The characteristics of the suicide attempter according to the onset time of the suicidal ideation.

Kotaro Otsuka,Katsuhito Hoshi,Junko Yagi,Kentaro Fukumoto,Hikaru Nakamura,Jin Endo,Katsumi Sanjo,Kaoru Kudo,Akio Sakai

doi:10.1186/s12991-015-0087-6

Abstract

ObjectiveTo determine the timing of development of suicidal ideation and factors associated therewith in suicide attempters who required psychiatric emergency treatment.MethodsOf a total of 2818 suicide attempters in Japan who presented to the primary or secondary emergency department of Iwate Medical University Hospital (hereinafter, referred to as our hospital) or Iwate Prefecture Advanced Emergency and Critical Care Center (hereinafter, referred to as the emergency center), an affiliated institution to our hospital, during the 12-year period from April 1, 2002–March 31, 2014, 2274 patients for whom the timing of development of suicidal ideation was identified were included in the study. The study subjects were classified into three groups according to the timing of development of suicide ideation: the “same-day” group, those who developed suicidal ideation and attempted suicide on the same day; the “short-term” group, those who developed suicidal ideation 2–7 days before attempting suicide; and the “long-term” group, those who developed suicidal ideation more than 7 days before attempting suicide. Factors associated with the development of suicidal ideation in each group were analyzed by a multiple logistic regression analysis with background factors, the diagnosis according to the ICD and the situations before and after the suicide attempt as explanatory variables.ResultsThe same-day group was characterized by a high female ratio, high global functioning, low stress level, non-depressed status and a lack of seeking consultation. In contrast, the long-term group was characterized by low global functioning and a high stress level, suggesting that these patients exhibit consultation behavior, but have not received psychiatric services. In the short-term group, only male gender was identified as a significant factor.DiscussionFor those patients who developed suicidal ideation and attempted suicide on the same day, treatment strategies focusing on the acquisition of coping skills and stress management are recommended. For those with suicidal ideation lasting for more than a week or recurrent ideation, early detection and subsequent early treatment of such ideation are essential. In intermediate cases, treatment strategies that make the full use of mental health management in the workplace and gate-keeping are likely to be effective.

Highlights

A suicide attempt develops from suicidal ideation in the presence of complicating factors, such as anxiety, impulsivity and underlying psychiatric disorders
Patients of each group were examined for gender, age, years of schooling, living status, work status, history of presentation to psychiatric services, consultation prior to suicide attempt, history of suicide-related behavior, motives and means of suicide attempt, Asukai grade [a grading system for the seriousness of attempted suicide based on its means and outcome; absolutely dangerous (AD) or relatively dangerous (RD) group (1995)] [17], Japan Coma Scale (JCS), diagnostic classification according to the Mental and behavioral disorders section of the International classification of diseases and related health problems, 10th edition [18], and outcome of emergency treatment
In order to prevent the development of suicidal ideation followed by suicide attempt on the same day, supports are needed to facilitate the acquisition of stress management and stress coping skills and the control of mental conditions that can lead to direct actions, such as anxiety and impulsivity

Summary

Introduction

A suicide attempt develops from suicidal ideation in the presence of complicating factors, such as anxiety, impulsivity and underlying psychiatric disorders. Zimri et al have suggested that the trigger status of suicide is associated with factors such as the intensity of suicidal ideation, history of suicide attempt and current attempts [1], while others emphasize the importance of frantic hopelessness and loss of control over one’s thinking as underlying triggers for suicidal ideation [2]. While there are various known risk and protective factors associated with suicidal ideation and suicidal behaviors among young people, a population commonly affected by suicide attempts [7], stress has been shown to have a role in the development of suicidal ideation in this population [8]

Methods

Results

Discussion

Conclusion