Introduction

Poisoning is a condition resulting from toxin, drug or a specific substance gaining entrance into the body and damaging it through that substance. This injury can be mild (with symptoms such as headache and nausea) or severe (with symptoms such as convulsion or high fever). However, either chemical or pharmaceutical toxins can cause death in severe poisonings (1). Although technological progresses and science developments have led to greater access to chemical, agricultural and industrial drugs and materials, they have caused a lot of problems. This is because individuals use, either intentionally or unintentionally, many of these compounds which may cause some complications. Thus, it is essential to accurately identify and study these materials and the psychiatric impairments caused after their consumption (2).

More than 90 percent of the cases regarding toxin exposure happen at home and mortality resulting from it is significant among adolescents and adults (3-5). Most poisonings occur by exposing and taking anti-pain medications, sedatives, anti-depressants, incentive materials, hydrocarbons, cleansing agents, anti-psychosis, cardiomyopathy drugs, theophylline, insecticides and rodenticides, including rat poisons. Poisoning can occur in four different ways, consisting of random, purposeful, environmental and occupational poisoning. Therefore, committing suicide through poisoning is inevitable (1).

Studies showed that the majority of suicides are affected by psychiatric disorders and those who commit suicide are not psychiatrically treated in spite of the need for that. The authorities have failed to provide this kind of treatment, especially for public clients. The most common psychiatric problem among patients is mood disorders such as major depressive, bipolar, psychotic, anxiety (e.g. panic disorder) and personality disorder, as well as financial and emotional failures and substance abuse (6-10).

In Iran, the exact number of cases of poisoning complications and mortality is not available and the experience of the recent decades shows that having the statistics for the past is essential for a favorable plan and development. In addition, controlling the causes of these psychiatric disorders is also regarded as one of the factors for health and medical development (11). Due to the high prevalence of deliberate poisoning, especially in women, and the easy access to drugs, and also since the illness caused by poisoning has been the most frequent reason of being admitted in hospitals, it seems that the number of such cases are still increasing. Thus, this requires a careful examination (12).

Due to the lack of a coherent, comprehensive system for collecting the data regarding poisoning and those poisoned, it was decided to obtain extensive information on some psychiatric disorders in patients with poisoning and to examine the role of each kind of toxin in their destiny; the effective factors in the treatment, recovery or death of the patients was also examined. In this way the number of the poisoned and the death caused by that can be obviously reduced by providing appropriate strategies for the prevention and treatment of poisoning. Informing the health departments can be useful in order to better control and improve these problems and design appropriate strategies for the promotion of physical and mental health of patients with psychiatric disorders. Finding the frequency of depression disorder in patients suffering from different poisonings can also be a step towards this direction.

Methods

The present study is a descriptive cross-sectional one. The population includes the poisoned patients admitted to Ali-Ebn-Abitaleb hospital of Rafsanjan, Iran, in 2017. Using random sampling method and based on the previous similar studies, up to 120 subjects were chosen, 116 of which were investigated.

Data collection

The researcher-made questionnaire was design to follow the study purpose. The demographic characteristics of the subjects, including age, sex, occupation, education level, place of residence, marital status, past history of suicide attempts, past history of mental illness, social class, type of the consumed material and type of poisoning were assessed.

Beck depression inventory (BDI-II): This questionnaire, consisting of 21 items, was first developed in 1961 by Beck and his colleagues. They basically revised it in 1996. Thus, the scale determines varying degrees of depression, including normal to mild (1 to 16), medium (17 to 30) and severe (31 and up). The score range obtained by the questionnaire is from 0 to 63. Due to the importance of using this instrument in the clinical intervention diagnosis, many psychometric researches have been done about its psychometric properties. Among the most important of them, a meta-analysis of conducted in 1988 by E. T. Beck, Steer, and Garbin can be noted. By reviewing the investigations that used this instrument, Beck and his colleagues found that using the test-retest method, its reliability co-efficient varied from 0.48 to 0.86, depending on the interval between the number of times it was performed and the type of population tested. Once again in 1996, Beck et al. obtained the test-retest reliability coefficient within one-week interval, which was 0.93.  Various researches have also been conducted in Iran that tried to measure the psychometric properties of this instrument. Among the others, Tashakori and Mehryar (1994) obtained reliability coefficient, which was equal to 0.78. In other researches, such as Partou (1975), Vahabzadeh (1973) and Chegini (2002), the reliability of Beck's questionnaire was reported to be high and ranged from 0.70 to 0.90 (12).

The collected data were interpreted using SPSS (version 16) and different statistical analyses such as descriptive statistics including frequency, mean and standard deviation through the considering statistical assumptions of the inferential Chi-Square test.

Results

Regarding the relative frequency of depression, 63 subjects (54.3%) suffered from severe depression, 29 subjects (25%) from moderate depression, and 24 subjects (20.7%) from mild depression.

