Suicidal Behavior in Individuals with Substance Use Disorder Who Apply to the Probation Outpatient Clinic

Abstract

Objective: The aim of this study was to investigate the correlation between psychological pain, childhood mental trauma, alexithymia, impulsivity and psychological resilience and suicide attempts in individuals with substance use disorder (SUD) who applied to the Probation Outpatient Clinic. Method: The study was conducted with 120 individuals who applied to the probation outpatient clinic and healthy controls. Socio-Demographic Data Form, Childhood Psychological Trauma Scale (CTQ-28), Toronto Alexithymia Scale (TAS), Psychological Pain Scale (PP), Barratt Impulsiveness Scale (BIS), Psychological Resilience Scale (PRS) were applied to all participants. Results: PP, TAS, BIS, CTQ-28 scale scores of patients with suicide attempt history were higher. In the forward stepwise model designed to predict the risk of suicide attempt, PRS, TAS-A, PRS-social competence and BIS-total scores contributed significantly to the model. It was determined that the four significant variables explained 65,6% of the variance in suicide risk. Conclusion: High psychological pain, alexithymia, impulsivity and childhood trauma and low psychological resilience in individuals with substance use disorder could be a predictor of suicide risk.

Keywords

• Probation
• substance use disorder
• childhood traumas
• alexithymia

Denetimli Serbestlik Polikliniğine Başvuran Madde Kullanım Bozukluğu Tanılı Bireylerde İntihar Davranışı

Öz

Amaç: Bu çalışmada Denetimli Serbestlik (DS) Polikliniğine başvuran Madde Kullanım Bozukluğu (MKB) tanılı bireylerde psikolojik acı, çocukluk çağı ruhsal travmaları, aleksitimi, dürtüsellik ve psikolojik dayanıklılığın intihar girişimi ile ilişkisinin incelenmesi amaçlanmıştır. Yöntem: Çalışma DS Polikliniğine başvuran 120 kişi ve sağlıklı kontrol ile yapılmıştır. Tüm katılımcılara; Sosyo-Demografik Veri Formu, Çocukluk Çağı Ruhsal Travma Ölçeği (CTQ-28), Toronto Aleksitimi Ölçeği (TAÖ), Psikolojik Acı Ölçeği (PAÖ), Barratt Dürtüsellik ölçeği (BDÖ), Psikolojik Dayanıklılık ölçeği (PDÖ) uygulanmıştır. Bulgular: İntihar girişimi olan hastaların PAÖ, TAÖ, BDÖ, CTQ-28 ölçek puanlarının daha yüksek olduğu tespit edilmiştir. İntihar girişimi riskini tahmin etmek için kurulan modelde (forward stepwise) PAÖ, TAÖ-A, PDÖ-sosyal yeterlilik ve BDÖ-toplam değişkenlerinin modele anlamlı katkı yaptığı bulunmuştur. Anlamlı olan dört değişkenin intihar riskindeki değişimin % 65,6’sını açıkladığı tespit edilmiştir. Sonuç: MKB’lerde psikolojik acı, aleksitimi, dürtüsellik ve çocukluk çağı travmalarının yüksek, psikolojik dayanıklılığın daha düşük olmasının intihar riskini değerlendirmede öngörürücü etkenlerdir.

Anahtar Kelimeler

• Denetimli serbestlik
• madde
• intihar

References

1. 1. World Health Organization. Suicide in the World: Global Health Estimates. Geneva: World Health Organization, 2019.
2. 2. Darke S, Ross J, Lynskey M, Teesson M. Attempted suicide among entrants to three treatment modalities for heroin dependence in the Australian Treatment Outcome Study (ATOS): prevalence and risk factors. Drug Alcohol Depend 2004; 73:1-10.
3. 3. Zhornitsky S, Le TM, Dhingra I, et al. Interpersonal Risk Factors for Suicide in Cocaine Dependence: Association with Self‐Esteem, Personality Traits, and Childhood Abuse. Suicide and Life‐Threatening Behavior 2020; 50.4: 867-883.
4. 4. Maloney E, Degenhardt L, Darke S, Mattick RP, Nelson E. Suicidal behaviour and associated risk factors among opioid-dependent individuals: a case-control study. Addiction 2007; 102: 1933-1941.
5. 5. Practice Guidelines Assessment and Treatment of Patients With Suicidal Behaviors.http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/su icide.pd. APA: 2003.
6. 6. Altıntoprak AE, Akgür SA, Coşkunol H. Yasa dışı madde kullanımı nedeniyle denetimli serbestlik tedbiri uygulanan kişilerde tedavi uygulamaları ve toksikolojik analiz. Türkiye'de Psikiyatri 2007; 9: 166-72.
7. 7. Yavuz HA. Denetimli Serbestliğin Türk Ceza Adalet Sistemindeki tarihsel gelişim süreci. Türkiye Barolar Birliği Dergisi 2012; 100: 318-42.
8. 8. Perry AE, Darwin Z, Godfrey C, et al. The effectiveness of interventions for drug-using offenders in the courts, secure astablishments and the community: A sysmatic review. Subst Use Misuse 2009; 44: 374-400.

