الفهرس 
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Abstract
Suicide is a fatal act that represents the person’s wish to die. In psychiatry, suicide is the primary emergency.
Suicide rates have continued to rise in recent decades, despite ongoing clinical and research efforts. In 2012, suicide was the second leading cause of death among 15–29 year olds. Annual rates of non-fatal suicidal behavior are estimated to be 10–20 times higher than, those of completed suicide.
Previous Non-fatal suicidal behaviors and mental disorders are the strongest and most consistent risk factors of suicide.
Other vulnerability factors may contribute to risk are; gender, age, religion, cultural acceptability of suicide, legal definitions of suicide, unemployment, physical illness, family history of suicide, or childhood adversities.
All mental disorders are associated with increased risk of suicide; with more than 90% of suicides have a psychiatric illness. Psychiatric patients’ risk for suicide is 3 to 12 times that of non-patients.
Cross-nationally, mental disorders are equally predictive in developed and developing countries. However, a key difference being that the strongest predictors of SAs in developed countries were mood disorders, whereas in developing countries impulse-control, substance use disorder (SUD), and post-traumatic stress disorder (PTSD) were most predictive. Comorbidity is an important predictor across all countries.
Moreover, Comorbidity with personality disorders (PDs) contributes to suicidality and may markedly elevate suicide risk. In addition, Suicide attempters with PDs have the highest level of repetition, especially individuals with cluster (B) PDs.
However, most individuals, who are acutely suicidal, are extremely ambivalent about living and dying. If techniques for identifying these individuals exist and if there are agencies, in the community that can give individuals sanctuary, then most individuals can go on, willingly, to live useful lives.
Fortunately, suicide rate in Cairo city is much lower than other rates worldwide. However, it is still a public health problem and should be given high priority with regard to prevention.
Suicide still is an under-reported and under researched area in Egypt. This study is one of the few comprehensive evaluations of patients with serious SAs.
The present study involved 120 patients admitted to Ain Shams Hospital’s psychiatry department because of attempted suicide, regardless of their diagnosis. Our goal was to determine the generalizability and relative importance of risk factors for suicidal acts across diagnostic boundaries.
All subjects involved in the study were subjected to:
1. Beck’s Suicidal intent scale (BSIS). The scale was translated to Arabic in the study and tested for reliability.
2. Semi-structured clinical interview for Socio-demographic data and suicidal history.
3. Arabic version of Structured Clinical Interview for DSM-IV Axis I (SCID I)
4. Arabic version of Structured Clinical Interview for DSM-IV Axis II Disorders (SCID II)
5. Arabic version of Suicide Probability Scale (SPS)
6. Arabic version of Barratt impulsivity scale (BIS-11)
7. Arabic version of Social Readjustment Rating scale (SRRS)
The main findings of this study were:
¬Studying the characteristics of the subjects, we concluded that specific efforts should focus on persons at risk, characterized as being younger, single, and unemployed. No gender predominance was found in our sample, not keeping with previous studies.
In contrast to commonly cited reports, childhood adversities were very uncommon in the current sample. This may be attributed to underreporting.
Regarding suicidal history, the most common method used was self-poisoning, in agreement with other studies, with 35% of suicide attempters had made previous suicide attempts (SAs).
However, in contrast to previous reports, hopelessness and stressful life events (SLEs) did not emerge to be of significance in association of SAs in our sample. On the other hand, most of our subjects reported significant SI and hostility. Moreover, the present findings, reported significantly high impulsivity in Egyptian suicide attempters that correlated positively with suicide probability in this sample.
Regarding mental disorders at the time of the attempt, 95.83% of patients met the criteria for an axis I disorder. The most frequent diagnosis was depression (58.33%) followed by schizophrenia, borderline personality disorder (BPD) and SUD. Comorbidity was not uncommon, with 32% having two or more co morbid axis I disorders and 40.83% of the sample having co morbid axis I and axis II disorders.
Taking into consideration, the need to recognize more precisely the role of specific mental disorders and their comparative importance for understanding suicide and its prevention, we attempted to compare attempters of each single disorder with those with other mental disorders.
Regarding depression, the results of the present study revealed that, the patients with depression were significantly more often older, with no gender predominance, with older age of onset of illness. They mainly used self- poisoning as a method of suicide more often and with less disabling outcome compared with patients with other mental disorders. Particularly, the major risk factors of attempted suicide (i.e. a young female), did not apply to our depressed patients.
The suicide attempters with depression had significantly more SI in reference to other psychiatric disorder. However, contradicting seminal studies, hopelessness did not emerge to be of significant association with depressed suicide attempters.
It is also worth noting, that the present study indicated that the attempted suicides with depression were not less impulsive than the other psychiatric disorders group, in contrast to well-replicated studies.
Comparing the characteristics of schizophrenic attempters with other mental disorders, the current study found that they were significantly more often had longer duration of illness and more medical comorbidities. The patients in the schizophrenia group were more likely to make SAs using violent methods with more serious outcomes. They scored significantly less on suicidal ideation and did not show more hostility or impulsivity than the other psychiatric disorders group.
Describing the characteristics of drug-dependent patients who attempt suicide, SUD patients consisted exclusively of males.
Significantly more of the SUD patients who had attempted suicide had quarrelsome relations with spouse or family, had a family history of a psychiatric illness.
However, the SUD attempters had significantly higher impulsivity, which could be viewed as a possible mechanism underlying the role of substance disorders in leading to future SAs.
Regarding BPD diagnosis, the current data do not support the common clinical view that the suicidal behaviors of patients with BPD are less serious than, those of other psychiatric disorders. In this study, the attempters with BPD differed from the other mental disorders patients in having more disrupted relation to family.
Attempters with comorbid BPD had higher levels of lifetime impulsivity, compared with attempters with other psychiatric disorders. Moreover, they did report more SLEs in the year before the SA than those with other disorders.
Surprisingly, in our results the number of previous SAs did not differentiate BPD suicide attempters from those of with other psychiatric disorders.
At last, concerning repeatability of SAs, our results revealed that a great variety of risk factors is associated with an increased risk for multiple SAs. Most of these attempts appeared to be associated with impulsivity with less degree of planning. In particular, this study highlights the importance of longer duration of illness, and more frequent pattern of seeking psychiatric help, and coexisting BPD diagnosis as risk factors for repeated SAs.
Finally, suicide remains a major public health problem, nevertheless preventable, and action for its prevention calls for a coordinated multi-sectorial approach.