Hospitalized Suicide Attempters Research Articles

Service Utilization by Hospitalized Suicide Attempters With Schizophrenia or Depression in Montreal

The purpose of this study was to analyze patterns of mental health-related service utilization before and after hospitalization for attempting suicide. This retrospective cohort study included all persons 15 years or older with a clinical diagnosis of schizophrenia (N=195) or depression (N=330) hospitalized in Montreal, Quebec, from April 2003 to December 2004 for attempting suicide. Data on the publicly managed health and social services system were retrieved from the linked administrative databases of Montreal's Health and Social Services Agency (April 2002 to March 2005). Twelve-month preattempt service utilization profile, health care contacts three months pre- and postattempt, and predictors of postattempt service utilization were analyzed for two diagnostic groups (schizophrenia and depression). Specialized outpatient care and hospital emergency departments were the services most used by both groups before and after attempting suicide. Use of hospital emergency services as a primary care service did not adequately ensure aftercare, whereas prior contact with services and concurrent substance use disorder predicted greater service utilization postattempt among men but not women. The publicly managed health and social services system in Montreal seems to respond rather well to severe suicide attempts, including those by men with a concurrent substance use disorder known to be at high suicide risk. However, better coordination among hospital emergency departments, primary care, specialized mental health services, and addiction services is needed in order to enhance continuity of care.

When Adoptees Become Suicidal, Do Genes Come Into Play?

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessWhen Adoptees Become Suicidal, Do Genes Come Into Play?Aaron LevinAaron LevinSearch for more papers by this authorPublished Online:16 Mar 2012https://doi.org/10.1176/pn.47.6.psychnews_47_6_15-aAbstractBiology is not destiny, concludes a study of suicide-attempt hospitalizations among adoptees in Sweden.The study compared adopted children whose biological parents were suicidal with those whose parents were hospitalized for other psychiatric disorders.Adoptees with a biological parent who died by suicide or was hospitalized for suicidal behavior had a fourfold greater risk of a suicide attempt only if the adoptive mother was hospitalized for a psychiatric illness during the child’s childhood or adolescence, wrote Holly Wilcox, Ph.D., an assistant professor in the Johns Hopkins Bloomberg School of Public Health, and colleagues in AJP in Advance on February 7. “It’s the interaction during development between the adoptee’s genetic ancestry and living with the adoptive mother that increases risk, but not either one alone,” explained child psychiatrist William Beardslee, M.D., the Gardner Monks Professor of Psychiatry at Harvard Medical School, in an interview. Beardslee was not involved in Wilcox’s research.Separating the effects of growing up with suicidal parental behavior from a childhood shadowed by some other parental psychiatric illness is a challenge, said the authors.However, once again, Scandinavian record keeping provided valuable insights.The researchers used several Swedish population and health registries to study 25,688 adoptees in Sweden between 1973 and 2003. Of those, 2,516 had a biological parent who had a confirmed suicide (531), uncertain suicide (116), certain suicide-attempt hospitalization (1,361), or uncertain suicide-attempt hospitalization (508). They were compared with another 5,875 adoptees with biological parents hospitalized with an International Classification of Diseases (ICD) psychiatric code. All adoptions were domestic and the registry is very complete, since private adoptions are illegal in Sweden.Even with the large numbers in the general cohort, only 38 adoptees had the overlapping risks from both biological and adoptive parents, resulting in wide confidence intervals and limiting generalizability.Background data on suicidality in Sweden’s general population or on biological parents without psychiatric hospitalization or death by suicide might have added context to the study, said Beardslee. It also would be valuable to know about biological parents who attempted suicide but did not need hospitalization, he said.Unsurprisingly, adoptive parents in general were older than biological parents and had fewer lifetime psychiatric hospitalizations.Ultimately, biology alone did not predict risk, concluded Wilcox and colleagues.Adoptees who had a biological parent with suicidal behavior were at four times greater risk for suicide-attempt hospitalizations compared with adoptees with a psychiatrically hospitalized (but not suicidal) biological parent—but only when the adoptive mother had been hospitalized for psychiatric reasons when the child was under age 18.“In contrast, no difference was observed between offspring of [biological parents with suicidal behavior] and offspring of [biological parents with psychiatric hospitalization] when the adoptive mother was not psychiatrically hospitalized,” wrote the researchers.The researchers noted that the study may underestimate risk for adoptees, given that adoptive parents have been well screened for mental health and socioeconomic factors.The effects of childhood adversity on later mental health are well known, and studies have shown the importance of treating mothers to remission, said Beardslee. “When you compare the two, the children of mothers who remit do better psychiatrically than those who do not remit.”Maternal psychiatric illness is a modifiable factor, agreed Wilcox. Thus, identifying and treating psychiatric disorders among both biological and adoptive mothers “could be a critical step in the prevention of the generational transmission of suicidal behaviors.”An abstract of “The Interaction of Parental History of Suicidal Behavior and Exposure to Adoptive Parents’ Psychiatric Disorders on Adoptee Suicide Attempt Hospitalizations” is posted at http://ajp.psychiatryonline.org/Article.aspx?ArticleID=1028563. ISSUES NewArchived

