Abstract
Background: The purpose of this study is to determine, by classifying emergently admitted suicide attempter patients according to their Global Assessment Scale (GAS) scores, the characteristics of and factors associated with each group of patients. Methods: The subjects of this study were 1,317 suicide attempters who were seen at the primary/secondary emergency department of the Iwate Medical University Hospital and at the Iwate Advanced Critical Care and Emergency Center, during the period of 7 years from April 1, 2006. These subjects were classified into three groups, consisting of the low, middle and high score groups, and were analyzed by comparing these groups with each other in terms of background factors and psychiatric assessment of emergency psychiatry case cards. Comparison examination was performed among 3 groups, and multiple logistic regression analysis was performed by using investigation items and the three GAS score groups as explanatory and dependent variables, respectively Results: Factors associated with the low score group included being male, advanced age and unemployed, and high life event values. The odds of completed suicide in this group were more than 5-fold higher than in the other two groups. Past history of suicide attempts was extracted as a factor associated with the middle score group. Factors associated with the high score group included: being female; young age; having no history of regular psychiatric visits; having history of advice seeking prior to the attempted suicide; and complex motives. Conclusions: This paper determined characteristics of emergently admitted suicide attempters according to their GAS score levels, and proposed specific measures to be taken according to individual patients’ GAS scores. It was suggested that in an emergency setting involving a suicide attempter, a global assessment of the patient and treatment given according to the assessment results may lead to the prevention of further suicide attempts.
Highlights
Suicide occurs as a result of a multifactorial interaction between biological, genetic, psychosocial, environmental and other factors
In the emergency system of the target area of this study, because most cases of emergency patients related to mental illness is transported to this institution, we have selected this institution Of these, 1,317 patients who met the criteria for the diagnosis of suicide attempt (i.e., (i) the patient confirms that he/she attempted suicide, (ii) the patient left a suicide note or gave advance notice of suicide, (iii) there is a witness/es of suicidal acts, or (iv) it was concluded by judicial personnel or by autopsy that the patient attempted suicide [8] were included in this study
There were 57 suicide completers, including 33 patients who were pronounced dead upon admission at the Center and 24 patients who died within 24 hours of admission
Summary
Suicide occurs as a result of a multifactorial interaction between biological, genetic, psychosocial, environmental and other factors. It has previously been pointed out that there is a considerably strong association between unemployment rate and suicide rate [16,17], with the suicide rate in the unemployed being reported to be approximately seven times higher than in the employed, regardless of gender, and higher in men than women [14] This is consistent with the present study, in which a high proportion of the unemployed belonged to the low score group. It has been reported, from results of psychological autopsies in Western countries, that approximately 90% of suicide victims have mental disorder [18,19,20], 50% of which is reported to be accounted for by depression [21,22]. Since substance-related disorders are closely related to decreased social function, as seen in the fact that many suicide attempters are in a drunken condition when going into suicide-attempting action, we believe that patients with suicidal behavior and substance-related disorders require further investigation
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