Previous Parasuicide Research Articles

In-depth analysis of clinical case study on parasuicide counselling in Dhanvantri critical care center at Erode

Parasuicide is an apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death. Parasuicide is considered to be a serious public health issue. Previous parasuicide is a predictor of suicide. The increased risk of ensuing suicide sustains without decline for at least two decades. Other researchers also eke that those who attempt suicide with the intent to kill themselves can be defined as parasuicide. Studies have found that about half of those who commit suicide have a history of parasuicide. Parasuicide is utmost common in adolescents and young adults. This clinical case study focuses on counselling for parasuicidal early adulthood clients.

Analysis of parasuicide, psychiatric care and completed suicides, implications for intervention strategy (Czech Republic, 1996–2000)

This retrospective study analyses the differences between suicide with and without previous parasuicide. The Czech Republic was one of the countries with the traditionally highest level of suicide mortality. During collapse of the communist regime and deep societal changes in the Czech Republic after the year 1989 the escalation of suicides was expected. Mortality from suicides decreased, however the gender and age differences increased. A total of 2,711 suicides in the Czech Republic (1996-2000) were studied. Effects of socioeconomic characteristics, psychiatric diagnosis and care, and lifetime history of parasuicide on the risk of death from suicide were estimated using logistic regression. Twenty-three percent of persons who committed suicide had a prior history of parasuicide and almost twenty percent of them received no psychiatric care after the attempt. Young males with basic education, economically active and diagnosed with substance abuse related disorders and the elderly were least likely to receive psychiatric care before their suicide death. Implications for age specific primary and secondary prevention are discussed.

Case-control study of unemployment and parasuicide

Objective The objective of the study was to estimate the odds ratio for the association between unemployment and parasuicide, controlling for potential confounding variables. Methods A case-control study was conducted involving 507 cases of parasuicide and 200 age- and sex-matched controls presenting to emergency departments in Edmonton, Canada. Subjects were interviewed using an extensive questionnaire developed for a World Health Organization study of parasuicide. The data were analyzed using conditional logistic regression. Results In a crude analysis, the odds ratio for the association between unemployment and parasuicide was 12.0 (95% confidence interval, 6.0-23.9). After controlling for sociodemographic factors, lifetime prevalence of several Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, disorders, previous parasuicide, hopelessness, childhood experiences, and emotional support from family and friends, the odds ratio was 5.2 (95% confidence interval, 2.3-11.4). Conclusions Those who are unemployed have an increased risk of parasuicide, and this association persists after accounting for a wide range of potential confounders.

The Epidemiology of parasuicide in Canary Islands

Objective: To analyze the epidemiology of parasuicide in Canary Islands. Methods: Emergency Department reports at every Hospitals and clinical data of all Mental Health Units were revised in Tenerife (1992-1996) and in Gran Canaria (1994-1996). Data about age, sex, address, educational level, marital status, job situation, time and methods used for committing parasuicide and previous parasuicide events were collected. Results: In Tenerife Island the annual average was 355 parasuicides among which 24.9% of the episodes were repeaters. The average crude rate was 70.99 cases per 100.000 inhabitants and the standardized rate was 61.81. In Gran Canaria Island the annual average was 634 and 21.3% were repeaters. The average crude rate was 120.23 per 100.000 and the standardized rate was 103.7 per 100.000. The age group 15-34 years, showed the higher rate values. Women presented higher rates as compared to men in all age categories. Conclusion: These findings are in agreement with those of the WHO-EURO Multicentre Project on Parasuicide. We found in Tenerife the lowest parasuicide rate values published in Europe.

Suicidal behaviour in early psychosis

This was to determine the prevalence of suicidal behaviours prior to and during the first year of treatment in a comprehensive early psychosis program (EPP) and to identify predictors of suicidal behaviour. In a cohort study of 238 subjects, patients were assessed at initial presentation to an EPP and 1 year later. Measures included a range of demographic variables, suicide attempts, depression, positive and negative symptoms, social functioning and substance misuse. Although 15.1% attempted suicide prior to program entry, only 2.9% made an attempt in the year after program entry and 0.4% completed suicide. No further attempts were seen in those with previous parasuicide. These rates are lower than other published rates for first-episode patients. It is possible that specifically designed first-episode programs can reduce the suicidal behaviour in this high-risk population. The low prevalence of attempted suicide makes modeling predictors difficult.

Psychiatric morbidity in prisoners and solitary cellular confinement, II: special ('strip') cells

Placement of prisoners in 'strip' cells has been criticized as inappropriate for those with psychotic symptoms and at risk of suicide and self-harm. A national survey confirmed that prisoners who reported having been placed in special cells had extensive histories of previous psychiatric treatment, parasuicide and diagnoses of depression and schizophrenia. They were more likely to have cluster A and C Axis II personality disorders and criminal histories of arson and sexual offending. Current policy for mentally disordered prisoners who pose risks to themselves and others reflects the lack of more appropriate facilities for disturbed mentally disordered individuals in prison and psychiatric hospitals, and the failure of 'diversion' to NHS psychiatric inpatient facilities. In future, all prisoners placed in 'strip' cell conditions should receive specialist psychiatric assessment.