The Interaction of Parental History of Suicidal Behavior and Exposure to Adoptive Parents' Psychiatric Disorders on Adoptee Suicide Attempt Hospitalizations

The authors examined the risk of suicide attempt or other psychiatric hospitalization among adoptees whose biological parents died from or were hospitalized for suicidal behavior (BPSB) relative to adoptees whose biological parents had a psychiatric hospitalization but never for suicide attempt (BPPH). The authors examined whether risk was moderated by having an adoptive parent who had a psychiatric hospitalization during the adoptee's childhood or adolescence. This retrospective cohort study used national longitudinal population-based Swedish registry data from 1973 to 2003 to identify 2,516 adoptees with BPSB and 5,875 adoptees with BPPH. Cox regression models compared the risk for suicide attempt and other psychiatric hospitalization in the two groups. The interaction of BPSB with adoptive mothers' psychiatric hospitalization while the adoptee was younger than 18 years old increased the risk for an adoptee's suicide attempt. Neither BPSB nor psychiatric hospitalization among adoptive mothers alone placed adoptees at greater risk for suicide attempt hospitalizations. The interaction results were specific to adoptee suicide attempt. Exposure to the hospitalization of an adoptive mother because of a psychiatric disorder amplified an adoptee's risk for suicide attempt hospitalization among those adoptees at high genetic risk of suicide or suicide attempt. These results imply that suicide attempts among those at biological risk might be prevented with the early recognition and care of parental psychiatric illness.

P-1412 - Analysis of sociodemographics, diagnostic characteristics and suicide attempt method of hospitalized suicide attempters

Prior suicide attempt is the strongest single risk factor for death by suicide: 30–40% of those who commit suicide, have made a previous suicide attempt. Many nations have surveillance system to monitor deaths by suicide, but not such a system to monitor suicide attempts. Patients (N = 60) admitted for after a suicide attempt to Special hospital of neuropsychiatric diseases in Belgrade from 2008-10, were assessed to sociodemographic, diagnostic characteristics and suicide attempt method. Sociodemographic characteristics: Mean age 43.07 (SD 15.658); gender: male 53.3%, female 46.7%; education: 12years (86.6%), 12years (13.3%); occupational status: unemployed 56.7%, invalid pensioner 16.7%, employed 26.7%; marital status: single 53.3%, widow/er 11.7%, divorced 8.3%, married 26.7%; without any children 86.7%; unsettled housing 46.6%. Diagnostic characteristics: Depressive disorder (36.7%), Schizophrenia (33.3%), other (30%); psychiatric comorbidity: abuse/addiction of alcohol/drugs 41.6%, personality disorder 28.3%; illness duration (years): M 15.117 (SD 14.1); mean age of first suicide attempt 41.2 years (SD 15.172); Suicide attempt method: self-harming with sharp objects 35.0%, jumping from a high place 23.3%, self-poisoning 23.3%, hanging 18.3%. A follow-up surveillance of suicide attempters should be established (by national office or register), in order to clarify characteristics that would predict possible suicide.

