Medical

Communication

Biosci. Biotech. Res. Comm. 10(3): 419-423 (2017)

Investigations on the physical activity level of some

Iranian drug suicidal patients

Maryam Hajain MD

, Shahram Mohaghegh MD

*, Latif Gachkar MD

and Effat Barari

Community Medicine Specialist, Minimally Invasive Surgery Research Center, Iran University of Medical

Sciences, Tehran, Iran

Assistant Professor of Sports and Exercise Medicine, Clinical Research Development Center of Loghman

Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Professor of Shahid Beheshti University of Medical Sciences, Tehran, Iran

Toxicological Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

ABSTRACT

As it is important to use the preventive and therapeutic effects of exercise and physical activity in the management

of suicidal patients, we primarily need to know physical activity level of suicidal patients. However there are little

data in this topic. The females to male ratio of patients were about 2.1:1. with the average age of 29.7, minimum 13

and maximum 88 years, with standard deviation of 12.1. Physical activity level of majority (76.4 percent) of patients

was in the range of low (less than 600 Metabolic equivalent/minute per week). Other variables except sex were not

associated signi cantly with the physical activity level of patients. Physical activity level was signi cantly lower in

females than males (P = 0.001, Chi square test). Low physical activity level and female sex are possible risk factors

for drug suicidal attempts in Iranian patients.

KEY WORDS: EXERCISE, MENTAL HEALTH, PHYSICAL ACTIVITY, POISONING, SUICIDE

419

ARTICLE INFORMATION:

*Corresponding Author: sh.mohaghegh@sbmu.ac.ir

Received 27

Nov, 2016

Accepted after revision 26

Jan, 2017

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007 CODEN: USA BBRCBA

Thomson Reuters ISI ESC and Crossref Indexed Journal

NAAS Journal Score 2017: 4.31 Cosmos IF: 4.006

reserved.

Online Contents Available at:

http//www.bbrc.in/

DOI: 10.21786/bbrc/10.3/14

INTRODUCTION

Suicide is a global public health problem. Annually,

almost 1 million people die in suicides worldwide

(Turecki etal. 2015). The global suicide rate in 2008 was

about 11.6 per 100,000. However, suicide has an increas-

ing incidence and it is estimated to be for more than

2% of the global burden of disease by the year 2020

(Behmanehsh Poor et al. 2014). Demographic, social,

and cultural factors can affect suicidal epidemiology

(Mirhashemi et al. 2016). As suicide is condemned in

Islam, the suicidal rate is low in most Islamic countries,

420 INVESTIGATIONS ON THE PHYSICAL ACTIVITY LEVEL OF SOME IRANIAN DRUG SUICIDAL PATIENTS BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Maryam Hajain etal.

yet it has shown to have increasing rate in recent years

(Pritchard etal. 2007). According to the last WHO report,

the reported suicide rates in Iran per 100,000 was 5.3 in

both sexes: 3.6 in females and 7.0 in males (Mirhashemi

etal. 2016) but  gure nearly 2 times greater for average

suicide rate (9.9 per 100,000) was measured based on data

elucidation (Hassanian-Moghaddam et al. 2017). Suicide

and attempted suicide rates in Iran increased from 8.3

per 100,000 in 2001 to 19.4 in 2005, then declined to

16.3 in 2007 (Saberi-Zafaghandi etal. 2012). However,

the of cially reported  gures for suicide are lower than

what really occurred (Malakouti et al. 2015). Suicide

with drug and self-immolation are two most common

reported methods of suicide in Iran (Nazarzadeh et al.

2013, Poorolajal etal. 2015).

Physical training and an active lifestyle have been

used as major public health tools in the prevention and

treatment of many physical diseases including cardiovas-

cular and metabolic diseases (Peluso etal. 2005). Also, the

effects of exercise on the brain, cognitive function, and

behavior have been of interest (Deslandes 2014). Based

on several epidemiological studies, it has been shown

that exercise and physical activity can have preventive

or delaying effects on the onset of different mental dis-

orders, and also can be used as therapeutic tools solely

or in adjunct with other treatments for mental disorders

(Zschucke etal. 2013). About 90% of individuals who had

successful suicide had an identi able psychiatric disorder

before death (Arsenault-Lapierre etal. 2004) and at least

50% of suicide deaths are related to depressive episodes,

either as major depressive disorder or bipolar disorder

(Holma et al. 2014). In a Cochrane review which com-

pared exercise intervention with no treatment, or with

standard interventions (cognitive therapy and pharma-

cotherapy) in the management of depressive symptoms,

a moderate clinical effect was found for exercise, which

indicated that exercise was as effective as these standard

treatments (Rimer etal. 2012). In a recent cross-sectional

study which examined the relationship between suicidal

thoughts (ST) and suicidal attempts (SA) and the level of

physical activity (PA) among South Korean adolescents,

there was an inverse dose-response relationship between

the level of physical activity (de ned as vigorous, moder-

ate, and low) and ST and SA (Cho 2014). Also, in urban

areas of the Iran, suicide is more common than rural areas

(Shirazi etal. 2012). The cause of higher rate of suicide in

cities may be related to lifestyle factors including more

stress and lower physical activity level which can be the

result of air pollution (Hajian et al. 2015).