Table 1. Frequency distribution of depression among the subjects categorized by demographic characteristics

According to the above result, severe depression in women (60%) is more than in men (50.7%). Mild depression in men (18.3%) is the lowest. This relationship was tested by Chi-square test, which was not significant by p-value=0.168. Therefore, the depression severity is identical in both sexes. Given the above results in the age group between 14 to 24 years of old, severe depression (58.5%) had the highest rate, while mild depression (16.9%) had the lowest. This relationship was tested using Chi-Square, which was not significant with the p-value=0.474. Thus, the severity of depression was similar in both age groups. Given the above results, severe depression (67.6%) had the highest rank among those with high school education level, while mild depression in the elementary level (12.5%) was the lowest. This relationship was tested by Chi-Square test was significant with p-value=0.045. Thus, severity of depression is higher in those with high school level.

Given the above results, severe depression (75%) was the highest among the widowed/divorced group, and again mild depression among the same group was the lowest. This relationship was tested by Chi-square and it was not significant with the p-value=0.251. Thus, depression severity was not dependent upon marital status. Given the above results, severe depression was highest (83.3%) among the subjects with a history of mental disorder, while mild depression was lowest (6.7%) among subjects with a history of mental disorder. This relationship was tested by Chi-square and it was significant with p-value=0.001. Thus, the depression severity in subjects with mental disorders was higher. Given the above results, severe depression was highest (95.5%) among the subjects with a history of suicide attempt, while mild depression was lowest (0%) among subjects with no history of suicide attempt. This relationship was tested by Chi-square and it was significant with p-value = 0.001. Thus, the depression severity in subjects with suicide attempt was higher.

Discussion

Regarding the relative depression, 54.3 percent of depression was severe, 25 percent was moderate, and 20.7 percent was mild. Given our statistical sample, severe depression was the most frequent among poisoned subjects. Among the patients with a history of psychological problems, the most common problem was social dysfunction (97.57%) and depression (88.9%) (2). Pajoumand et al. (2012) conducted a study on 6414 patients in Luqman Hakim Hospital. One out of every five patient suffered from a psychological problem, the most common of which was compatibility disorder (13).

The findings of the former study are consistent with our statistical findings and the two latter ones are against those of ours. That can be explained by a large sample size of the mentioned studies as well as the study of mental disorder that was not our matter of concern. In our study, one of the common reasons was deliberate poisoning among subjects with severe depression; this can be treated by psychological treatments in order to decrease depression severity and consequently deliberate poisoning. As suffering from a mental illness, especially depression, can increase deliberate poisoning (14, 15), inadequate treatment of depression can also be an important factor in the creation of intentional poisoning [15]. Suffering from physical disease also increases the risk of poisoning because suffering from chronic physical disease in many cases is associated with mood disorders (16).

Regarding the history of suicide attempt in the past, 81 percent of the subjects did not declare any history. Only 19 percent declared a history of suicide attempt.In a study conducted by Lee et al. (2012) on 2996 patients in Korea, one of the most important factors of suicide attempt was found to be the previous suicide attempts (17). In addition, in a study by Alberdi-Sudupe et al. (2011) on 5424 patients at the Psychiatric Center of the University of La Coruna, Spain, previous suicide attempt was the most important factor of the future suicide attempt (18).

Based on The Summary of Psychology by Kaplan and Sadouk (2007), the most common factor in suicide is the previous suicide attempt. One of the reasons that cause the inconsistency between the above-mentioned cases and our statistical findings was that the poisoned subjects with several suicide attempts were not sent to a psychiatric center.  As these subjects were not admitted in a psychiatric center, they were not honest about the history of suicide attempt. The second reason is that as the study was conducted in a small city, the subjects denied such attempts to save face and avoid some possible future educational, occupational and marriage problems by declaring such facts. Due to the fact that unsuccessful suicide attempts may consequently lead to successful ones, this issue needs to be taken more consideration (19).

In addition, in our study, depression severity had a significant relationship with a history of mental illness in the past (p-value=0.001), education (P-value=0.045), and a history of suicide attempt in the past (p-value = 0.001). The subjects with a history of mental illness in the past suffered from higher depression; this can be explained by the fact that such subjects have accepted their psychological problem, are not able to perform daily tasks, and are rejected by others in their surroundings. Depression is also more severe at the ages of high school education. One of the reasons for that is emotional, academic (especially failing the university entrance examination), and other problems related to this age. No significant relationship was found between age, sex, socioeconomic status, occupation, type of poisoning, history of suicide attempt in the past, and the type of drug used.

Conclusion

The frequency of psychiatric disorders among patients poisoned by a variety of toxins and drugs are more likely than the general population. This emphasizes the need to provide counseling services and treating such disorders in the community both before and after they occur.

Conflict of Interest

The authors declare that they have no conflict of interest.

Acknowledgments

The authors of this article would thank all the respected authorities of Islamic Azad University, Yazd Branch for their help in conducting the research and also those students in Rafsanjan city who participated the researchers in data collection process. Also, We thanks specially of Central education and other educational and training centers in Rafsanjan for their support                                                                                  

Funding

No.  

Ethical Approval

Our study was approved by Ethics Committee of Islamic  Azad  University, Yazd Branch, Ali-Ebn-Abitaleb  medical  school.