İntihar Girişimi Nedeniyle Konsülte Edilen Çocuk ve Ergenlerin Psikopatojilerinin Sosyodemografik ve İntihar Davranışı Özelliklerinin Çok Yönlü Değerlendirilmesi

Yıl 2019, Cilt: 5 Sayı: 1, 94 - 103, 01.01.2019

Pınar Uran

Öz

Amaç: Çocuk ve ergenlerde intihar davranışları majör bir halk sağlığı sorunudur. Çalışma, çocuk ve ailelerin olası risk faktörlerini belirleyebilmek amacıyla dizayn edilmiştir.Gereç ve Yöntemler: ‘İntihar girişimi’ nedeniyle Ankara Üniversitesi Tıp Fakültesi Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları Anabilim Dalı’na Kasım 2013-Ekim 2015 tarihleri arasında konsülte edilen 78 çocuk ve ergenin sosyodemografik özellikleri, psikiyatrik açıdan tanısal değerlendirmeleri, intihar davranışına ilişkin özellikleri retrospektif olarak değerlendirilmiştir.Bulgular: Çocukların %75,6’ını kızlar, %24,4’ünü ise erkekler oluşturmuştur. Ortalama yaş 15,29 ± 1,78 olup, %71,8’i; 15-18 yaş aralığındadır. Çocukların %94,6’sı ağızdan ilaç kullanmak suretiyle intihar girişiminde bulunmuştur. Çocukların %82,1’inin psikiyatrik sorununun sürmesine karşın, %67,9’u herhangi bir tedavi almadığını belirtmiştir. Çocukların yaklaşık %80’i sadece aileleriyle sorunlar yaşamadığını aynı zamanda akademik hayatında sorunlar yaşadığını, %43,4’ü romantik partnerleri ile, %17’si akranlarıyla sorun yaşadığını, %25,6’sı daha önce istismara uğradığını belirtmiştir. Çocukların %30,8’inin ebeveyninin boşanmış ya da ayrı olduğu bildirilmiştir. Psikiyatrik tanılar içinde en sık majör depresyon tanısı konulmuş olup, 62 çocuk bu tanıyı karşılamış ve bunu 18 çocukla dikkat eksikliği hiperaktivite bozukluğu tanısı takip etmiştir. Çocukların yalnızca yarısının takiplere devam ettiği anlaşılmıştır.Sonuç: Çalışmamız, çocuk ve ergende intihar davranışının genellikle aile içi çatışmaların olduğu, aile işlevselliğinin bozulduğu, akademik ve disiplin alanında zorlukların görüldüğü durumlarda, akran, romantik arkadaş ilişkilerinde bozulmaların sonucunda, istismara maruziyette, majör depresyon başta olmak üzere belirgin psikopatolojilerin eşlik ettiği durumlarda görüldüğünü göstermiştir. İntihar davranışı için risk faktörlerinin ve koruyucu faktörlerin belirlenebilmesi, gerekli önlemlerin alınması, uygun müdahale ve tedavilerin yapılması için önem taşır

Anahtar Kelimeler

İntihar, Çocuk, Ergen, Psikopatoloji, Sosyodemografik Özellik

Multidimentional Assessment of the Psychopathologies Sociodemographic and Suicide Behavior Characteristics of the Children and Adolescents Referred for Attempting Suicide

Öz

Objective: Suicidal behavior in children and adolescents is a major health problem. This study was designed to identify the possible risk factors of children and their families. Material and Methods: The consultation requests from Ankara University School of Medicine Child and Adolescent Psychiatry Department for 78 child and adolescents who attempted suicide between November 2013 and October 2015 were screened retrospectively with respect to their sociodemographic, psychiatric and suicide behavior characteristics Results: Among the children, 75.6% were female and 24.4% were male. The mean age of the children was 15.29 ± 1.78 and 71.8% of the children were between the ages of 15 and 18 years. In order to commit suicide, 94.6% of children took toxic doses of oral medicines. 67.9% of the children were not on any treatment even though 82.1% of them had ongoing psychiatric problems. Nearly 80% of them indicated that they had not only problems with their family but also with their academic life, 43.4% of them stated problems with their partners, 17% of them stated problems with their peers, 25.6% indicated that they were exposed to abuse before. 30% of the parents were divorced or separated. Major depression was the most common psychopathology among the diagnoses n=62 . The second common psychopathology was attention deficit hyperactivity disorder n=18 . Only half of the children maintained their follow-up and treatments. Conclusion: As shown in this study, child and adolescent suicidal behavior often occurs in the context of family conflict, academic and disciplinary difficulties, with the comorbidity of significant psychopathologies like major depression or as a consequence of distortions in peer, family, and partner relationships and exposure to abuse. Identifying risk factors and protective factors is necessary for the prevention and for appropriate interventions and treatments for suicidal behavior in children and adolescents.