Can the Edinburgh Risk of Repetition Scale predict repetition of deliberate self-poisoning in an Australian clinical setting?

This study tested the ability of the Edinburgh Risk of Repetition Scale (ERRS) to identify patients at high risk for repeat deliberate self-poisoning (DSP). Consecutive DSP patients (N= 1,317) over a 3-year period were followed-up for 12 months. A statistically significant relationship between ERRS scores and repetition was observed; however, sensitivity and specificity were low. Logistic regression analysis revealed only "previous parasuicide" contributed significantly to repetition. The ERRS had limited value in identifying patients at high risk of repeat DSP in this clinical population.

Perceptions of the environment, suicidal ideation and problem‐solving deficits in an offender population

Purpose. This study was designed to explore relationships that exist among suicidal ideation, perceptions of the prison environment and problem‐solving deficits in an offender population.Method. Participants were 46 male offenders in two separate prisons in the Republic of Ireland. A semistructured interview ascertained demographic and personal history details. Participants were (i) non‐ideators with no previous parasuicide history (control group), (ii) non‐ideators with a past parasuicide history (past parasuicide group), and (iii) current ideators. Participants completed the Beck Depression Inventory II, Beck Hopelessness Scale, Beck Suicidal Ideation Scale, Means‐Ends Problem‐Solving Scale and Prison Preference Inventory.Results. Participants in the current ideator and past parasuicide groups had significantly higher preferences for privacy and significantly lower preferences for social stimulation within the prison environment than did the control group. There were no significant differences in the number of problem‐solving means produced among the three groups. Participants in the control group offered significantly more active relevant problem‐solving means than did participants in the other two groups. The current ideator group produced significantly more passive relevant problem‐solving means than did the past parasuicide and control groups.Conclusions. The significant differences in perceptions of the prison environment may be indicative of different coping mechanisms used to adapt to time in prison. It is concluded that the lack of significant differences in the generation of passive relevant problem‐solving means are related to parasuicide history. The lack of significant differences in the number of problem‐solving means produced is accounted for by the prevalence of problem‐solving deficits among an offender population.

A review of the literature on the epidemiology of parasuicide in the general population.

The author reviewed recent literature on the epidemiology of parasuicide in the general population. Major risk factors are also discussed. Parasuicide was defined as suicide attempts and deliberate self-harm inflicted with no intent to die. Articles in English on rates of parasuicide in the general population from 1970 through June 2000 were identified by keyword searches of the PsycINFO and MEDLINE databases. Studies that provided data from a representative population sample and provided incidence or prevalence rates were included in the review. Articles focusing on subsamples such as adolescents or psychiatric patients were excluded. Twenty studies were analyzed. Although methodological problems constitute a major limitation in interpretation of the results, the literature indicates that parasuicide is a serious public health problem. Reported annual rates of parasuicide in recent decades range from 2.6 to 1,100 per 100,000, and lifetime prevalence rates range from 720 to 5,930 per 100,000. The most important risk factors identified were younger age and female gender. Others included being single or divorced, being unemployed, having a recent change in living situation, having a mental disorder, and having a previous parasuicide incident.

Repetition of parasuicide--ICD-10 personality disorders and adversity.

Patients with a history of previous parasuicide were compared to those who had made their first attempt. A scale for suicidal ideation derived from the Scaled Version of the General Health Questionnaire was completed by patients. ICD-10 personality disorder diagnoses were derived from the Standardized Assessment of Personality which was administered to knowledgeable informants. Logistic regression showed that unemployment, increasing severity of suicidal ideation, previous psychiatric treatment and borderline personality disorder increased the risk of reports of previous parasuicide. Anankastic personality disorder decreased the risk of reports of previous parasuicide. Unemployment and specific personality disorders have independent risks for repetition of parasuicide. Specific ICD-10 personality disorders may increase or decrease the risk for repetition of parasuicide.

Prediction of repetition of parasuicide: with special reference to unemployment.

Economically active male parasuicides admitted to the Regional Poisoning Treatment Centre, Edinburgh in 1984 were divided into two groups--those with a previous history of parasuicide and those without. The two groups were compared on a number of psychosocial and clinical characteristics to examine which were related to repetition. A further analysis (of economically active male admissions in 1985 and 1986) tested the predictive value of these discriminating characteristics. By stratification of the population, the interaction of unemployment (a discriminator and a predictor of repetition) with certain other variables was examined. A final analysis examined the risk of repetition by duration of unemployment. Unemployment discriminated those with a past history of repetition from those with no past history and also predicted repetition within a calendar year of the initial episode. The 35-64 age group were particularly vulnerable to repetition if unemployed as were those in social classes I-III and those with a past psychiatric history (inpatient or outpatient). The relationship between unemployment and parasuicide was no longer significant when the population was stratified by presence or absence of personality disorder and history of previous parasuicide, suggesting that these might be confounding variables in the relationship. The particular vulnerability of the long-term unemployed (greater than one year) to repetition was confirmed.

