Index Suicide Attempt Research Articles

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.

In This Issue

In This Issue

Completed suicide after a suicide attempt: a 37-year follow-up study.

Attempted suicide is the strongest known predictor of completed suicide. However, suicide risk declines over time after an attempt, and it is unclear how long the risk persists. Risk estimates are almost exclusively based on studies of less than 10 years of follow-up. The authors followed a cohort of 100 consecutive self-poisoned patients in Helsinki in 1963, for whom forensically classified causes of death during the following 37 years were investigated. They found that suicides continued to accumulate almost four decades after the index suicide attempt. A history of a suicide attempt by self-poisoning indicates suicide risk over the entire adult lifetime.

Further Suicidal Behavior Among Medically Serious Suicide Attempters

Analysis of rates of further suicidal behavior among individuals making medically serious suicide attempts may help to predict suicide and suicide attempt from baseline characteristics of the individual and the index suicide attempt. Data are drawn from a 5-year study of 302 individuals making medically serious suicide attempts with information collected by personal interview at baseline, 6, 18, 30, and 60 months after the index attempt. Within 5 years, 6.7% died by suicide; 37% made at least one nonfatal suicide attempt. Although baseline characteristics permitted a modest prediction of suicide attempt, only a very limited prediction of suicide was possible. Almost half of those who made serious suicide attempts made a further fatal or nonfatal attempt within 5 years. These findings imply the need for enhanced follow-up, treatment, and surveillance of all patients making serious suicide attempts.

Sex differences in risk factors for suicide after attempted suicide-a follow-up study of 1052 suicide attempters.

This study aims to investigate suicide risk factors after attempted suicide and whether and how these risk factors differ between the sexes. A total of 1052 suicide attempters admitted to the Medical Emergency Inpatient Unit, Lund University Hospital, Sweden were followed up concerning suicide and death from other causes after a median period of 6 years and 5 months. In all, 50 persons committed suicide during follow-up. At the index suicide attempt, socio-demographic data and information about clinical characteristics were gathered in a standardised manner. Risk factors were identified among these data using survival analyses for the whole sample and for each sex separately. Men had a higher frequency of suicide and a greater overall mortality than women. Cox regressions showed that suicide attempt(s) prior to the index attempt and the use of a violent method for the index attempt were risk factors for men only, whereas older age and a high suicidal intent (Beck SIS score) were female ones. Major depression was a risk factor for both sexes. More attention probably needs to be paid to the importance of gender in assessment of suicide risk and treatment of suicide attempters.

Long-term risk factors for suicide mortality after attempted suicide--findings of a 14-year follow-up study.

To determine the risk of suicide over a 14-year follow-up period, and to investigate the long-term risk factors for suicide using survival analysis. Data were collected on all unselected deliberate self-poisoning patients (n=1018) treated during 1983 in the emergency unit of Helsinki University Central Hospital. By the end of the 14 -year follow-up period 222 (21.7%) of these patients had died. Sixty-eight (6.7%) had committed suicide; 44 (9.2%) men and 24 (4.5%) women. The long-term risk factors for suicide were male sex, previous psychiatric treatment, previous suicide attempts, somatic disease and a self-reported 'wish to die' motive for the index suicide attempt. The essential risk factors for suicide were being male and having previous suicide attempts. In addition, history of earlier psychiatric treatment, presence of somatic disease and genuine intent to die in the index suicide attempt suggest that the long-term risk has remained high for over a decade. The findings emphasize the need for long-term planning and treatment of suicide attempters met in the emergency room of general hospitals.

One-year follow-up of significant others of suicide attempters.

In a previous study we interviewed significant others (SOs) directly following a patient's suicide attempt as a part of the psychiatric assessment. SOs added important information to the assessment and they needed professional counselling themselves. In the present study the opinions of SOs were investigated 1 year after a suicide attempt. Semi-structured interviews of 84 SOs (93% of a consecutive series) were performed by telephone, focusing on the patient's situation, their own involvement in care and treatment as well as their own well-being and need for support. Forty-four percent of the SOs were parents, 27% partners and 29% persons with other relationships. An independent researcher interviewed the patients. According to SOs, 63% of the patients had mental health problems and 80% had other kinds of problems (e.g. relationship problems, financial problems, unemployment and substance abuse) at follow-up. A majority of SOs were worried that the patient was going to hurt their self again. There were differences in the information given by patients and SOs concerning suicide attempts during the follow-up period. Many SOs had questions about the suicidal behaviour, and nearly half of the SOs reported that they had not talked to the patient about the index suicide attempt. Nearly half of the SOs would like to have had professional counselling, preferably shortly after the suicide attempt. Two-thirds of the inpatient SOs and 90% of the outpatient SOs had not been involved in the patient care and treatment, although a majority of them desired such involvement. The well-being of the SOs was generally good, except for a small subgroup. The findings of this study provide further evidence that SOs contribute valuable information about the patient after a suicide attempt. They also point strongly to the fact that SOs themselves need support. Insufficient communication between patient and SOs indicates the need for joint counselling directly after a suicide attempt in order to reduce some of the burden and stress experienced by SOs.

Deliberate self-poisoning: treatment follow-up of repeaters and nonrepeaters.