Anahtar Kelimeler

Suicide, Child, Adolescent, Psychopathology, Sociodemographic Characteristics

Kaynakça

• Uran Şenol P. Çocuk ve ergenlerde intihar düşünce ve davranışlarına müdahale. Psikiyatride Güncel 2017; 7(1):53-63.
• Miller AB, Esposito-Smythers C, Weismoore JT, Renshaw KD. The relation between child maltreatment and adolescent suicidal behavior: A systematic review and critical examination of the literature. Clin Child Fam Psychol Rev 2013; 16(2):146–72.
• Mcloughlin AB, Gould MS, Malone KM. Global trends in teenage suicide: 2003-2014. Qjm 2015; 108:765–80. 4. İntihar İstatistikleri, PreHaberBultenleri.do?id=16049). 2013. (www.tuik.gov.tr/
• Gould MS, Greenberg T, Velting DM, Shaffer D. Youth suicide risk and preventive interventions: A review of the past 10 years. J Am Acad Child Adolesc Psychiatry 2003; 42(4):386-405.
• Rhodes AE, Boyle MH, Bridge JA, Sinyor M, Links PS, Tonmyr L, Skinner R, Bethell JM, Carlisle C, Goodday S, Hottes TS, Newton A, Bennett K, Sundar P, Cheung AH, Szatmari P. Antecedents and sex/gender differences in youth suicidal behavior. World J Psychiatry 2014; 4(4):120-32.
• Verhulst FC, Achenbach TM, van der Ende J, Erol N, Lambert MC, Leung PWL. Comparison of problems reported by youths from seven countries. Am J Psychiatry 2003; 160:1479-85.
• Fleishmann A, Bertolote JM, Belfer M, Beautrais A. Completed suicide and psychiatric diagnoses in young people: A critical examination of the evidence. Am J Orthopsychiatry 2005; 75:676-83.
• Hauser M, Galling B, Correll C. Suicidal ideation and suicide attempts in children and adolescents with bipolar disorder: A systematic review of prevalence and incidence rates, correlates, and targeted interventions. Bipolar Disorders 2013; 15:507-23.
• Chechil S, Kutcher S. Suicide Risk Management: A Manual for Health Professionals. 2nd ed, New Jersey: John Wiley & Sons, Ltd, 2012.
• Öncü B. İntihar davranışı: Epidemiyoloji ve risk etmenleri. Psikiyatride Güncel 2017; 7(1):1-14.
• Natsuaki MN, Klimes-Dougan B, Ge X, Shirtcliff EA, Hastings PD, Zahn-Waxler C. Early pubertal maturation and internalizing problems in adolescence: Sex differences in the role of cortisol reactivity to interpersonal stress. J Clin Child Adolesc Psychol 2009; 38:513-24.
• Furczyk K, Thome J. Adult ADHD and suicide. Atten Defic Hyperact Disord 2014; 6(3):153-8.
• Ünlü G, Aksoy Z, Ersan EE. İntihar girişiminde bulunan çocuk ve ergenlerin değerlendirilmesi. Pam Tıp Derg 2014; 7(3):176-83.
• Murphy KR, Barkley RA, Bush T. Young adults with attention deficit disorder: Subtype differences in comorbidity, educational and clinical history. J Nerv Ment Dis 2002; 190:147-57.
• Moffitt TE, Scott S. Conduct disorders of childhood and adolescence. In: Rutter M, Bishop D, Pine D, Scott S, Stevenson J, Taylor E, Thapar A, eds. Rutter’s Child and Adolescent Psychiatry. 5th ed. Oxford: Blackwell Publishing Ltd., 2008:543-64.
• Taylor E, Sonuga-Barke E. Disorders of attention and activity. In: Rutter M, Bishop D, Pine D, Scott S, Stevenson J, Taylor E, Thapar A, eds. Rutter’s Child and Adolescent Psychiatry. 5th ed. Oxford: Blackwell Publishing Ltd., 2008:521-42.
• Peyre H, Hoertel N, Stordeur C, Lebeau G, Blanco C, McMahon K, Basmaci R, Lemogne C, Limosin F, Delorme R. Contributing factors and mental health outcomes of first suicide attempt during childhood and adolescence: Results from a nationally representative study. J Clin Psychiatry 2017; 78(6):e622- e30.