Hajain et al. (2015) compared with those in rural

areas. As it is important to use the preventive and thera-

peutic effects of exercise and physical activity in the

management of suicidal patients, we primarily need to

know physical activity level of suicidal patients in Iran.

There is no data on the physical activity level of sui-

cidal patients in Iran. So, the aim of the present study

was to investigate physical activity level of drug suicidal

patients in a referral hospital of poisoning management

in Tehran.

MATERIAL AND METHODS

In the current cross-sectional study, the Persian-trans-

lated long form interview-administered International

Physical Activity Questionnaire (IPAQ) was used for

assessing physical activity level of 406 drug suicidal

patients who were admitted to poisoning ward of

Loghman Hospital (the next morning after admission)

between December 2014-April 2015. The validity and

reliability of this version of IPAQ have already been

proven in Iranian sample of individuals (Vasheghani-

Farahani etal. 2011). After obtaining the consent form,

interview was conducted by an expert with alive drug

suicidal patients who had good consciousness level and

cooperation or with close relatives of the patients who

were informed about the physical activity habits of the

patients. The results were expressed as low (less than 600

metabolic equivalent (MET). minute per week), medium

(between 600 to 3000 MET. minute per week), and high

(more than 3000 MET. minute per week) level of physi-

cal activity. Also, the patients were asked about their

age, weight, marital and educational statuses, number

of children, absence or presence, and in this case, the

type of background mental disorders, the history and

the number of previous suicide attempt(s). The data was

then analyzed using SPSS (v. 16) and related statistical

tests (ANOVA test for quantitative and Chi square test

for qualitative variables).

RESULTS

Totally, 406 patients were evaluated: 278 females

(68.4%) and 128 males (31.6%) with the average age of

29.7, minimum 13 and maximum 88 years, with stand-

ard deviation of 12.1. The average weight of patients

was 64.8 kilograms, minimum 37 and maximum 145

kilograms, with standard deviation of 15.6. Other epi-

demiologic characteristics of patients are provided in

Table 1. A total of 310 patients (76.4%) had low physi-

cal activity level, 80 patients (19.7%) medium, and 16

patients (3.9%) had high physical activity level. There

were no signi cant differences in weight, number of chil-

dren, and suicide history, marriage and educational status

between patients with different physical activity levels (p

value more than 0.05). There was signi cant difference

in terms of different physical activity levels between the

two sexes (p value = 0.001), which means females in low

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS INVESTIGATIONS ON THE PHYSICAL ACTIVITY LEVEL OF SOME IRANIAN DRUG SUICIDAL PATIENTS 421

Maryam Hajain etal.

Table 2. Physical activity levels of drug suicidal patients

according to sex of them

Physical activity Level Total

low moderate high

Sex

female

224 49 5 278

Percent 80.6% 17.6% 1.8% 100%

male

86 31 11 128

Percent 67.1% 24.2% 8.7% 100%

Total 310 80 16 406

Percent 76.4% 19.7% 3.9% 100.0%

Table 1. Demographic properties of drug suicidal

patients

Variable Description Number Percent

Marriage status

Single

187 46.1

Married 202 49.8

Divorce

17 4.2

Number of

children

0-1 320 79

2-3 71 17.5

More than 3 15 3.5

Education

Up to Diploma 305 75.1

Diploma to BSc 86 21.1

MSc and higher 15 3.6

Mental disorder

(according

to patient’s

statement)

No disease

317 78.1

Depression 52 12.8

Anxiety 3 .7

Psychosis 2 .5

Bipolar 4 1.0

Other 20 4.9

0 245 60.3

History of

suicide

70 17.2

2 15 3.7

3 14 3.4

4 5 1.2

5 4 1.0

63.7

71.2

physical activity group had relatively higher percentage

than their male counterparts and males in moderate and

high physical activity groups had relatively higher per-

centage than their female peers.(Table 2).

