Risk Of Subsequent Suicide Research Articles

Adolescent self-poisoning: a cohort study of subsequent suicide and premature deaths.

Previous self-harm has been identified as a risk factor for subsequent suicide by adolescents. The objective of the study was to identify further risk factors for subsequent premature death and suicide in a population of adolescents presenting with self-poisoning. A longitudinal cohort design using data-linkage of consecutive adolescent patients presenting to the Hunter Area Toxicology Service, a regional toxicology service for Newcastle, Australia, with the National Death Index of the Australian Institute of Health and Welfare was used. A total of 441 adolescents aged 10 to 19 years presented with self-poisoning over 5 years from January 1991 to December 1995, with follow-up to March 2001. There were 14 deaths total, eight of which were likely suicides. There was a 22-fold increase in suicide rate for males and a 14-fold increase for females compared with age-normalized population rates. Adjusted hazard ratios (95% CI) forpremature death were male gender 3.77 (1.11-12.78), nonaffective psychotic disorders 16.3 (3.83-69.34) and the mental illnesses of childhood 6.12 (1.68-22.23). There was a similar pattern for suicide: Male gender, nonaffective psychotic disorders, and the mental illnesses of childhood confer greater risk for subsequent suicide or premature death in this population.

Violent suicidal behavior and the thyrotropin-releasing hormone-thyroid-stimulating hormone test: a clinical outcome study.

A relation between abnormal response of thyroid-stimulating hormone (TSH) to thyrotropin-releasing hormone (TRH) and a personal history of violent suicidal behavior was observed in a sample of 60 depressive women. Patients with a blunted TSH response to TRH were also at greater risk for subsequent suicide. There was no relationship between TSH response to TRH and age, severity of depression and polarity of the illness.

Dealing with the suicidally inclined.

In England and Wales in 1980 there were 4314 suicides. This figure is probably an underestimate because of the well-known propensities of some coroners to avoid verdicts of suicide and to record them as accidental death and the like. In men and women under 35 suicide is among the top three causes of death and accounts for 10% of all deaths.1 Parasuicide (those surviving self-poisoning or self-injury) in this age group is the commonest cause of emergency referral to hospital in women and the second commonest in men. Parasuicide is 20-30 times more common than suicide and carries a risk of subsequent suicide 100 times that of the general population in the first year, and this remains raised for 10 years.2 An average general practitioner with a list of 2500 may expect a suicide every three to six years and five to six parasuicides annually. In Harrow Health District (where nearly 500 parasuicides are treated at Northwick Park Hospital every year?all seen by a psychiatrist) it was thought that more effective detection of risk factors and decision-making could reduce the mortality from suicide. A district working party was set up of which MWPC was a member. One of us (EMP) worked as a general practi? tioner trainee in both hospital and district. Doctors dealing with these patients are often young and inexperienced, whether they are trainee general practitioners, casualty officers, or psychia? trists. Furthermore, we are not aware of any publication giving terse, practical advice on identifying and weighing up risk factors or a decision-tree to be followed in management. To remedy these deficiencies we compiled these notes for the Harrow Health District. We hope they may be helpful to others. They are not a treatise on the complex aetiology of suicidal behaviour or on the purely medical management of self poisoning or deliberate self-harm. These topics are well reviewed elsewhere. We assume that in most districts, like Harrow, all parasuicides sent to hospital are seen by a psychiatrist who co-ordinates the acute management of the patient once he is out of danger from the physical effects of his self-poisoning or self-injury.

Near-death experiences and attempted suicide.

Attempted suicide is correlated with an increase subsequent risk of committed suicide. However, preliminary data and psychodynamic hypotheses suggest that serious suicide attempts followed by transcendental near-death experiences (NDEs) may decrease rather than increase subsequent overt suicide risk, despite the NDEs' apparent "romanticization" of death. Studies of NDEs and of their influence on suicidal ideation are proposed which may yield greater understanding of self-destructive urges and new strategies of suicide prevention.

SUICIDE AND PSYCHIATRIC CARE IN THE AGING.

A cumulative psychiatric case register to which all psychiatric experience for residents of a geographic area is routinely reported can facilitate unique investigation into the epidemiology of suicide. For example, the register provides an accurate mechanism for learning which of the persons who suicide had psychiatric contact. It is, thus, a method for obtaining data recorded prior to the event. The case records may provide further insight into the natural history of mental disorders leading to suicide and, thus, enhance predictability of potential suicide. Suicides who had previous psychiatric contact can be compared to those without such contact to determine features unique to each group. Persons who attempt suicide also can be followed prospectively through the register to study their subsequent psychiatric care and changing risk of suicide with the passage of time. In addition, the entire psychiatric register population can be followed indefinitely