• Hoyert DL, Kung HC, Smith BL. Deaths: Preliminary data for 2003. National Vital Statistics Reports 2005; 53(15):1-48.
• Hoyert DL, Xu J. Deaths: Preliminary data for 2011. National Vital Statistics Reports 2012; 61(6):1-51.
• Braquehais MD, Picouto MD, Casas M, Sher L. Hypothalamic pituitary-adrenal axis dysfunction as a neurobiological correlate of emotion dysregulation in adolescent suicide. World J Pediatr 2012; 8(3):197-206.
• Brent D, Melhem N, Ferrell R, Emslie G, Wagner KD, Ryan N, Vitiello B, Birmaher B, Mayes T, Zelazny J, Onorato M, Devlin B, Clarke G, DeBar L, Keller M. Association of FKBP5 polymorphisms with suicidal events in the Treatment of Resistant Depression in Adolescents (TORDIA) study. Am J Psychiatry 2010; 167(2):190-7.
• Şenol V, Ikizceli İ. İntihar girişimi nedeniyle Erciyes Üniversitesi Acil Anabilim Dalı’na başvuran olguların incelenmesi. Anatolian Journal of Psychiatry 2005; 6:19- 29.
• Yalaki Z, Tasar MA, Yalçın N, Dallar Y. Çocukluk ve gençlik dönemindeki özkıyım girisimlerinin değerlendirilmesi. Ege Tıp Dergisi 2011; 50(2):125-8.
• Tezcan, AE, Oğuzhanoğlu, NK, Ülkeroğlu F. Çocuk ve genç-lerde intihar girişimleri, Kriz Dergisi 1995; 3:70-4.
• Kolves K, de Leo D. Suicide methods in children and adolescents. Eur Child Adolesc Psychiatry 2017; 26(2):155-64.
• Ajdacic-Gross V, Weiss MG, Ring M, Hepp U, Bopp M, Gutzwiller F, Rossler W. Methods of suicide: International suicide patterns derived from the WHO mortality database. Bull World Health Organ 2008; 86(9):726-32.
• Karaman D, Durukan İ. Çocuk ve ergenlerde özkıyım. Psikiyatride Güncel Yaklaşımlar 2013; 5:30-47.
• Gunnell D, Lewis G. Studying suicide from the life course perspective: Implications for prevention. Br J Psychiatry 2005; 187:206-8.
• Onishi K. Risk factors and social background associated with suicide in Japan: A review. Jpn Hosp 2015; 34:35-50.
• Owens D, House A. General hospital services for deliberate selfharm. Haphazard clinical provision, little research, no central strategy. J R Coll Physicians Lond 1994; 28(4):370-1.
• Owens D, Horrocks J, House A. Fatal and non-fatal repetition of self-harm. Systematic review. BR J Psychiatry 2002; 181:193-9.
• Fortune SA, Hawton K. Suicide and deliberate self- harm in children and adolescents. Paediatr Child Health 2007; 17:443-7.
• Ystgaard M, Arensman E, Hawton K. Deliberate self- harm in adolescents: Comparison between those who receive help following self-harm and those who do not. J Adolesc 2009; 32:875-91.
• Barbe RP, Williamson DE, Bridge JA, Birmaher B, Dahl RE, Axelson DA, Ryan ND. Clinical differences between suicidal and nonsuicidal depressed children and adolescents. J Clin Psychiatry 2005; 66(4):492-8.
• Bebbington PE, Cooper C, Minot S, Brugha TS, Jenkins R, Meltzer H, et al. Suicide attempts, gender, and sexual abuse: Data from the 2000 British Psychiatric Morbidity Survey. Am J Psychiatry 2009; 166:1135-40.
• Fergusson DM, Horwood LJ, Lynskey MT. Childhood sexual abuse and psychiatric disorder in young adulthood: II. Psychiatric outcomes of childhood sexual abuse. J Am Acad Child Adolesc Psychiatry 1996; 35:1365-74.
• Brodsky BS, Mann JJ, Stanley B, Tin A, Oquendo M, Birmaher B, Greenhill L, Kolko D, Zelazny J, Burke A, Melhem N, Brent D. Familial transmission of suicidal behavior: factors mediating the relationship between childhood abuse and offspring suicide attempts. J Clin Psychiatry 2008; 69:584-96.
