خودآسیبی، افکار خودکشی و اقدام به خودکشی در میان دانشجویان

Abstract Self-harm, suicidal ideation, and suicide attempts are well represented behaviours in the general population of both developed and developing countries. These behaviours are indicative of underlying risk factors that show a strong interdependent correlation. In this study we attempted to define correlates for and prevalence of self-harm, suicidal ideation, and suicide attempts among Turkish college students. This 2006 study included 636 students from two Turkish state universities. Our results showed that the lifetime prevalence of self-harm was 15.4%, the prevalence of suicidal ideation was 11.4%, and the prevalence of suicide attempts was 7.1%. We uncovered correlates for self-harm, including low income, unsatisfying familial relationships, smoking, and alcohol, inhalant, and tranquilizer abuse. Tranquilizer abuse shared a dual role as a correlate for suicide ideation and as a means to attempt suicide. Additionally, we found that drug abusers and adolescents who practise self-harm presented the highest suicide risk.

1. Introduction In recent literature self-harm has been recorded most prevalently among young people (Ross and Heath, 2002, Nock et al., 2006 and Laukkanen et al., 2008). Historically related to different psychiatric disorders such as depression, bipolar disorder, and borderline personality disorder (Suyemato, 1998), self-harm has also been shown to be common in non-clinical samples of adolescents and young adults (Laye-Gindhu and Schonert-Reichl, 2005). The dominant approach of the literature is to distinguish between suicide attempts and self-harm without intent to die (Messer and Fremouw, 2008). “Although suicidal ideation has been found in 28–41% of self-injury cases, still, upward of 85% of self-injury events are undertaken with the primary goal of releasing tension, rather than of ending life” (Yates, 2004). On the other hand, recent non-fatal self-harm indicates a large increase in the individual risk of lethal suicide intervention (Owens et al., 2002). Furthermore, those who have attempted suicide and present a history of self-harm also tend to be more depressed, impulsive (Dougherty et al., 2009), anxious and underestimating the lethality of their suicide attempts. Therefore, clinicians may be unintentionally evaluating the suicide risk in self-mutilators as less serious than it actually is (Stanley et al., 2001). The incidence and prevalence of self-harm are difficult to calculate because of the lack of a stringent defininiton of self-harm. However, previous studies show the incidence of self-harm in the psychiatric population to be much higher than in the general population — ranging from 4.3% to 20% of all psychiatric inpatients and ranging from 40% to 61% of adolescent inpatients (Suyemoto, 1998). In the literature the prevalence of self-harm in community adolescents ranges from 15% to 46.5% (Laye-Gindhu and Schonert-Reichl, 2005 and Lloyd-Richardson et al., 2007) and in college students from 6.9% (Rodham et al., 2004) to 13.9% (Favazza et al., 1989 and Ross and Heath, 2002). A relatively new study evaluating 13 to 18-year-old Finnish adolescents found that 11.5% had a lifetime prevalence of self-cutting, 1.8% is currently self-cutting, and all other self-harm was recorded at 10.2% (Laukkanen et al., 2008). A study performed on Turkish college students in 2003 in a metropolitan university found self-mutilation rate to be 8% (Oksuz and Malhan, 2005). A Turkish regional study sampling a group of students from a non-clinical high school found self-mutilative behaviour at 21.4% (Zoroglu et al., 2003). Additionally, deliberate self-harm and suicide attempts have been associated with many familial and external factors, such as parental psychopathology, neglect, parental substance abuse, and abuse in the context of pathological family relationships (Hawley et al., 1995, Baer and Maschi, 2003, Gratz, 2003, Ystgaard et al., 2004 and Ilomäki et al., 2006). In a sample of non-clinical Turkish high school students, suicide attempts were found to be more frequent in probands who self-mutilated (58.6) (Zoroglu et al., 2003). Turkish researchers, (Evren and Evren, 2005) found that age at initial substance use among substance dependent patients was lower in the group reporting self-harm (14.8 ± 3.5 years) than the group not reporting self-harm (18.7 ± 4.6 years). Rapid urbanization and economic restructuring are defining forces in much of the developing world and may lead to unique stressors (Das et al., 2007). Most of violence-related deaths occur in low- to middle-income countries, such as in a substantial number of those countries in 2000 the suicide rate was considerably higher than the global average (13.5 per 100,000 population) (Matzopoulos et al., 2008). Although suicide is forbidden in Islamic culture, a recently published review showed that deliberate self-harm and suicide have increased in recent years in Pakistan, a low income country with a predominantly Muslim population (Shahid and Hyder, 2008). Contrary to Pakistan, official suicide statistics suggest that suicide mortality is low in Turkey; as low as 3 per 100,000 population (Oksuz and Malhan, 2005 and Eskin et al., 2007). On the other hand non-fatal suicidal behaviours have been found to be common among younger segments of the population in Turkey, such as among college students (Eskin et al., 2007). We investigated self-harm in non-clinical samples of college students. By using different sample groups than prior studies we aimed to expand the data pool concerning self-harm, suicide ideation, and suicide attempts in Turkey. Most research on self-harm has examined the correlates for this behaviour; however, this area has not yet been adequately researched (Gratz, 2003). We analysed correlates of self-harm, suicide ideation, and suicide attempts. It is our hope that the basic research of our study will help our colleagues understand regional differences (Madge et al., 2008 and Portzky et al., 2008) in their evaluation of self-harm in Turkish college students in comparison to other countries.

Conclusion Our study showed three points: In our sample 1. The correlates of self-harm our study revealed and the correlates of self-harm found in previous studies share some important similarities, such as prevalence rates. 2. Self-harm and suicidal ideation are significant correlates for suicide attempts. 3. Drug abuse, especially tranquilizer abuse, is a common correlate for self-harm, suicide ideation, and suicide attempts. Thus, self-harm patients and drug abusers should be carefully monitored for subsequent suicide risk. As drug abuse, including smoking, is a common correlate for all kinds of self-harm, struggle with drug addiction is needed. Both groups, self-harm patients and drug abusers, need support and as well as some therapeutic interventions for healthy development. Lastly, we found self-harm to be more common among males in our sample. Further longitudinal and prospective research is necessary in order to understand gender differences in developed and developing countries. Appendix 1. The following items were used to define self-harm and suicidal experiences Self-harm questions: 1 Do you harm yourself intentionally? (never/only once/sometimes/always) 2 Have you ever cut your body or your arms?(never/only once/2–3 times/4–5 times/more than 5) 3 Have you ever intentionally extinguished a smoking cigarette on any site of your body? (never/only once/2–3 times/4–5 times/more than 5) Suicidal ideation question: Do you think of committing suicide? (never/only once/sometimes/often/always)Suicide attempt questions: 1 Have you ever tried committing suicide? (never/only once/2–3 times/4–5 times/more than 5) 2 If you tried committing suicide, have you received any medical intervention? (I have not tried committing suicide/needn't medical intervention/medical intervention needed/I was hospitalized 1 or more day/I was hospitalized in a reanimation unit)