Maternal or Paternal Suicide and Offspring's Psychiatric and Suicide-Attempt Hospitalization Risk

We examined whether the risk for psychiatric morbidity requiring inpatient care was higher for offspring who experienced parental suicide, compared with offspring of fatal accident decedents, and whether the association varied according to the deceased parent's gender. Children and adolescents (0-17 years of age) who experienced maternal (N = 5600) or paternal (N = 17,847) suicide in 1973-2003 in Sweden were identified by using national, longitudinal, population-based registries. Cox regression modeling was used to compare psychiatric hospitalization risks among offspring of suicide decedents and propensity score-matched offspring of accident decedents. Offspring of maternal suicide decedents had increased risk of suicide-attempt hospitalization, after controlling for psychiatric hospitalization for decedents and surviving parents, compared with offspring of maternal accidental decedents. Offspring of paternal suicide decedents had similar risk of suicide-attempt hospitalization, compared with offspring of accident decedents, but had increased risk of hospitalization attributable to depressive and anxiety disorders. The magnitude of risks for offspring suicide-attempt hospitalization was greater for those who experienced maternal versus paternal suicide, compared with their respective control offspring (interaction P = .05; offspring of maternal decedents, adjusted hazard ratio: 1.80 [95% confidence interval: 1.19-2.74]; offspring of paternal decedents, adjusted hazard ratio: 1.14 [95% confidence interval: 0.96-1.35]). Maternal suicide is associated with increased risk of suicide-attempt hospitalization for offspring, beyond the risk associated with maternal accidental death. However, paternal suicide is not associated with suicide-attempt hospitalization. Future studies should examine factors that might differ between offspring who experience maternal versus paternal suicide, including genetic or early environmental determinants.

Maternal or Paternal Suicide and Offspring's Psychiatric and Suicide-Attempt Hospitalization Risk

Maternal or Paternal Suicide and Offspring's Psychiatric and Suicide-Attempt Hospitalization Risk

Psychiatric Morbidity, Violent Crime, and Suicide Among Children and Adolescents Exposed to Parental Death

This retrospective cohort study examined the risk for suicide, psychiatric hospitalization, and violent criminal convictions among offspring of parents who died from suicide, accidents, and other causes. Population-based data from multiple Swedish national registers were linked from 1969 to 2004. Participants were 44,397 offspring of suicide decedents, 41,467 offspring of accident decedents, 417,365 offspring of parents who died by other causes, and 3,807,867 offspring of alive parents. We estimated risk by mode of parental death (suicide, accident, other) and offspring age at parental death (childhood, adolescence, young adulthood). Offspring of suicide decedents were at greater risk for suicide than offspring of alive parents (incidence rate ratio [IRR] = 1.9; 95% confidence interval [CI] = 1.4 to 2.5), whereas offspring of accident decedents and other parental death were not at increased risk (p < .001). The risk for offspring suicide differed by the developmental period during which parental suicide occurred. Child and adolescent offspring of suicide decedents were at threefold greater risk for suicide (IRR = 3.0; 95% CI = 1.7 to 5.3; IRR = 3.1, 95% CI = 2.1 to 4.6, respectively). Young adults were not at increased risk for suicide (IRR = 1.3; 95% CI = 0.9 to 1.9). Offspring of suicide decedents had an especially high risk of hospitalization for suicide attempt, depressive, psychotic, and personality disorders. Child survivors of parental suicide were at particularly high risk for hospitalization for drug disorders and psychosis. All offspring who experienced parental death, regardless of mode or age, were at increased risk for violent criminal convictions. Mode of parental death and offspring age at parental death are associated with offspring long-term risk for suicide and hospitalization for specific psychiatric disorders.