• Devries KM, Mak JY, Child JC, Falder G, Bacchus LJ, Astbury J, Watts CH. Childhood Sexual Abuse and Suicidal Behavior: A Meta-analysis. Pediatrics 2014; 133(5):1331-44.
• Kingsbury S, Hawton K, Steinhardt K, James A. Do adolescents who take overdoses have specific psychological characteristics? A comparative study with psychiatric and community controls. J Am Acad Child Adolesc Psychiatry 1999; 38:1125-31.
• Hoberman HM, Garfinkel BD. Completed suicide in youth. Can J Psychiatry 1988; 33:494-504.
• Deliberate self harm in adolescence. Fox C, Hawton K (eds). London: Jessica Kingsley Publishers, 2004: 17-24.
• Hawton K, James A. Suicide and deliberate self harm in young people BMJ 2005; 330:891-4.
• Soole R, Kolves K, De Leo D. Suicide in children: A systematic review. Arch Suicide Res 2015; 19(3):285-304.
• Coskun M, Zoroglu S, Ghaziuddin N. Suicide rates among Turkish and American youth: A cross-cultural comparison. Arch Suicide Res 2012; 16(1):59-72.
• Groholt B, Ekeberg O. Suicide in young people under 15 years: Problems of classification. Nord J Psychiatry 2003; 57(6):411-7.
• Peyre H, Hoertel N, Stordeur C, Lebeau G, Blanco C, McMahon K, Basmaci R, Lemogne C, Limosin F, Delorme R. Contributing factors and mental health outcomes of first suicide attempt during childhood and adolescence: Results from a nationally representative study. J Clin Psychiatry 2017; 78(6):622-30.
• Pelkonen M, Marttunen M. Child and adolescent suicide: Epidemiology, risk factors, and approaches to prevention. Paediatr Drugs 2003; 5(4):243–65.
• Beautrais AL. Child and young adolescent suicide in New Zealand. Aust N Z J Psychiatry 2001; 35(5):647–53.
• Johnson JG, Cohen P, Gould MS, Kasen S, Brown J, Brook JS. Childhood adversities, interpersonal difficulties, and risk for suicide attempts during late adolescence and early adulthood. Arch Gen Psychiatry 2002; 59:741-9.
• Brent DA, Baugher M, Bridge J, Chen T, Chiappetta L. Age- and sex-related risk factors for adolescent suicide. J Am Acad Child Adolesc Psychiatry 1999; 38(12):1497– 505.
• Mittendorfer-Rutz E, Rasmussen F, Wasserman D. Restricted fetal growth and adverse maternal psychosocial and socioeconomic conditions as risk factors for suicidal behavior of offspring: A cohort study. Lancet 2004; 364(9440):1135-40.
• Bjorkenstam C, Kosidou K, Bjorkenstam E. Childhood adversity and risk of suicide: Cohort study of 548 721 adolescents and young adults in Sweden. BMJ 2017; 357:1334.
• Stovall J, Domino FJ. Approaching the suicidal patient. Am Fam Physician 2003; 68:1814-8.
• Steck N, Egger M, G Schimmelmann B, Kupferschmid S. Suicide in adolescents: findings from the Swiss National cohort. Eur Child Adolesc Psychiatry 2018; 27:47–56.
• Coimbra DG, Pereira E Silva AC, de Sousa-Rodrigues CF, Barbosa FT, de Siqueira Figueredo D, Araşjo Santos JL, Barbosa MR, Alves VM, Nardi AE, Andrade TG. Do suicide attempts occur more frequently in the spring too? A systematic review and rhythmic analysis. J Affect Disord 2016; 196:125-37.
• Clerici CA, Gentile G, Marchesi M, Muccino E, Veneroni L, Zoja R.Two decades of adolescent suicides assessed at Milan University’s medicolegal unit: Epidemiology, forensic pathology and psychopathology. Journal of Forensic and Legal Medicine 2016; 37:15-21.