studied suicide attempters, 39 cases (41.5%) had a history of dispute and asperity. But this factor did not have a significant relationship with severity of depres of these cases (90%) had suddenly attempted suicide while the other 10 cases (10%) had already decided to do so. This factor ______________________________ __________ _______________ International Science Congress Association Frequency of different kinds of drugs used in suicide Twelve of the 100 suicide attempters (12%) did so u sing narcotics. 8 cases (66.6%) used opium, 2 cases (16.6%) used marjuana, 1 case (8.3%) used amphetamine and 1 case (8.3%) used other kinds of narcotics. No significant relationship was observed between the kind of narcotics and severity of Concerning the dose of narcotics, in 3 cases (25%) it was less than 1 gram and in 9 cases (75%) it was a large dose of between 1 to 5 grams. There was no significant statistical relationship between narcotics doses and severity of depression (P= 0. 56). Family disputes (48 cases; 48%) and love failure (20 cases; 20%) were the most frequent factors motivating individuals to attempt suicide, while physical illness was the less frequent factor (only 3 cases; 3%). There was no significant relationship tween the motivation to attempt suicide and severity of 19 cases (19%) had previously attempted suicide, 5 cases of which (26.3%) had one suicide attempt, 6 case (31.5%) had two suicide attempts, 5 cases (26.3%) had 3 suicide attempt s, 2 cases (10.5%) had 4 suicide attempts and one case (5.25%) had 5 suicide attempts. There was a significant relationship between having previous suicide attempt(s) and a severity of depression (P=0.00001). But no significant relationship was found betwe en the number of previous suicide attempts and severity of Out of 100 studied suicide attempters, 39 cases (41.5%) had a history of dispute and asperity. But this factor did not have a significant relationship with severity of depres sion (P= 0.19). 90 of these cases (90%) had suddenly attempted suicide while the other 10 cases (10%) had already decided to do so. This factor did not have a significant relationship with severity of depression (P= 0.44). May was the month in which most (48 cases; 48%) while September, December and January were the months in which fewest number of suicide attempts occurred (1 case in each month; 1%). In 15 cases (15%) suicide attempters have had a history of family suicide, 13 have had mental disorders and 8 cases (8%) had been hospitalized in psychiatry hospitals. Those cases who have had a history of family suicide or have suffered mental disorders had higher severity of depression (P=0.02). Those suicide attempte which had previously been hospitalized had meaningfully higher severity of depression (P=0.00001) (figure Figure - Severity of depression in single and married suicide attempters Discussion: The findings of the current study showed that suicide attempt is more frequent in people aged 20 These findings confirm the results obtained by most of recent studies undertaken in Iran17,19,22 . That is while researches done in some of developed countries show that suicide attempt in older ages has turned into a serious problem function in society, interpersonal conflicts (mostly with same age friends, spouse and parents), drug and narcotic abuse and unemployment are the leading cause of suicide attempts among youths26,27. The lowest number of suicide attempts relates to people over 40 years old which is in consistent with other studies in the world (figure-6). In this study it was shown that the number of suicide attempts by women are higher than that of men but such a differe not statistically different and calls for a large sample covering different city areas and including private hospitals and Legal Medicine Organizations. But most of recent studies have shown that attempting suicide is more frequent among women to be noted that the results of few studies have shown the opposite, i.e. the frequency of suicide attempts is more among males than females24,25 . Kooshan et al. relate the higher rate of females’ suicide attempts to their higher severity of depression31 , while in this study no meaningful relationship was found between sex and higher severity of depression. _______________ ISSN 2277-2502 Res.J.Recent Sci. 33 did not have a significant relationship with severity of May was the month in which most of suicide attempts occurred (48 cases; 48%) while September, December and January were the months in which fewest number of suicide attempts occurred (1 case in each month; 1%). In 15 cases (15%) suicide attempters have had a history of family suicide, 13 cases (13%) have had mental disorders and 8 cases (8%) had been hospitalized in psychiatry hospitals. Those cases who have had a history of family suicide