Socio-economic inequalities in suicide attempts and suicide mortality in Québec, Canada, 1990–2005

Little research has evaluated changes in the association between area deprivation and suicidal behaviour over time. This study investigated patterns in suicide attempts and suicide mortality according to material deprivation in the province of Québec, Canada between 1990 and 2005. Ecological analysis. Data on suicide attempts were extracted from the hospital discharge summary database (n=47,516) and data on suicides were extracted from the Québec death file (n=20,851). Gender- and age-specific (10-24, 25-44, 45-64 and > or = 65 years) suicide attempt and mortality rates were calculated for four time periods (1990-1993, 1994-1997, 1998-2001 and 2002-2005) for the entire Québec population aged 10 years and older residing in 162 communities ranked by decile of material deprivation. Absolute and relative measures of inequality were calculated to summarize differences between the most and least materially deprived areas. Commonly used methods of suicidal behaviour were examined. Differentials in suicide attempt hospitalization between the most and least deprived areas were present for all age groups, and these decreased slightly among males and increased among females over time. Inequalities in suicide attempts were greatest among young adults (age 25-44 years) for both genders, and were smallest among the elderly (> or = 65 years). For suicide mortality, differentials increased among females but not males; these differentials were greatest among males and 25-44 year olds, and smallest among the elderly. Differentials in commonly used methods were evident for poisoning hospitalizations in both genders and for hanging deaths among males. In Québec, differences in suicide attempts and mortality between the most and least materially deprived areas persisted or even increased over time. Inequalities were more pronounced for suicide attempts than for suicide mortality, and were greatest among adults of working age. Strategies to reduce socio-economic differences in suicidal behaviour may be important.

Suicidal Behavior and Psychotropic Medications for Adolescents: An Uneasy Association, as Yet Not Clarified

Despite considerable recent attention and wide-scale interventions by regulatory authorities that have changed drug usage patterns, the possible relationship between psychotropic pharmacotherapy and suicidal behavior among children and adolescents remains unclear. Confounding by diagnosis adds to confusion in the interpretation of the relationship between antidepressant use and suicidal behavior among young people. Recent research suggests that antidepressants may be protective against early readmission after hospitalization for suicide attempts or ideation, but that psychotropic polypharmacy (although common) may be associated with increased risk of rehospitalization. There remains an urgent need for high-quality, ongoing research into these clinical dilemmas.

Smoking, psychosocial factors, psychopathologic behavior, and other related conditions in hospitalized youth suicide attempters

Background Comorbidity of suicidal behavior with various risk factors has been reported. This study examines the combined effect and the interactions of the most prominent risk factors in hospitalized suicide attempters. Method Seventy-six successive hospitalized suicide attempters and 76 matched control subjects, 9 to 20 years old, were subjected to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I and Axis II diagnoses and were interviewed for the use of licit and illicit substances. Also, 18 control subjects with the same psychiatric disorders diagnosed in the attempters were examined. Logistic regression analysis was applied to determine the independent effect of the risk factors to suicide attempts. Results The findings showed an 18-fold greater frequency of psychiatric disorders, a 14-fold greater frequency of other conditions that may be a focus of clinical attention (mainly relational problems), a 9.7-fold greater frequency of smoking, and a 4.7-fold greater frequency of psychosocial and environmental problems in the attempters than in the control subjects. The independent association of these factors with increased suicide risk persisted after adjusting for the effect of other factors. Conclusions Psychopathologic behavior, psychosocial factors, and smoking are independently associated with increased risk for serious suicide attempts.

Attempted Suicide and the Elderly Trauma Patient: Risk Factors and Outcomes

To analyze the scope and burden of hospitalizations for suicide attempts among elderly patients in the United States. The National Trauma Data Bank (NTDB, American College of Surgeons, Chicago, IL, 2002) was used for this study. It is a multistate database of hospitalizations for traumatic injury in the United States. Information on all patients reported to the database from 1995 to 2002 was analyzed. Logistic regression was used to analyze the risk factors for suicide attempt in elderly patients, compared with both a younger suicidal cohort and a cohort of elderly patients injured in a motor vehicle collision (MVC). The impact of age on outcome after failed suicide attempt was also analyzed. A total of 1,812 persons aged 65 and over were hospitalized for suicide attempts during the study period, comprising 9.5% of total hospitalizations for suicide attempts. Regression analysis demonstrated that elderly patients who attempted suicide were more likely to be male, white, to have used a firearm, and to have insurance than younger patients. They were more likely to have a psychiatric condition but less likely to have insurance than elderly patients hospitalized for MVCs. Mortality was higher for elderly patients hospitalized for suicide attempts than for younger patients who attempted suicide. Suicidal elderly were less likely to be discharged to home than either younger suicidal patients or elderly patients hospitalized after MVCs. The failed suicide attempt is an opportunity for intervention. By better understanding risk factors and outcomes of suicide attempts among elderly patients, we can identify higher risk groups and begin to tailor social service programs, psychiatric interventions, and medical care. A multimodality approach to suicide prevention for the elderly would include compassionate, appropriate, psychosocial interventions, and could be studied prospectively to analyze its impact.

