Clinical Differences Between Single and Multiple Suicide Attempters, Suicide Ideators, and Non-suicidal Inpatients.

Isabella Berardelli,David Lester,Gaia Anibaldi,Gianluca Serafini,Benedetta Imbastaro,Alberto Forte,Marco Innamorati,Maurizio Pompili,Salvatore Sarubbi,Mario Amore,Gabriele Pasquale De Luca,Benedetta Montalbani,Martina Mastrangelo,Denise Erbuto,Elena Rogante

doi:10.3389/fpsyt.2020.605140

Abstract

Single suicide attempters (SSAs) and multiple suicide attempters (MSAs) represent distinct subgroups of individuals with specific risk factors and clinical characteristics. This retrospective study on a sample of 397 adult psychiatric inpatients analyzed the main sociodemographic and clinical differences between SSAs and MSAs and the possible differences between SSAs, MSAs, and psychiatric patients with and without suicidal ideation (SI). Clinical variables collected included psychiatric diagnoses (Mini International Neuropsychiatric Interview), presence of substance use, current suicide risk status (Columbia Suicide Severity Rating Scale), Clinical Global Impression at admission, Global Assessment of Functioning improvement between admission and discharge, age at onset of psychiatric illness, duration of untreated illness in years, number of hospitalizations in psychiatric settings, and lethality of the most severe suicide attempt. A multinomial logistic regression model with groups showed that MSAs had a higher lethality of their last suicide attempt as compared to SSAs. In addition, MSAs had distinct sociodemographic characteristics compared to both SSAs and patients with SI. Although the study was limited by the relatively small sample size and retrospective nature, the present results suggest that identifying MSAs could be useful in predicting suicide risk and designing ad hoc prevention strategies.

Highlights

Suicide is a major public health issue, and nonfatal suicidal behaviors are lethal risk factors for suicide [1]
Among the 40% of suicide attempters who died as a result of their second or later attempt, more than 80% died within a year of the initial attempt
The four groups did not differ in terms of sex, age, job, educational achievement, housing, psychiatric comorbidities, TABLE 2 | Differences between subgroups

Summary

Introduction

Suicide is a major public health issue, and nonfatal suicidal behaviors are lethal risk factors for suicide [1]. The study by Isometza and Lonnqvist [3] found that the majority of those who died by suicide (56%) died on their first attempt. In people who attempted suicide multiple times, Isometza and Lonnqvist reported sex differences and a change in suicide methods, which likely increased the lethality of subsequent suicidal behavior. A high lethality of nonfatal attempts is an important predictor of later suicide, and multiple self-harm acts alone increase subsequent suicide risk [4]. The impact of suicide attempt frequency and level of lethality on suicide mortality remains unclear

Methods

Results

Discussion

Conclusion