9. 9. Baumeister RF. Suicide as escape from self. Psychol Rev 1990; 97(1): 90-113.
10. 10. Orbach I, Mikulincer M, Sirota P, Schechtman EG. Mental Pain: A multidimensional operationalizetion and definition. Suicide Life Threat Behav 2003; 33(3): 219-230.
11. 11. Levinger S, Somer E, Holden RR. The importance of mental pain and physical dissociation in youth suicidality. J Trauma Dissociation 2015; 16: 322- 339.
12. 12. Conejero I, Olie E, Calati R, Ducasse D, Courtet P. Psychological Pain, Depression, and Suicide: Recent Evidences and Future Directions. Current Psychiatry Reports. 2018; 20:33.
13. 13. Bahk YC, Jang SK, Choi KH, Lee SH. The relationship between childhood trauma and suicidal ideation: Role of maltreatment and potential mediators. Psychiatry Investigation 2017; 14(1): 37–43.
14. 14. Evren C, Evren B, Dalbudak E, Ozcelik B, Oncu F. Childhood abuse and neglect as a risk factor for alexithymia in adult male substance dependent inpatients. Journal of psychoactive drugs 2009; 41(1): 85-92.
15. 15. Yazıcı K, Yazıcı AE. Dürtüselliğin nöroanatomik ve nörokimyasal temelleri. Psikiyatride Güncel Yaklaşımlar 2010; 2: 254-280.
16. 16. Gvion Y, Apter A. Aggression, impulsivity and suicide behavior: a review of the literatüre. Arch Suicide Res 2011; 15: 93–112.
17. 17. Swann AC, Bjork JM, Moeller FG, Dougherty DM. Two models of impulsivity: relationship to personality traits and psychopathology. Biol Psychiatry 2002; 51: 988-994.
18. 18. Baykara S, Atmaca M. Erkek opiyat kullanım bozukluğu hastalarında kendine zarar verici davranış ve intihar girişimi öyküsünün dürtüsellik ve bazı klinik verilerle ilişkisi. Anadolu Psikiyatri Dergisi 2019; 20(1): 29-37.
19. 19. Ögel K. Sigara, Alkol ve Madde Kullanım bozuklukları: Tanı, Tedavi ve Önleme. İstanbul: Yeniden Yayınları, 2010: 325-327.
20. 20. Holden RR, Mehta K, Cunningham EJ, Mcleod LD. Development and preliminary validation of a scale of psychache. Canadian Journal of Behavioural Science 2001; 33(4): 224–232.
21. 21. Demirkol ME, Güleç H, Çakmak S, et al. Psikolojik Acı Ölçeği Türkçe formunun güvenirliliği ve geçerliliği. Anadolu Psikiyatri Derg 2018; 19(Suppl1): 14-20.
22. 22. Bagby RM, Taylor GJ, Parker JDA. The twenty-item Toronto Alexithymia Scale: II. Convergent, discriminant, and concurrent validity. J Psychosom Res 1994; 38: 33-40.
23. 23. Güleç H, Köse S, Güleç MY, et al. Reliability and factorial validity of the turkish version of the 20- item toronto alexithymia scale (TAS-20). Klinik Psikofarmakoloji Bülten 2009; 19: 214- 220.
24. 24. Bernstein DP, Stein JA, Newcomb MD, et al. Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl 2003; 27(2): 169-190.
25. 25. Şar V, Öztürk PE, İkikardeş E. Çocukluk çağı ruhsal travma ölçeğinin Türkçe uyarlamasının geçerlilik ve güvenilirliği. Türkiye Klinikleri Tıp Bilimleri Dergisi 2012; 32(4): 1054-1063.
26. 26. Patton JH, Stanford MS, Barratt ES. Factor structure of the Barratt Impulsiveness Scale. J Clin Psychol 1995; 51: 768-774. 27. Güleç H, Tamam L, Güleç MY, et al. Psychometric properties of the Turkish version of the Barratt Impulsiveness Scale-11. Klinik Psikofarmakoloji Bülteni 2008; 18: 251-258.
27. 28. Friborg O, Barlaug D, Martinussen M, et al. Resilience in Relation to Personality and Intelligence. Int J Methods Psychiatr Res 2005; 14(1): 29-42.
28. 29. Basım H, Çetin F. Yetişkinler için psikolojik dayanıklılık ölçeği’nin güvenilirlik ve geçerlilik çalışması. Türk Psikiyatri Dergisi 2011; 22(2): 104-14.
29. 30. Verrocchio MC, Carrozzino D, Marchetti D, et al. Mental pain and suicide: a systematic review of the literature. Front Psychiatry 2016; 20(7): 108.
30. 31. Demirkol ME, Uğur K, Tamam L. The mediating effects of psychache and dissociation in the relationship between childhood trauma and suicide attempts. Anadolu Psikiyatri Dergisi 2020; 21(5): 453-460.
31. 32. Uğur K, Demirkol ME, Tamam L. The mediating roles of psychological pain and dream anxiety in the relationship between sleep disturbance and suicide. Archives of suicide research 2020 (Baskıda).