Since 1986 psychiatrists and social workers of the Lund Suicide Research Center have investigated subjects admitted to the medical intensive care unit after a suicide attempt. Fifty-nine of 79 deliberate self-poisoners were interviewed 12 months after a suicide attempt. Twenty-one had previously been interviewed 6 months after the index suicide attempt. We obtained minor information on 8 subjects. Two patients had committed suicide. Sixteen subjects (27%) of those who were interviewed showed repeated suicidal behavior (repeaters) during the 1-year follow-up, and their psychiatric diagnoses at the index attempt were most commonly alcohol abuse and dysthymia (DSM-III, Axis I). Compared with nonrepeaters, repeaters had more often made previous suicide attempts, their index attempt was less serious and they were more often in psychiatric treatment at index. At follow-up, repeaters more often than nonrepeaters expressed the need for professional mental health support. Two-thirds of the patients were in treatment at follow-up. About half had remained in continuous treatment and most in psychiatric care for more than 1 year. Repeated self-poisoning occurred despite ongoing treatment. In view of the fact that numerous suicide attempters obviously remain in treatment for several years, we suggest further development and evaluation of long-term treatment strategies.

Outcome of attempted suicide and psychiatric consultation: risk factors and suicide mortality during a five‐year follow‐up

A total of 1018 self-poisoned patients were treated during the year 1983 in the emergency room of Helsinki University Central Hospital. By the end of a 5-year follow-up period, 3.2% of these had committed suicide, making annual suicide mortality 589 per 100,000. During the first year after the index attempt, suicide mortality was 1768 per 100,000, a 50-fold risk compared with that of the total population in Helsinki. Risk factors were being male of advancing age, having mental disorders, previous suicide attempts, a nonimpulsive index suicide attempt, moderate to very serious lethality and severe intention to die during the index suicide attempt. When the lethality was assessed as being very serious or intention to die as certain, 21% later committed suicide. The relative risk for those left without psychiatric consultation was 0.6 when the lethality was mild and 1.6 when it was severe. Results indirectly indicate that psychiatric consultation seemed to have a positive effect on the outcome of these attempted suicides.

Gender-Mediated Clinical Features of Depressive Illness the Importance of Temperamental Differences

In a consecutive clinical series of 538 subjects with primary mood disorders the male:female differences were most skewed (1:4) in recurrent unipolars, 1:2 in single episode and bipolar I subtypes, and about even (1:1) in bipolar II. The sexes did not differ in age at onset of depression, stressors preceding index episodes, endogenous features, psychotic symptoms, suicide attempts, and rates of chronicity. Females had lower mean number of hypomanic, and higher mean number of depressive, episodes. Females also exhibited more anxiety and somatisation, and were more likely to endorse psychopathological items on self-report instruments, which were not reflected in objective measures. Finally, they were more likely to have been admitted to hospital. These gender differences could in part be explained by the higher prevalence of the depressive temperament in women, and of the hyperthymic temperament in men.

Estimating suicide risk among attempted suicides. II. Efficiency of predictive scales after the attempt.

We predicted that the closer the resemblance of attempted suicide to completed suicide, the greater the risk of patients later killing themselves after an unsuccessful attempt. Using two risk scales, one of 6 and the other of 18 socio-demographic and clinical items, weighted according to their value in discriminating between suicides and attempted suicides, and a rating of intent to die during the index suicide attempt, we followed up 1263 attempted suicides for two years. Ten of the twelve suicidal deaths in the first year occurred in patients scoring in the top quartile on the 6-item scale; and among high-risk scorers there was an excess of those defined as 'failed suicides' at the index attempt. The 18-item scale was superior to the shorter one, but both scales were improved by taking into account the rating of intent-to-die. The potential value of these findings is discussed in the light of some inherent problems of predicting suicide in the clinical setting.

Categories of attempted suicide: a longitudinal study.

A series of 151 index suicide attempts was categorized on the basis of situation and motivation: (a) 56 per cent occurred in a state of heightened emotionality due to a relatively limited stress;(b) 9 per cent were characterized by a life crisis which seriously challenged the patient' emotional homeostasis; and (c) 35 per cent attempted suicide in relation to the symptomatology of a pre-existing serious psychiatric disorder. At the time of first contact, usually in the general hospital emergency room, 69 per cent were sent home, the remainder being admitted for medical care (18 per cent) or transferred to a psychiatric hospital (13 per cent). In follow-up ambulatory care, successful referral correlated with the intensity of staff efforts during the early post-attempt contacts. The findings suggest that a brief hospitalization, perhaps two to three days, might be regularly utilized as a bridgehead for further ambulatory care, particularly for stress category patients with a high appointment failure rate. In a two-year follow-up, 16 of the 151 index cases re-attempted and two committed suicide. At the time of the index attempt, 24 (16 per cent) were in ongoing treatment. Among these 24 patients were many substance abusers and prior attempters as well as the two committed suicides of the follow-up period. Ongoing treatment should be weighed as a high risk factor suggesting particular caution in arranging the disposition for such patients.

Adolescents in Distress: Suicide and Out-of-Control Behaviors

While previous studies have examined motivational aspects of self-directed violence, few studies have included specific motivations in predictive models for future suicide attempts. The current study utilized a sample of 160 individuals treated in an acute emergency setting following a suicide attempt who completed an interview battery that included an assessment of functional aspects of the index suicide attempt. A follow-up interview was conducted at 6 months to ascertain subsequent suicide attempts. The functional domains of suicide attempts were labeled as reduction-of-distress, communication, perceived better alternative to living, and self-loathing. Above and beyond other known risk factors, including history and highest lethality of previous self-injury, suicide attempts that served a communication function (OR = 0.18, p = .02, CI = 0.04, 0.73) and higher ratings of clinical dysfunction (OR = 3.41, p = .05, CI = 1.02, 11.36) were associated with a significant reduction in likelihood to engage in a suicide attempt during the 6-month follow-up window. Including the perceived effectiveness of the index suicide attempt in getting one’s needs met strengthened the overall model predicting a suicide attempt in the follow-up window and was an independent risk factor above and beyond other variables in the model OR = 1.75, p = .04, CI = 1.02, 3.01). Assessment of functional aspects of suicide attempt is feasible and may improve formulation of risk in a population where typical risk factors for suicide are ubiquitous.