Why are Suicides With Unknown Cause the Most Important Reason for Suicide? A Retrospective Study.

This study will help in determining national suicide prevention strategies. Moreover, understanding the reasons for the lack of awareness about completed suicide will strengthen the measures to be taken in this regard. It was determined that the most important rate among the causes 48 419 completed suicide in Turkey in the years 2004 to 2019 was the 22 645 (46.76%) suicides of unknown cause and there was not enough information about the underlying causes. Suicide statistics data of the Turkish Statistical Institute (TUIK) between 2004 and 2019 were analyzed retrospectively in terms of geographical regions, gender, age groups and seasonality. Statistical analyses of the study were performed using the Statistical Package for Social Sciences for Windows (IBM SPSS version 25.0, Armonk, NY, USA) software. It was determined that the highest crude rate of suicide during 16 years was in the Eastern Anatolia region, the lowest rate was in the Marmara region, and the ratio of the number of female suicides with unknown cause to the number of male suicides was higher in Eastern Anatolia than in other regions, the rate of unknown crude suicide in both genders was highest in the under 15 age group, this rate decreased as the age progressed, the lowest rate was in women with unknown age, the effect of the season was observed in women with unknown cause, but not in men. Between 2004 and 2019, suicides with unknown cause were the most important reason for suicide. We think that there may be geographical, gender, age, seasonal, sociocultural and economic factors that may affect this, national suicide prevention and planning strategies will be insufficient unless this issue is adequately examined, and institutional structures should be established, including psychiatrists, where deep forensic investigations can be carried out.

The Relationship Between Depression, Anxiety and Stress Levels on Suicidal Behavior in Patients with Schizophrenia.

Background: Suicide is a major public health problem, and most people, who attempt suicide, have a psychiatric disorder. The preventable nature of suicide has further warranted the conduct of studies on suicide. Methods: This cross-sectional and descriptive study aimed to investigate the effects of depression, anxiety, and stress levels on suicidal behavior in patients with schizophrenia. The study included 222 patients with schizophrenia. Data were collected by using the Descriptive Information Form, the Suicide Behaviors Questionnaire, and the Depression Anxiety Stress Scales-Short Form. Results: It was found that 47.7% of the participants had suicidal ideation and 33.8% of them had attempted suicide by taking pills, self-cutting, jumping from a height, and hanging. While the participants had moderate levels of depression and anxiety, their stress levels were normal. The study has shown that the variables of stress, a good income level, and employment affect suicidal behavior, with a 1-unit increase in stress scores leading to an increase by 0.942, a 1-unit decrease in the good income level leading to an increase by 1.132, and a 1-unit increase in employment leading to an increase by 1.316 in suicidal behavior. Stress, income status, and employment accounted for 42.3% of the change in suicidal behavior. Conclusion: This study has shown that suicidal ideation and suicide attempts are common in patients with schizophrenia compared to the normal population, and increased stress levels, poor income, and working in a job increased the risk of suicide among these patients. It can be suggested that efforts for improving stress management in patients during the post-pandemic period may be effective in reducing the risk of suicide.

The effect of insight, loneliness, and hope levels on medication adherence in patients with schizophrenia.

PURPOSE: It is important to investigate the negative factors affecting medication compliance to continue the treatment of schizophrenia. DESIGN AND METHODS: In this descriptive and analytical study, the effects of insight, loneliness, and hope levels on medication adherence in 202 patients with schizophrenia were studied. FINDINGS: The correlation was positive between medication adherence and insight, negative between medication adherence and loneliness, and no correlation between medication adherence and hope. A 1-point increase in insight scores increased medication adherence 1.226 times and a 1-point increase in loneliness scores decreased medication adherence 0.946 times. Medication adherence was 0.499 times lower in nonsmokers compared to smokers. PRACTICE IMPLICATIONS: Further studies on patients with schizophrenia should be conducted to evaluate factors affecting medication adherence and preventing smoking in schizophrenia.

Characteristics of paraphilics in Turkey: A retrospective study-20years.

OBJECTIVE: This study is carried out to research the frequency of occurrence and the characteristics of paraphilic cases in Turkey and forensic aspects of them and to explain forensic psychiatric studies of people show paraphilic actions and assess them from legal aspects. METHOD: This research is done by studying a total of 101,208 cases who were sent to Istanbul Forensic Medicine Institute (FMI) by the judicial organs of 4th Specialization Board between 1984 and 2004 to decide whether they show paraphilic actions or not. When choosing the cases of pedophilic actions, incest incidents were excluded and 307 incidents were taken into assessment. RESULTS: The male subjects are 97.4%, 39.7% of them are 19-29years old, 10% of them are over age 60, 59% of the subjects are single, 36.5% of them are unemployed, 71.7% of the incidents have no physical disorder. The subjects who were imprisoned before were 20.2% and 22.1% of them had undergone psychiatric treatment before the incident. Twenty separate diagnosis are determined by the FMI for the subjects. There were mental retardation, schizophrenia and various personality disorders on the top the diagnosis list. The paraphilia type of the incidents are pedophilia (60.3%), exhibitionism (8.1%), pedophilia and exhibitionism (7.5%) and fetishism (5.9%). It was determined that there were more than one paraphilia type in 40 incidents (13%). FMI decided that 54.7% of them have criminal responsibility, 25.1% of them have no criminal responsibility, and 20.2% of them have reduced criminal responsibility. CONCLUSION: There were 20 separate type of diagnosis for the incidents. It is understood that paraphilic incidents do not seek for help although they have the symptoms of disorder and they are exposed to psychiatric assessment only when they face a criminal inquiry. This suggests that there are more paraphilic incidents in the society than what we encounter.