Youth suicides unknown to psychiatric care providers.

Less than 50% of young suicides have consulted psychiatric care providers. Thus the population not found within the psychiatric care sector is described in this paper. Fifty-eight consecutive suicides among adolescents and young adults, studied by psychological autopsies, were classified according to presence or absence of previous psychiatric care. Fifteen of the sixteen subjects without previous care were males, six of these were diagnosed as having an adjustment disorder related to a recent event. Unemployment was less common (p < 0.01), the suicidal processes were shorter (p < 0.001), and previous parasuicide was less frequent (p < 0.001) among nonpatients. Evaluation in accordance with DSM-III-R criteria showed fewer substance abuse disorders (p < 0.01). Open suicidal communication prior to the suicide was less frequent but active methods were used by this population as often as by subjects known to care providers.

Suicide in psychiatric patients: risk and prevention.

The prevention of suicide requires an understanding of protective as well as risk factors, and the recognition of high-risk groups. Factors which increase the risk in patient populations include previous parasuicide, recent relapse or discharge, features of mental state (depression, psychosis), social circumstances (isolation, unemployment), and demographic characteristics (male sex, young age). Protective factors are under-researched but are likely to lie in the nature of psychiatric care. Consequently, community care may affect suicide by altering the level of protection at critical periods in an episode of illness. The clinical prevention of suicide should therefore be a priority for community services, and the relationship between suicide and mental health care should be researched by a national process of monitoring.

Problem Resolution and Repetition of Parasuicide

Resolution of presenting problems at three-month follow-up was studied in 228 parasuicides. 'Non-resolvers' presented with less severe problems, but prodromes were longer, prior episodes more frequent, and they experienced more powerlessness and internally directed hostility than the resolvers. At follow-up resolvers had improved more on measures of depression, externally and internally directed hostility, locus of control, powerlessness, self-esteem, sensitivity to criticism, and social adjustment. Baseline problem severity, powerlessness (negatively), and 'normlessness' 'predicted' degree of problem resolution, while baseline problem severity, the number of previous parasuicide episodes, and baseline internal hostility (the latter two variables negatively) were associated with problem resolution as a dichotomous variable. Resolvers improved more in social functioning during the follow-up than non-resolvers, but a similar proportion (16%) in each group reported repeat episodes of parasuicide at follow-up.

Predictive scales for parasuicide repetition. Further results

A six-item predictive scale for parasuicide repetition was retested on a second sample of Italian parasuicides. All the patients firstever admitted after a deliberate self-harm to the psychiatric department of a general hospital during the period April 1973-March 1976 were interviewed and followed-up after an interval of 1 year. The scale showed the same predictive power found in the first sample (1970-73) and gave a range of probability of repetition within 1 year of 15% at a score of 0 up to 44.8% at the scores 3, 4, 5, and 6. Moreover it discriminated between repeaters and non-repeaters at a significant level. Only two items (diagnosis of sociopathy and change of domicile in the last year) of the five items which discriminated repeaters from non-repeaters in the first study were still significantly associated with repetition, while four additional items (previous in-patient psychiatric treatment; previous parasuicide resulting in hospital admission; unemployment; criminal record) appeared as new discriminating factors. In spite of these changes the rate of repetition remained constant over the years at around 26%.

Aspects of suicide and parsuicide.

Five aspects of suicidal behaviour in Edinburgh from 1968 to 1974 were examined. The data referred to 478 suicidal deaths and to parasuicide (attempted suicide) admissions to the Regional Poisoning Treatment Centre (R.P.T.C.). Firstly: 28% of suicides were found to have had a parasuicide admission and there was some evidence of a slight excess of deaths in the years immediately following parasuicide. Secondly: among suicides preceded by parasuicide, those with a recent episode (within 2 years of death) were found to be essentially similar to those with a longer interval. Thirdly: a history of previous parasuicide at any time was found to be important in delineating two groups of suicide. Suicides with prior parasuicide died more often from poisoning with drugs and were more likely to have a history of psychiatric treatment; suicides without prior parasuicide died more often from poisoning with domestic gas or violent means, were older, of higher social class and less often married. Fourthly: parasuicides who killed themselves within 2 years of admission to the R.P.T.C. were compared with a group of (broadly nonsuicidal) parasuicides. And lastly: a scale predictive of repetition of parasuicidal behaviour was used in an attempt to distinguish parasuicides who killed themselves from those who did not. The scale did not discriminate between the two groups.

Cross-validation of a predictive scale for subsequent suicidal behaviour in an Italian sample.

A six-point prodictive scale for parasuicide repetition developed by Buglass and Horton (1974a) was tested on a group of patients admitted for parasuicide to a psychiatric ward of one of the city hospitals of Verona. The scale gave a range of probability of repetition within 12 months of 15 per cent at a score of o up to 45-5 per cent at the scores 3, 4, 5 and 6. Moreover the scale discriminated significantly between repeaters and non-repeaters. Items significantly associated with repetition in the Italian sample, which are not represented by the six-point scale were: previous parasuicide not admitted to hospital, violence received, alcohol taken at time of act, less than one year at the present address.