or have suffered mental disorders had higher severity of depression (P=0.02). Those suicide attempte rs which had previously been hospitalized had meaningfully higher severity of depression (P=0.00001) (figure -5). - 5 Severity of depression in single and married suicide attempters The findings of the current study showed that attempt is more frequent in people aged 20 -40 years old. These findings confirm the results obtained by most of recent . That is while researches done in some of developed countries show that suicide attempt in has turned into a serious problem 23-25. Inability to function in society, interpersonal conflicts (mostly with same - age friends, spouse and parents), drug and narcotic abuse and unemployment are the leading cause of suicide attempts among lowest number of suicide attempts relates to people over 40 years old which is in consistent with other In this study it was shown that the number of suicide attempts by women are higher than that of men but such a differe nce is not statistically different and calls for a large sample covering different city areas and including private hospitals and Legal Medicine Organizations. But most of recent studies have shown that attempting suicide is more frequent among women 17,30. It is to be noted that the results of few studies have shown the opposite, i.e. the frequency of suicide attempts is more among . Kooshan et al. relate the higher rate of females’ suicide attempts to their higher severity of , while in this study no meaningful relationship was found between sex and higher severity of depression. Research Journal of Recent Sciences ______ ______________________________ Vol. 4(8), 30-36, August (2015) International Science Congress Association Figure-6 Frequency of suicide attempts classes according to age As for marital condition, the results of this study are in consistent with the results of studies carried out recently in Iran17,28,31,36, . There was no meaningful relationship between marital condition and the number of suicide attempts, but it had a meaningful relationship with severity of depression. Single males attempt suici des more than single females. Based on the findings of this study, housewives, educated people and the unemployed are more prone to attempt suicide, thus confirming results of the studies done by Jamshid Zadeh Heidari33 and Ziaoddini36. However, occupa tion status was not meaningfully related to severity of depression. Some studies18,22 have considered low level of education a cause of suicide attempts. In contrast to these studies, in the current study, although the number of uneducated suicide attemp ters is higher, the difference is not meaningful partly due to the small size of the sample. In addition, there was no meaningful relationship between levels of educat severity of depression. According to findings of a study by Moravaji et al. conc epidemiologic analysis of completed suicide attempts in Kashan, 79.5% of studied cases had done so using drugs; this is close to the statistical information presented in this paper study by Shirzad et al. after hanging, drug abuse was shown be the commonest used method of suicide, though its frequency was much less than hanging15 . It seems that due to individuals’ difference tolerance, the various doses taken and the type of drug, most of suicide attempter who do so by abusing drug will have nonfatal suicides. Regarding the factors motivating suicide attempts, the results of this study are in line with other studies 32,35 findings of this study, family disputes and emotional breakdown are the leading causes of suicide attempts. That is while Heidari et al. introduce family disputes; quarrel with spouse and ______________________________ __________ _______________ International Science Congress Association Frequency of suicide attempts classes according to age As for marital condition, the results of this study are in the results of studies carried out recently in . There was no meaningful relationship between marital condition and the number of suicide attempts, but it had a meaningful relationship with severity of depression. Single des more than single females. Based on the findings of this study, housewives, educated people and the unemployed are more prone to attempt suicide, thus confirming results of the studies done by Jamshid Zadeh 32, tion status was not meaningfully related to severity of depression. have considered low level of education a cause of suicide attempts. In contrast to these studies, in the current study, although the number of uneducated suicide ters is higher, the difference is not meaningful partly due to the small size of the sample. In addition, there was no meaningful relationship between levels of educat ion and According to findings of a study by Moravaji et al. conc erning