Help-seeking for Suicidal Thoughts in the Poisoned Patients at Loghman Hakim Teaching Hospital in Tehran, Iran

A history of suicide attempt is the most important risk factor for repeated and successful suicide. Seeking help is essential to access to proper mental healthcare services, and appropriate help-seeking could protect individuals against the risks of suicidal thoughts and behavioral progress in this regard. In addition, seeking help from a professional or personal source that could facilitate access to professional psychological help mitigates or eliminates the immediate risk of successful suicide in those with suicidal thoughts or manifesting suicidal behaviors. The level of help-seeking is higher in the areas where the suicide rate is lower. Considering the role of cultural background in help-seeking, studies must be conducted in Iran to gain insight into the intention of help-seeking for suicidal thoughts. The present study aimed to determine the intention of help-seeking from formal sources for suicidal thoughts and assess its correlation demographic factors in the poisoned patients with a history of suicide attempt prior to the current condition in Loghman Hakim teaching hospital in Tehran, Iran.

This cross-sectional, descriptive study was conducted on all the poisoned patients with a history of suicide attempt prior to the current condition, who were being discharged from the men's and women's poison wards of Loghman Hakim teaching hospital affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran. In total, 130 patients were selected via continuous sampling from late April to late June, 2019. In addition to the demographic form (age, gender, education level, marital status, occupation status, economic status, number of suicide attempts, family history of suicide, history of receiving consultative and psychological services, history of psychiatric medication use under the supervision of a physician, and history of admission to the psychological ward), data were collected using the general help-seeking questionnaire (GHSQ) developed by Wilson et al. (2005) in Australia for the measurement of help-seeking intentions. To confirm the validity of the GHSQ, the process of translation and re-translation was utilized. Moreover, the reliability of the scale was confirmed by 15 eligible poisoned patients (not the main research units) who completed the questionnaire, and the Cronbach’s alpha coefficient was calculated to be 0.70. After obtaining informed consent and explaining the responding process of the questionnaires, the demographic form and GHSQ were completed for each research unit by the researcher based on the responses of the patients within 15-20 minutes at their bedside. Data were obtained from 130 completed questionnaires. Data analysis was performed in SPSS version 20, and descriptive statistics were used in the form of tables and numerical measures in order to describe the research units. To determine the correlations between the demographic variables and help-seeking intentions, the data were analyzed using Pearson's correlation-coefficient, independent t-test, and the analysis of variance (ANOVA) at the significance level of P<0.05.

In total, 76.9% of the participants were female, and the age of the patients was within the range of 18-57 years (mean: 26.76±9.1 years). Among the patients, 40.0% had a high school diploma, 56.9% were single, 61.5% were unemployed, and 41.5% had an average economic status. The number of suicide attempts was 2-14 times (mean: 2.91±2.3), and 11.5% of the subjects had a family history of suicide attempt. In addition, 41.5% had no history of receiving consultative and psychological services, 52.3% had no history of psychiatric medication use under the supervision of a physician, and 20.8% had a history of admission to the psychiatric ward. The help-seeking intentions for suicidal thoughts from formal sources were low, with the mean of 2.51±1.18 (achievable range: 1-7), and the most significant formal sources of help-seeking intentions were psychologists (3.78±2.65), psychiatrists (3.64±2.58), and social services hotlines (2.34±2.08), respectively. Among the demographic variables, no significant correlations were observed between help-seeking intentions from formal sources and age, gender, education level, marital status, occupation status, economic status, number of suicide attempts, history of receiving consultative and psychological services, history of psychiatric medication use under the supervision of a physician, and history of admission to the psychiatric ward. History of suicide attempt in the first-degree family members was the only demographic variable that had a significant correlation with help-seeking intentions from formal sources (P=0.021), and the mean score of help-seeking intentions from formal sources was higher in the patients with a family history of suicide attempt.

According to the results, the help-seeking intentions from formal sources for suicidal thoughts were low in the poisoned patients with a history of suicide attempt. Help-seeking is an effective coping strategy when experiencing suicidal thoughts, which facilitates access to professional psychological help and plays a key role in reducing the rate of suicide; therefore, efforts should be made to promote help-seeking. The individuals who are at the risk of suicide need interventions developed to improve mental health care, especially primary care to encourage quicker help-seeking from proper sources. In this regard, measures such as the normalizing of help-seeking from formal sources, expanding insurance coverage to cover mental healthcare services, and improving communication skills in the families of those with a history of suicide could act as the facilitators of help-seeking from formal sources, as well as the training, identification, and referral of these individuals to available professionals, such as teachers and clerics. The familiarity of these individuals with various help-seeking sources (e.g., social aid hotlines and media campaigns) to increase the level of help-seeking may also facilitate the access of individuals to proper help-seeking sources. Moreover, the barriers against help-seeking in the individuals attempting suicide must be identified and mitigated. In this study, only about half of the individuals with a history of suicide attempt had a history of visiting a professional psychologist or using psychiatric medications under the supervision of a physician, while their intention of help-seeking from formal sources was relatively low. Therefore, the prevention of suicide required investment for creating a positive image of mental health care, which must be made accessible to the highest extent possible to the individuals who need to seek help from formal sources.