Association of mental health status between self-poisoning suicide patients and their family members: a matched-pair analysis

Around the world, self-poisoning is a frequent method of ending one’s life, and poisoning can be caused by exposure to toxins chemicals, and drug overdoses [1]. It is a serious public health issue that contributes to global morbidity and mortality, particularly in low- and middle-income nations [1]. Self-poisoning is particularly prevalent in China, and a recent study pointed out that self-poisoning was responsible for roughly 60% of suicides [2]. In addition, both the prevalence and rate of suicide attempts using self-poisoning are dramatically rising among young people [3, 4].

Based on epidemiological and toxicological data, it was determined that national restrictions on harmful pesticides were an effective strategy for preventing suicide by pesticides intake [5, 6]. Even so, illicit drugs and medically prescribed drugs, such as psychotropic drugs, sedative-hypnotics, analgesics, and antidepressants [7], are still readily accessible and can be the most frequently misused drugs [8]. Identification of risk and protective factors is a crucial component of national suicide prevention since it helps to further understand the kind and type of preventive actions needed. Risk factors can occur on a variety of scales, including the individual, sociocultural, and situational, and numerous factors have been linked to increased self-poisoning, including borderline personality disorder or traits [9, 10], alcohol use disorder [9], depressive disorder [9], substance abuse [11, 12], asthma [11], fewer social connections [13], living in neighborhoods [13], being female [10, 14], and being young [13]. However, to the author’s best knowledge, there were few research that looked at the relationship between the mental health state of self-poisoning patients and their family members. It is important to stress that a thorough understanding of the risk factors for suicide behaviors in terms of patients and family members is necessary to carry out prevention activities, which highlights the need for a wider investigation.

In addition, during the Corona Virus Disease 2019 (COVID-19) pandemic, lockdowns and other public health measures had a significant impact on suicide [15]. Researchers noticed a decline in hospital admissions for self-poisoning suicide during the great pandemic, and, of note, this underlying trend actually reflected a decline in the number of patients receiving medical care for self-poisoning rather than a real decline in incidence. Thus, early professional healthcare seeking should be emphasized more, especially during the great pandemic. Identification of risk factors is an important step in guiding suicide prevention.

Therefore, the purpose of this study was to examine the relationship of mental health status between self-poisoning suicide patients and their family members, as well as to identify potential risk factors for predicting suicide attempt, anxiety, and depression using information from both the patients and their family members. In this study, it was expected that new risk factors for self-poisoning could be discovered from patients and their relatives. The study’s findings will be very helpful in directing the implementation of preventive interventions from the perspective of patients and their families.

Suicide has developed into a serious global public health problem linked to significant psychological disability, mortality, and impairment [22]. This study showed that compared to non-suicide patients who were admitted to the hospital due to poisoning, self-poisoning suicide patients experienced more serious mental health issues, such as anxiety, depression, hopelessness, and a lack of social support. The findings highlighted the need for more mental health care for people who were prone to self-poisoning. Also, among self-poisoning patients in particular, family members’ mental health state was substantially correlated with patients’ psychiatric status, despite the fact that they scored statistically significantly lower on anxiety and depression than patients did. It suggested that not only self-poisoning patients but also their matched family members should seek professional assistance and access to mental healthcare. Hence, an emphasis on modifiable aspects is now necessary to enable the value of the evidence in suicide prevention.