DISCUSSION

According to the  ndings of the present study, from

among 406 drug suicidal patients admitted to Loghman

Hospital, the majority (76.4% percent) had low physical

activity level. In a randomized cross over trial in high-

level suicide risk patients, regular endurance training in

the form of mountain hiking was shown to reduce hope-

lessness, depression, and suicide ideation (Sturm et al.

2012). Moreover, the moderate level of evidence has

been reported for the inverse dose-response relationship

between mental disorders (depression and distress) and

physical activity level in the latest guideline for exercise

testing and prescription of American College of Sports

Medicine (ACSM) (Ferguson 2014).

The mechanisms whereby exercise and physical

activity induce positive psychological health are diverse

and complex. Broadly, it can be divided into reducing

stress response, minimizing excessive in ammation, and

enhancing growth factor expression and neural plastic-

ity. Physical  tness, achieved through regular exercise

and/or spontaneous physical activity blunts stress reac-

tivity, protects against potentially adverse behavioral

and metabolic consequences of stressful events of life

(Silverman etal. 2014).

Physical activity level of the patients of the preset

study was measured by IPAQ includes both physical

activity and exercise, i.e. a type of physical activity that

is planned, structured, repetitive, and purposeful (Carek

et al. 2011). Although much of the research on posi-

tive psychological effects of exercise has been done on

aerobic exercise, resistance exercise or strength training

can also induce many physiological and psychological

advantages. Increase in cognition and self-esteem, and

decrease in depression and anxiety after both single-

bout sessions and long-term resistance training have

been identi ed in growing body of literature (Strickland

etal. 2014). Also there are evidences that indicate that

outdoor physical activity interventions such as moun-

tain hiking, stimulates higher positive and lower nega-

tive affective responses compared to an indoor physical

activity condition(Niedermeier etal. 2017).

In our study, the majority (68.4 percent) of drug sui-

cidal patients were female. Also, the female to male ratio

was higher in low physical activity level group. These

sexual differences have been seen in the previous studies

(Esteghamati etal. 2011, Koohpayehzadeh etal. 2014),

as well, and may be due to Iranian cultural and social

backgrounds which encourage men to be more physi-

cally active compared with women.

The most common underlying mental disorder in

our study was depression. Depression was also found

in other studies as a risk factor for suicide and suicidal

thought and self-destructive behavior in Iranian people

(Ekramzadeh et al. 2012, Dabaghzadeh et al. 2015). It

has been reported that the risk of suicide is increased by

more than 50 percent in depressed individuals and it is

about 20 times that of the general population in people

422 INVESTIGATIONS ON THE PHYSICAL ACTIVITY LEVEL OF SOME IRANIAN DRUG SUICIDAL PATIENTS BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Maryam Hajain etal.

with major depression (Baek etal. 2015). There is now

compelling evidence that lifestyle factors including diet,

physical activity and exercise, relaxation and meditative

techniques, quality of sleep, environmental pollutants,

and social support are signi cant in the pathogenesis

and treatment of depression; moreover, epidemiological

studies have shown that low physical activity can be a

risk factor for the development of depressive symptoms

and that regular physical activity in early years of life

is linked with reduced risk of experiencing depression in

adulthood (Sarris etal. 2014).

Therefore, prevention of depression and other mental

disorders by doing regular physical activity and exercise

is a cost-effective approach for people who experience

higher rates of mental illness compared with the general

population. Indeed, mandatory physical exercise for the

prevention of mental illness has been proposed for medi-

cal students in USA (Bitonte etal. 2014) as high prevalence

of depression and anxiety has been reported among USA

and Canada medical students, with levels of overall psy-

chological distress indicators consistently higher than that

in the general population and age-matched peers (Dyrbye

etal. 2006). This approach can be used in the public sui-

cide prevention programs too, as exercise has been shown

to improve stress management ability, general feelings of

well-being, and self-esteem and can act as a nonspeci c

psychological therapy (Kaminsky etal. 2006).

CONCLUSION

Low physical activity level and female sex are possible

risk factors for drug suicidal attempts in Iranian patients.

More precisely designed studies are needed to evaluate

the relationship between physical activity and suicidal

attempts in females. Promotion of increasing physical

activity and exercise for patients at risk of suicide espe-

cially females, are recommended.

LIMITATIONS

The study was done in a drug poisoning management

center and suicidal patients with causes other than drug

poisoning were not included. Also the cases were alive

patients and the dead ones were not included.

ACKNOWLEDGMENT

The fund of this study was provided by research pro-

posal number 4589 of Shahid Beheshti university of

medical sciences, Clinical Research Development Center

of Loghman Hakim Hospital.

CONFLICT OF INTEREST

There is no con ict of interest.

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