Adverse Perinatal Outcomes and Risk for Postpartum Suicide Attempt in Washington State, 1987–2001

Postpartum suicide attempts are serious events with a significant impact on women and their families. Our objectives were to determine the temporal risk period for these events and to assess whether maternal complications and adverse infant outcomes are associated with risk for postpartum suicide attempt. We performed a case-control study that compared 520 women who were hospitalized for a postpartum suicide attempt with 2204 control women who were not hospitalized for a postpartum suicide attempt in Washington State from 1987 to 2001. We performed logistic regression to evaluate whether maternal complications and adverse infant outcome, after controlling for other risk factors, were associated with a hospitalization for a suicide attempt within 1 year after delivery. Most attempts were the result of poisoning (63.6%). Suicide attempts were most frequent in the first and 12th months after delivery. Maternal complications including labor and delivery complications and cesarean delivery were not associated with risk for postpartum suicide attempt. After adjustment for age and marital status, fetal or infant death was associated with postpartum suicide attempt. Other adverse infant outcomes, including preterm delivery, low birth weight, and congenital malformations, were not associated with attempts. Maternal complications were not associated with hospitalizations for suicide attempts in the year after delivery. However, fetal death or the death of an infant in the first year after delivery was strongly associated with hospitalization for a suicide attempt. These risk factors may be useful predictors for health care providers who care for women or children during the postpartum period.

Risk factors of future suicide in suicide attempters – A comparison between suicides and matched survivors

The objective of this study was to find risk factors for suicide by looking for clinical and care/treatment consumption differences between 15 hospitalized suicide attempters, who later committed suicide (“completers”), and 15 suicide attempters who did not (“non-completers”), matched according to sex, age and principal diagnosis. Completers had significantly more often attempted suicide after the index admission. After index, completers had received more psychiatric care and treatment than non-completers. Comorbidity was common in both groups of patients. Personality disorders according to the DSM III-R, axis II, Cluster B, however, tended to be more common in the completer group. Increased comorbidity over time could also be seen to a larger extent in completers. In spite of the matching of principal diagnosis, completers tended to have higher Montgomery–Åsberg Depression Rating Scale ratings than non-completers. They also had significantly higher Suicide Assessment Scale (SUAS) scores. From this study, it is apparent that suicide attempters at risk of future suicide have major and multiple psychiatric problems, which cause difficulties in the care and treatment.

Mortality and further suicidal behaviour after an index suicide attempt: a 10-year study

To examine further suicide attempts and mortality in the 10 years after a suicide attempt requiring hospital admission. Participants were a consecutive series of 3690 individuals admitted to Christchurch Hospital for attempted suicide during the 10-year period 1993-2002. Data were obtained on admissions to Christchurch Hospital for attempted suicide during the study period. Mortality subsequent to the index suicide attempt was established from the National Mortality Database. The influence of age, gender and method of index suicide attempt on mortality and further suicide attempts requiring hospitalization were examined. Within 10 years, 28.1% of those who had been admitted for an index suicide attempt were readmitted for a further non-fatal suicide attempt, and 4.6% died by suicide. Risks and rates of readmission were higher in: females; those under 55; and those whose index attempt involved a method of low lethality. Risks and rates of suicide were higher in: males; those aged 25 and over; and those using an index suicide attempt method of high lethality. Risks and rates of readmission and mortality from suicide were highest in the first 2 years after the index attempt, although deaths and readmissions occurred throughout the 10 years study period. Those making suicide attempts requiring hospital admission are at high risk of further hospitalization for suicide attempt and of death from suicide. These findings suggest a need for ongoing support and monitoring, and for enhanced treatment and management of all those making suicide attempts which require hospital admission in an effort to reduce risks of further suicidal behaviour.

