In our study, Emotional instability trait was present in the highest number of patients 70 (61.9%), followed by Depressive tendency 46 (40.7%). Introversion was present in 42 (37.2), Activity 37 (32.7%), Social desirability 23 (20.4%), Dominance 21 (18.6%), Cyclothymia 20 (17.7%), Paranoid tendency 14 (12.4) and Super-ego was present in 10 (8.8%). Clinical and community researches suggest links between suicide attempts and psychological traits of aggression, anger and impulsivity.4
There is lack of literature, based on personality traits within the country and outside; our finding might open an avenue for further more intensive studies on individual personality traits.
Identifying personality disorder as risk factors for suicide attempts is an important consideration both for research and clinical care. We found that personality disorder was seen in 34% of the total cases where Emotionally unstable personality disorder and Anxious personality disorder were found in the highest number of patients. This finding corresponds to the study by Pandey et al13 in the same setting where 24% of the cases were found to have personality disorder, mainly Emotionally unstable impulsive subtype. Also a study by Risal A et al14 found that Personality disorder was present in 26% of the patients admitted for intentional self-harm, mainly Emotional unstable personality disorder (impulsive type).
Our finding in BPKIHS was consistent with the study by Nabi J et al15 where most predominant type of personality disorder was Borderline personality (28%). There was also a significant association (P < 0.05) between personality traits and past attempts interval, i.e. patients with Borderline personality traits were significantly associated with re-attempt suicide. Our finding also corresponds with Ansell Emily B et al16 where Borderline personality disorder was a significant predictor of any attempt in the presence of all personality disorders. Another study by Bhatt M et al17 found that impulsivity and borderline personality symptoms were significantly associated with attempted suicide. This suggests that symptoms of impulsivity in personality are strong predictors of suicide and may act in many ways by impairing the ability to cope with any situation and by drawing a person into conflicts with family members and others.
The mean age of our subjects was 28.27 years and the age range was 13–75 years. This finding corresponds with the study by Shakya DR18 in the same setting with the average age of 29.68 years, age range of 15–81, and age groups (20–29) and < 20 years were the largest. This finding is in line of current literature indicating increasing suicide rates among young people. The age distribution was similar to the other study by Sapkota N et al19 conducted in the same setting where majority (67%) of the suicide attempters were less than 35 years age and the commonest age groups attempting suicide in both the sexes were 15–24 years. Gender wise, among the suicide attempters visiting our OPD, 71 (62.8%) were female and 42 (37.2%) were male. Our finding was similar to the studies conducted in the same settings by Shakya DR18 with 57.39% and Sapkota N et al19 with 56% female subjects. This may be accounted to the fact that females are often exposed to the stress and strain of day to day life in our society.
In our study, 47 (42%) was found to have Substance use disorder, mainly alcohol 28 (24.7%) followed by Stress related and Neurotic disorder (34%) mainly Adjustment (22%) and mood disorder (22.1%). The preponderance of substance and mainly alcohol problem among suicide attempt cases was consistent with a previous study of same institute.20 Among the mood disorders, most common was Severe Depressive Episode seen in (10.6%) of the subjects. A study by Risal A et al14 found that maximum patients (41.1%) were found to have Depression Spectrum Disorder (Depression, Dysthymia, Adjustment Disorder) as in our study.
Our finding also corresponds with the finding of the study done by Sapkota N et al19 in the same setting where mood disorder was found in 28% cases where Depression was reported in 22%, followed by Adjustment disorder in 7% cases. Bansal P etal21 reported that majority of the suicide attempters were suffering from mood disorders (57%) and Depression was found in 46% subjects, out of which 30% had Severe Depressive Episode. More research is needed to improve the prediction of suicide in mental disorders, along with more effective implementation of preventive measures.