Suicidal hanging in Istanbul, Turkey: 1979-2012 Autopsy results.

A retrospective study was carried out on 4549 which is the total number of hanging cases autopsied at Forensic Medicine Institute in Istanbul, Turkey. 4502 hanging cases of suicidal origin were detected and evaluated in terms of demographic features, the type of hanging material used for ligature, internal findings in neck organs, toxicological findings and microscopic findings. Of these suicides, 3295 (73.2%) were males and 1207 (26.8%) were females. The average age of the victims was 37.8 (SD 1.6). Crude suicidal hanging rate is approximately two-fold increase in women, while it is about five-to six-fold increase in men during 33 years. 1424 of the victims committed suicide by hanging themselves at home, and 441 of them in prison and indoor areas. The alcohol in the blood of all autopsy victims was tested and results were positive for 687 people. A drug active agent was detected in 108 (2.4%) victims: 70 (1.5%) of them were antidepressants, 20 (0.5%) of them were analgesic/anti-inflammatory/anti-histaminic and 18 (0.4%) of them were antipsychotic. In the examination of the psychoactive substances in blood and urine, any of such substances was not detected in 4146 of the victims. However, victims' blood and urine contained a sedative-hypnotic-anxiolytic with 74 (1.6%), a cannabinoid with 16 (0.4%) and an opioid with 12 (0.3%). Psychoactive substance examination was not carried out for 243 victims. Of these cases, 4060 (90.2%), ecchymosis in soft tissues and 2800 (62.1%) fracture in neck organs was found.

Analysis of the Maternal Filicide in Terms of Forensic Medicine in Turkey: A Clinical Research.

INTRODUCTION: In the literature, 15% of the victims of homicide consists of children under 16 years of age; children under the age has been proved that they have the maximum risk. The vast majority of the victims were killed by their mothers. Thus, if mothers are the perpetrators of crime child murders are discussed in different ways, so it is conceptualized under the name of maternal filicide in the literature. This study has been performed for, in Turkey, women who killed their own children between 0-6 years old, victims of crimes, and to determine features of crime regarding on forensic medicine, eventually in order to provide a basis for taking necessary precautions and measures. METHODS: This research includes 74 reports of maternal filicide cases came to IV. Board of Specialization at the Council of Forensic Medicine in Istanbul, Ministry of Justice of Republic of Turkey between 1996-2006 years. In the light of data came from these reports, the socio-demographic characteristics of mothers who attempted filicide and children who were killed, and crime occurrence methods and mothers' criminal legal responsibility were examined. RESULTS: Mothers, suspected of the filicide crime, are often at a young age, and did not desire pregnancy, 73 of mother's do not have criminal history, and 48 of mothers confessed the crime. Found that 71 of child victims are biological kids, 38 of them were killed around age, and 20 of them were girls, 35 of them were boys. The study group, seven of defendants killed or attempted to kill more than one child at the same time. The majority of mothers committed the crime during the daylight. When filicide methods were examined strangling or throwing up the child from higher were seen the most. The majority of mothers committed crime wiithout weapon or other objects, just by their hands. Based on decisions of IV. Board of Specialization, no significant difference was observed between the the mothers with criminal liability and mothers with non-criminal liability. CONCLUSION: In this study, important data procured from the demographic characteristics of the mothers, findings on conditions during the crime and the method of the crime, and mothers' psychosocial stressors, but it has been discerned that this data is limited to define the crime of filicide. At the end of the study, besides studied the parameters that directed people to commit this crime, other factors, like mental status and/or motives should be probed.

Gender differences in completed suicides in Istanbul, Turkey.

BACKGROUND: Psychological autopsy studies have been widely used to identify the cause of suicide. However, gender is one of the most frequently replicated predictors for suicide. To identify further the significant risk factors for suicide among males and females separately. METHOD: Data were obtained from The Turkish-Istanbul Forensic Medicine Institute Morgue Department for all suicides deaths from April to August 2002 in Istanbul. 124 completed suicides were included in the study. RESULTS: This study findings suggest that unemployed, not married or in a de facto relationship, previous suicide attempt, and alcohol or substance abuse were common amongst those who died by suicide. Most of the victims were male; the most frequent suicide methods were hanging and jumping down a high building followed by firearms. Both males and females were most frequently affected by psychiatric disorders. It was found that 108 cases that did not receive psychiatric care attempted suicide for the first time and committed suicide. CONCLUSION: This finding suggests that suicides should be investigated by an expert team and not by the police and victims' relatives only to determine whether they are really suicides or not.