A Study On The Mental State Of The Family Members Of Suicide Attempters

Purpose: suicide attempt is the behavior that people are intentionally resulting in physical injury but not death by themselves for the purpose of death.Suicide attempters are involed in the psychological problems before or after all kinds of suicidal behaviors.Family members play an important role in patient care and suicide prevention.In order to effectively help suicide attempt patients,families need to recognize their mental state.Current research on suicide attempts and family members' psychological status is limited.Most of the clinical studies of family and suicide are focused on how to help families cope with the loss of loved ones or family treatment,and mainly for children or adolescents committed suicide.In this study,we investigated the psychological status of suicide attempt patients and their family members after suicide attempt.Explore the relationship between exogenous variables(demographic characteristics and event records of patients and their families)and endogenous variables(attitude and spirit of suicide attempt,family relationships,care and demand information)through sample data analysis(direct and indirect effects)to provide targeted information and services for suicidal patients and their family members.Methods: Using the method of convenience sampling,we selected 148 suspected suicide attempt and family members groups(each group combined with one patient and one of his or her family member)from August 16 to June 2017 in emergency department of Shanghai Sixth People's Hospital,Shanghai First People's Hospital Hongkou Hospital District,Shanghai First People's Hospital Songjiang Hospital.Who meet the requirements of the diagnosis of suicide risk assessment by concise International Neuropsychological Interview(MINI)suicide module.According to the results of the assessment,the 148 group was divided into suicide attempt group(in accordance with the degree of suicidal ideation and suicidal behavior,they can also be divided into impulsive suicide group,first time suicide attempt and repeated suicide attempt group)and non-suicide attempt group.All of two groups' patients are evaluated by homemade general information questionnaire,including general demographic information,mental examination,patient admission behavior questionnaire,information needs willingness questionnaire to investigate.And clinical assessors do measure for the two groups' family members by homemade general information questionnaire,the Chinese Short Version of Depression Anxiety and Stress Scale(DASS-C21),Family Caregiver Task Inventory(FCTI),and Family Adaptability and Cohesion Scale,Second Edition.Chinese version(FACESII-CV),information needs willingness questionnaire.SPSS24.0 software was used to analyze all the data.The patient and family members' demographic information were analyzed by independent sample t test and chi-square test.The patient and family members' information needs and family relationship data were analyzed by variance.Logistic regression was used to analyze the correlation between family members' attitude and factors.Linear regression analysis Family care ability and the relevance of each factor.Results: 1.According to the suicide risk assessment results,84 cases(56.8%)were belonged to suicide attempt group(SA),including 54 cases of repeated suicide attempt patients,16 cases of first time suicide patients,14 cases of impulsive suicide patients and 64 cases were belonged to non-suicide attempt group(NA)(43.2%).The number of female patients of repeated suicide attemptgroup was significantly more than that of the riskless group(x~2 = 12.835,P <0.05).The age of the high-risk group was significantly higher than that of the riskless group(x~2 = 13.449,P <0.05).The family relationship of repeated suicide attemptgroup was significantly worse than riskless group and impulsive suicide group(x~2 = 40.921,P <0.01).2.The degree of suicidal ideation of suicide attempt group(59.94 ± 37.431)was significantly higher than that in the non-suicide attempt group(1.09 ± 4.407,P = 0.000),and there was significant difference among the life events(x~2 = 18.834),in low spirits(x~2 = 36.529),whether it was quarreling or breaking up recently(x~2 = 36.729),whether the job was stable(x~2 = 10.134),whether someone was helping you when you were in trouble(x~2 = 32.480);family relationship(x~2 = 42.322),willing to let the family know real reason for admission(x~2 = 19.900);disease history: history of physical illness(x~2 = 4.879),history of mental illness(x~2 = 22.145);attitude: be hopeless for the future(x~2 = 27.563),willing to let others know the real reason for admission(x~2 = 49.203),regret the occurrence of injury(x~2 = 9.942)(P <0.05).In terms of behavioral characteristics,there were significant differences in the place,manner and cause of the occurrence of suicide attempt and non-suicide attemept patients(x~2 = 69.621,x~2 = 41.457,x~2 = 54.300,p <0.01).3.There were significant differences among family members of different groups in admission were associated with suicide attempt(repeated suicide attempt group was higher than riskless group,impulsive suicide group and first time suicide group),minding knowing by others(repeated suicide attempt group was higher than riskless group and impulsive suicide group,first time suicide group was higher than riskless group and impulsive suicide group)and shame for patients to be admitted to hospital(repeated suicide attemptgroup was higher than riskless group and impulsive suicide group,first time suicide group was higher than riskless group and impulsive suicide group)(x~2 = 44.097,x~2 = 76.752,x~2 = 93.202,P <0.01).Logistic regression analysis showed that impulsive suicide patiens(OR = 0.202),the lower the age of the patients(OR = 0.464),the more likely the family members were to deny suicide attempts(P <0.05).4.According to the results of the scale assessment,suicide attempt patients made higher degree of impact on family life(F=4.117,P= 0.044)and lower family intimacy(F = 51.061,P = 0.000),and adaptation ability(F = 53.573,P = 0.000)to family members.And the care ability family members provide is relatively lower(F = 11.194,P = 0.001).Linear regression analysis found that the greater the impact of the patient on family memvers,the lower family intimacy,the lower care ability family provide(P <0.01).5.The needs score in disease information;treatment-related information;access to medical information;cure probability;understanding of prognostic considerations;self-care or family care information of patients or family members are more than family members or patients' expectation score,but the willingness degree of non-suicide attempt group was higher than that of the suicide attempt group(P <0.05).Conclusions: 1.Experienced big events,depressed,have had a quarrel or break up,no work or work is unstable,no help,family relationship is poor,there are physical illness and mental illness history,hopeless future,do not want others to know the behavior and other factors may be suicide attempt risk factors.Suicide attempt often occurred at home,with taking drugs,falling and taking pesticide-based behaviours,and mainly due to family disputes,other accidents,mental illness and marriage problems.2.From the family environment,the emotional connection between the family members of the suicidal patient and the family system have a lower ability to change at different stages of development.3.The impulsive suicide patient,the younger the patient,the more likely the family members to deny suicide attempt.When the patient diagnosed as fall injury,drug overdose,fracture,the family members are more likely to deny suicide attempt and expressed as: accident falls,cause unknown,food poisoning and so on.4.Due to the sense of shame and family role,family members may passively seek help or refused to seek help.5.The greater the impact of the patient on family life,the lower the family intimacy,the lower the ability of family members to take care.6.In general,patients and their families are concerned about the status of the disease; treatment-related information;how to obtain more available medical education information;cure probability;to understand the prognostic considerations;self-care or family care information have a higher demand,and want others to know less about the information.Patients without suicide attempt are more likely to have their families informed about their disease status than those with suicide attempts.