32. 33. Levinger S, Somer E, Holden RR. The importance of mental pain and physical dissociation in youth suicidality. J Trauma Dissociation 2015; 16: 322- 339.
33. 34. Iskric A, Ceniti AK, Bergmans Y, et al. Alexithymia and self-harm: A review of nonsuicidal self-injury, suicidal ideation, and suicide attempts. Psychiatry research 2020; 288: 112920.
34. 35. Iancu I, Horesh N, Offer D . Alexithymia, affect intensity and emotional range in suicidal patients. Psychother Psychosom 1999; 68: 276-280.
35. 36. Sayar K, Acar B, Yazıcı MK . İntihar Girişiminde Bulunan Kişilerde Aleksitimi. Nöropsikiyatri Arşivi 1999; 36: 6-11. 37. Taiminen TJ, Saarijarvi S, Helenius H. Alexithymia in suicide attempters. Acta Psychiatr Scand 1996; 93: 195- 198.
36. 38. Demirkol ME, Tamam L, Namli Z, Karaytug MO, Ugur K. Association of psychache and alexithymia with suicide in patients with schizophrenia. The Journal of nervous and mental disease 2019; 207(8): 668-674.
37. 39. Roy A. Relationship of childhood trauma to age of first suicide attempt and number of attempts in substance dependent patients. Acta Psychiatrica Scandinavica 2004; 109(2): 121-125.
38. 40. Braquehais M, Oquendo MA, Baca-García E, Sher L. “Is İmpulsivity A Link Between Childhood Abuse And Suicide?” Comprehensive Psychiatry 2010; 51.2: 121-129.
39. 41. Şen M. Psikolojik destek alan ve almayan bireylerde çocukluk çağı travmaları ve dürtüsellik ilişkisinin incelenmesi. Yüksek Lisans Tezi, İstanbul: Maltepe Üniversitesi, Sosyal Bilimler Enstitüsü, 2019.
40. 42. Cáceda R, Durand D, Cortes E, et al. Impulsive choice and psychological pain in acutely suicidal depressed patients. Psychosomatic Medicine 2014; 76(6): 445–451.
41. 43. Gvion Y, Horresh N, Levi‐Belz Y, et al. Aggression–impulsivity, mental pain, and communication difficulties in medically serious and medically non‐serious suicide attempters. Comprehensive Psychiatry 2014; 55(1): 40–50.
42. 44. Brent DA, Johnson BA, Perper J, et al. Personality disorder, personality traits, impulsive violence, and completed suicide in adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 1994; 33(8): 1080–1086.
43. 45. Bridge JA, Goldstein TR, Brent DA. Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry 2006; 47(3‐4): 372–394.
44. 46. McMahon K, Hoertel N, Olfson M, et al. Childhood maltreatment and impulsivity as predictors of interpersonal violence, self-injury and suicide attempts: A national study. Psychiatry research 2018; 269: 386-393.
45. 47. Price EC. Impulsivity and suicidal ideation or attempt in younger and older adults. Dissertations & Theses–Gradworks 2012; 53(6): 359–359.
46. 48. Rajalin M, Hirvikoski T, Jokinen J. Family history of suicide and exposure to interpersonal violence in childhood predict suicide in male suicide attempters. Journal of Affective Disorders 2013; 148(1): 92–97.
47. 49. Liu DW, Fairweather-Schmidt AK, Roberts RM, Burns R, Anstey KJ. Does resilience predict suicidality? A lifespan analysis Arch Suicide Res 2014; 18: 453–464.
48. 50. Roy A, Carli V, Sarchiapone M. Resilience mitigates the suicide risk associated with childhood trauma. J Affect Disord 2011; 133: 591–594.
49. 51. Matel-Anderson DM, Bekhet AK, Garnier-Villarreal M. Mediating effects of positive thinking and social support on suicide resilience. West J Nurs Res 2019; 41: 25–41.
50. 52. Svetaz MV, Ireland M, Blum R. Adolescents with learning disabilities: risk and protective factors associated with emotional well-being: findings from the National Longitudinal Study of Adolescent Health. J Adolesc Health 2000; 27: 340–348.
51. 53. Youssef NA, Green KT, Beckham JC, Elbogen EB. A 3- year longitudinal study examining the effect of resilience on suicidality in veterans. Ann Clin Psychiatry 2013; 25: 59–66.
52. 54. Roy A, Sarchiapone M, Carli V. Low resilience in suicide attempters. Arch Suicide Res 2007; 11: 265–269.
53. 55. Sher L. Resilience as a focus of suicide research and prevention. Acta Psychiatrica Scandinavica 2019; 140(2): 169-180.