epidemiologic analysis of completed suicide attempts in Kashan, 79.5% of studied cases had done so using drugs; this is close to the statistical information presented in this paper 35. In a study by Shirzad et al. after hanging, drug abuse was shown to be the commonest used method of suicide, though its frequency . It seems that due to individuals’ difference tolerance, the various doses taken and the type of drug, most of suicide attempter who do so by abusing drug will Regarding the factors motivating suicide attempts, the results of 32,35 . Based on the findings of this study, family disputes and emotional breakdown are the leading causes of suicide attempts. That is while Heidari quarrel with spouse and unemployment as the main causes of suicide attempts another study by Kooshan et al. which was carried out in Sabzevar, couple’s dissatisfaction, family problems, unemployment and educational failure were shown to be the most frequent causes of suicide attempts In most of the studies done up t o now, taking sedative drugs as a way of suicide attempts has played a major role thing was approved in our study with an exception that NSAID drugs were more frequently used, what Kooshan et al. had already pointed out31 . In Ziaoddini and Y suicide attempters in Kerman had done so using benzodiazepines and opioid drugs 36 that due to the passage of time and social changes, using NSAID drugs have become more prevalent. Self-reporting was one of t he limitations of this study that was done away with ensuring participants of the confidentiality of the documents and anonymity of the questionnaires. One other important limitation was that most suicide attempters declined to fill in the questionnaires. A third limitation was the small size of the sample. Future studies should take these limitations into account. Conclusion Single females with low level of education are the most frequent suicide attempters in Kerman. Depression, previous mental hospital izations or suicide attempt(s) and a history of family suicide are the identified risk factors. Easy access to sedatives and NSAID drugs should seriously be reconsidered and pharmacy workers should be given appropriate instructions. Acknowledgement We would like to thank all the patients who cooperated with us in this research. This study was supported by the Neurology Research Center of University of Kerman Medical Sciences. References 1. Sadock B.J.V.A., Comprehensive textbook of psychiatry. 8th ed. Vol 2. Philadelphia: Lippincott Williams and Wilkings, (2005)2. Krug E., Dahlberg L.L., Mercy J.A., Zwi A.B. Lozano R., (eds). World Report on Violence and Health Geneva (2002)3. Mann J.J., A current perspective of suicide and Attempted suicide, Ann inten me 4.Alvaro- Meca A., Kneib T., Gil Miguel A., Epidemiology of suicide in Spain, 1981 A spatiotemporal analysis, Public Health 5.Herea S.G. and Scripcaru C., Statistical analysis of suicide characteristics in lasi country Med Nat lasi., 116(3), 674- 80 _______________ ISSN 2277-2502 Res.J.Recent Sci. 34 unemployment as the main causes of suicide attempts 33. Still in another study by Kooshan et al. which was carried out in Sabzevar, couple’s dissatisfaction, family problems, unemployment and educational failure were shown to be the most frequent causes of suicide attempts 31. o now, taking sedative drugs as a way of suicide attempts has played a major role 32-35. The same thing was approved in our study with an exception that NSAID drugs were more frequently used, what Kooshan et al. had . In Ziaoddini and Y asami’s study, most of suicide attempters in Kerman had done so using 36 . The present study shows that due to the passage of time and social changes, using NSAID drugs have become more prevalent. he limitations of this study that was done away with ensuring participants of the confidentiality of the documents and anonymity of the questionnaires. One other important limitation was that most suicide attempters declined A third limitation was the small size of the sample. Future studies should take these limitations into Single females with low level of education are the most frequent suicide attempters in Kerman. Depression, previous mental izations or suicide attempt(s) and a history of family suicide are the identified risk factors. Easy access to sedatives and NSAID drugs should seriously be reconsidered and pharmacy workers should be given appropriate instructions. would like to thank all the patients who cooperated with us in this research. This study was supported by the Neurology Research Center of University of Kerman Medical Sciences. Sadock B.J.V.A., Comprehensive textbook of psychiatry. 2. Philadelphia: Lippincott Williams and Krug E., Dahlberg L.L., Mercy J.A., Zwi A.B. and Lozano R., (eds). 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