In the present study, multivariable analysis showed that married marital status, sedentary time of 1 to 6 h, and participation in sports more than five times per week were significantly associated with a lower rate of self-poisoning suicide, while current smoking and anxiety were significant risk factors. Previous studies have shown that divorce was a risk factor for self-poisoning [23], and anxiety was one of most relevant risk factors for suicide [24]. In addition, anxiety disorders raised the chance of subsequent episodes of purposeful self-harm among adolescents and young adults [25]. A meta-analysis showed that depressive and anxious symptoms and comorbid substance use increased the risk of suicide attempts [26]. Another meta-analysis also demonstrated that anxiety increased suicide risk [27]. Interestingly, in this study, we further identified risk factors for self-poisoning based on variables from patient’s matched family members. Family member’s identity, gender, education level, and personality had an impact on patient’s self-poisoning rates. Spouse was severed as a protective factor which was confirmed by the result that married marital status was associated with a lower risk of self-poisoning suicide. A larger monthly income for family members was associated with a tendency for a reduction in the probability of self-poisoning suicide. Yet, patients with higher monthly incomes can experience more worry and depression as opposed to a reduction in the probability of self-poisoning suicide. To earn a high salary, a patient might need to work more and take on more tasks, which could lead to anxiety and sadness owing to the strain of the labor. Patients were more likely to receive financial assistance from their family members if they made a greater monthly income, which may have lessened the patient’s suicidal thoughts. In addition, high school education and an introverted personality trait among family members were additional risk factors for self-poisoning among patients. Previous study also showed that higher introversion increased the risk of suicide ideation [28], and our present study demonstrated that introvert personality among family members also increased the risk of suicide attempts. Family members with introvert personality might not have effective communications with patients, which might possibly affect the mental health of patients. Family members living together with patients might be beneficial to curb anxiety, and this could be explained that such accompany was a protective factor for anxious status. Previous study had already showed that female was vulnerable to self-poisoning suicide [10, 14], and our study also depicted a similar trend. But, interestingly, having female family members helped to prevent self-poisoning suicide for patients. The above-mentioned findings demonstrated a connection of psychiatric health between self-poisoning patients and their family members.

In addition, specifically among self-poisoning suicide patients, multivariable analysis demonstrated that married marital status and no history of psychiatry disease were protective factors for preventing anxiety and depression, while older age, divorced or widowed marital status, a sedentary time of 1 to 3 h, drinking, and a higher monthly income were significant contributors to anxiety or depression. As shown in the above, anxiety was one of main contributors to self-poisoning [25‐27]. Our study further depicted concise suggestions for patients to deal with anxiety, such as finding a partner, treating previous psychiatry disease, and cultivating health lifestyle. Among the parental traits, a meta-analysis revealed less warmth, more interparental conflict, over-involvement, and aversiveness were linked to higher rates of depression and anxiety [29], indicating that a peaceful home environment was helpful in preventing anxiety and depression. In addition, a more recent study found that having a depressed mother increased the probability of adolescent anxiety and depression, as well as the amount of peer stress these adolescents experienced [30].

National restrictions on harmful pesticides were thought to be one of the most effective ways to avoid self-poisoning suicide [5, 6]. However, this intervention had relatively less impact on preventing suicide by self-poisoning, and toxic substances such as pesticides were still readily accessible among many countries, including China. In addition, Weerasinghe et al. [31] showed that pesticide vendors were willing to be a “gatekeeper” to prevent patient’s access to pesticides from their stores. Nonetheless, it was challenging for the sellers to differentiate between consumers who might be self-poisoning and those who bought pesticides for agricultural use [32]. Thus, the matter at hand is complicated. Even worse, illicit drugs and medically prescribed drugs are also readily accessible and the most frequently misused medicine [7, 8]. But one was sure that suicides was able to, at least partially, be decreased by limiting the accessibility of means to suicide [24], by training hospital doctors and community medical workers to screen people at high risk of suicide, manage self-poisoning patients more appropriately, as well as provide adequate follow-up health care [24]. Suicidality is a significant social and medical issue, and hence it should be prioritized in many areas.

Self-poisoning suicide patients have severe mental health issues. Patients who self-poison have a close connection to their family member’s mental health, particularly their levels of anxiety and depression. According to the findings, being married and adopting healthy lifestyle habits, such as quitting smoking and drinking, increasing their physical activity levels, and managing their idle time, are able to help patients with mental health concerns and even suicidal thoughts.