Mortality and Further Suicidal Behaviour After an Index Suicide Attempt: a 10-Year Study

To examine further suicide attempts and mortality in the 10 years after a suicide attempt requiring hospital admission. Participants were a consecutive series of 3690 individuals admitted to Christchurch Hospital for attempted suicide during the 10-year period 1993-2002. Data were obtained on admissions to Christchurch Hospital for attempted suicide during the study period. Mortality subsequent to the index suicide attempt was established from the National Mortality Database. The influence of age, gender and method of index suicide attempt on mortality and further suicide attempts requiring hospitalization were examined. Within 10 years, 28.1% of those who had been admitted for an index suicide attempt were readmitted for a further non-fatal suicide attempt, and 4.6% died by suicide. Risks and rates of readmission were higher in: females; those under 55; and those whose index attempt involved a method of low lethality. Risks and rates of suicide were higher in: males; those aged 25 and over; and those using an index suicide attempt method of high lethality. Risks and rates of readmission and mortality from suicide were highest in the first 2 years after the index attempt, although deaths and readmissions occurred throughout the 10 years study period. Those making suicide attempts requiring hospital admission are at high risk of further hospitalization for suicide attempt and of death from suicide. These findings suggest a need for ongoing support and monitoring, and for enhanced treatment and management of all those making suicide attempts which require hospital admission in an effort to reduce risks of further suicidal behaviour.

Suicide attempts and impulsivity

Impulsivity in suicidal behavior can describe the attempt (state) or the attempter (trait). There are no studies simultaneously measuring attempt impulsivity and attempter impulsivity in representative samples of suicide attempts. A one-year study of 278 suicide attempts in a general hospital tested the continuous versus dichotomous relationship between attempter impulsivity (Barratt Impulsiveness Scale) and attempt impulsivity (low scores in the planning subscale of Beck's Suicidal Intent Scale). Attempter impulsivity was not a good predictor of attempt impulsivity independently of how both dimensions were measured (continuous or dichotomous ways). Impulsive attempts were associated with low lethality and lack of depression. Opportunities for prevention of suicide attempts in major depression and some personality traits may exist but require attentive monitoring of suicidal ideation and intent.

Depression, Anxiety, and Psychological Defense in Attempted Suicide: A Pilot Study using PORT

Depressive affect, anxiety, and psychological defenses were studied in the presented research with PORT, a projective test that exploits subliminal perception of object-relation images. Protocols of 20 hospitalized suicide attempters were compared to those of 20 matched controls, 34 previously studied nonsuicidal depressed patients, 18 patients with panic attack, and 32 patients with borderline and psychotic disorders. The suicide attempters were anxious; their defenses resembled those seen in borderline pathology; depressive reactions were limited in symbolic content; reality testing was poor. The closeness between depression and anxiety in suicidality is further discussed throughout this article. A constellation of signs using the PORT test was hypothesized to be a marker for suicidality. The test is deemed useful for future research on suicide.

What are the characteristics of adolescent hospitalized suicide attempters?

To study the specificity of hospitalized adolescent suicide attempters. Among a national sample of students (n = 11,718, mean age = 16.6 years) studied in 1999, 9.2% (n = 1078) made at least one suicide attempt during their life (SA); 21.9% (n = 234) of them were hospitalized (HSA). We identified the risk factors (family, school, behavioral and psychological) of SA and HSA by comparing (by gender) a) suicide attempters to non-suicide attempters and b) hospitalized suicide attempters to non-hospitalized suicide attempters. Both for girls and boys, the risk factors for SA varied. However, certain risk factors, particularly depressive mood, low self-esteem and poor parent-child relationships, were not associated with hospitalization. Hospitalized suicide attempters had more personal and social problems. But there is an important difference according to gender: in boys, hospitalization is related to physical fighting (OR = 2.2) and offences (OR = 3.4), in girls to running away (OR = 1.7), consumption of illegal drugs other than cannabis (OR = 2.0), having a living standard outside average (OR = 2.0) and going to a private school (OR = 1.7). Suicide attempters with problem behavior are more at risk of being hospitalized than others. However, the difference between hospitalized and non-hospitalized subjects was smaller than expected.

