Psychological distress of suicide attempters predicts one-year suicidal deaths during 2007–2016: A population-based study

Abstract

Of the risk factors for suicide, prior attempt is regarded as one of the strongest for subsequent attempts or completed suicide. This large-scale cohort study aims to examine whether the distress level of individual mental symptoms and general psychopathology measured at the index attempt can predict subsequent suicide death within one year. The participants were 104,441 suicide attempters first reported to the Taiwan National Suicide Surveillance System during 2007-2016, who completed the five-item Brief Symptom Rating Scale (BSRS-5) at the index attempt. Kaplan-Meier survival curve analysis with log-rank test and Cox regression model were used to examine whether the level of psychological distress could predict the cumulative incidence of re-attempted suicidal death in the following year. In total, 1254 (1.2%) participants subsequently killed themselves within one year. Survival curves analysis and Cox regression modelling indicated that levels of distress of individual items (i.e., suicide ideation, depression, inferiority, anxiety, hostility and insomnia) and total BSRS-5 scores were significantly correlated with the incidence of subsequent suicidal death within one year for both genders. The study revealed that self-rated psychological distress was a significant and sustained predictor of re-attempted suicide death within one year after the index attempt. These results imply that suicide is not only an issue of acute crisis, but also a prolonged problem of lasting psychological distress. The BSRS-5 assessment could provide a symptom profile on which to develop a pertinent person-centered approach to prevent subsequent suicide attempts.