Hospitalization for suicide attempt and completed suicide: epidemiological features in a managed care population.

Understanding factors that contribute to high suicide risk holds important implications for prevention. We aimed to examine the sociodemographic and medical predictors of attempted suicide (severe enough to require hospitalization) and of completed suicide in a large population-based sample from a health maintenance organization (HMO) in northern California, USA. We designed a cohort study, including 87,257 women and 70,570 men aged 15 through 89 years old at baseline (in 1977-1985) with follow-up for hospitalizations and mortality through the end of 1993. After a median of 10 years, 169 first hospitalizations for attempted suicide (111 among women, 58 among men) and 319 completed suicides (101 among women, 218 among men) were identified. There was a greater incidence of hospitalization for suicide attempt in women than in men and, conversely, a greater incidence of completed suicide in men than in women. The predominant methods of attempted and completed suicides were ingestion of psychotropic agents and use of firearms, respectively. In gender-specific multivariate analysis of hospitalization for suicide attempt, statistically significant associations were seen for age 15-24 years (women), 65-89 years (men), white race (women), 12th grade or less education (both genders), technical/business school education (men), never being married (men), history of emotional problems (both genders), history of family problems (women), history of job problems (men) and presence of one or more comorbidities (men). The independent predictors of completed suicide were: age 15-24 years (both genders), Asian race (women), Caucasian race (both genders), never being married (both genders), being separated/divorced (women), prior inpatient hospitalization for suicide attempt (both genders) and history of emotional problems (both genders). These findings could help health professionals be more effective in the prevention of suicide morbidity and mortality.

Completed and attempted youth suicide in Victoria

Objective. To examine the biopsychosocial background of persons aged 15–24 years who had committed suicide in Victoria, compared with young people who presented to hospital after attempting suicide and who were either hospitalized or given outpatient treatment. From these data it was hoped to develop a screening instrument to delineate attempters at high risk to suicide. Design. A prospective study was undertaken using a standardized youth suicide interview schedule of all suicides in the 15–24-year age group in Victoria, compared with a sample of those presenting to public hospital emergency departments following attempted suicide. Data on completed suicides were collected by the staff of the Coroner's Office and Victoria Police, while psychiatric staff of Victorian hospitals assisted the collection of data on suicide attempters. Main outcome measures. Data comprised demographic features, method of suicide or attempt, reasons for the event, social and personal history, psychiatric background and life stressors. Results. One hundred and forty-eight completed suicides were compared with 105 hospitalized suicide attempters and 101 non-hospitalized suicide attempters. The majority of those completing suicide were male (86 percent), while those attempting suicide were predominantly female (64 percent in both groups). Those completing suicide typically used violent methods, while attempted suicides were mainly from overdose. The most common reported reasons for suicide were psychiatric problems and generalized feelings of worthlessness. Relationship problems and family conflict were the dominant reasons in both groups of suicide attempters. The data suggest that completed suicide was not related to specific events. Unemployment was cited as a reason for suicide in less than 5 percent of cases. Significantly, those who attempted suicide were more likely to have sought help prior to the attempt (hospitalized 64 percent and non-hospitalized 66 percent) compared with those who successfully suicided (12 percent). Conclusions. These data did not support common assumptions about suicide. Suicide threats or attempts do not discriminate between subsequent attempts and completed suicide. Approximately 88 percent of those who completed suicide displayed no discernible help-seeking behaviour. No specific events were related to completed suicide, indeed, those who completed suicide appeared to have experienced fewer stressful life events than those who attempted suicide. Over half the subjects lived at home. For attempters, there was a history of physical abuse, not reported for those who completed suicide. The majority of subjects were not heavy drug or alcohol users. These data suggest: (1) research needs to address the antecedents of suicidal behaviour, not the behaviour itself; (2) we need to explore the role of such causal factors as feelings of worthlessness and interpersonal skills, rather than homelessness and unemployment; and (3) suicide completers and attempters are heterogeneous groups, to be helped separately. © 1998 John Wiley & Sons, Ltd.