Suicide Reattempt Research Articles

Development and validation of the Assessment for Repeated Suicide

AbstractIntroductionThis study developed and validated a multidimensional measure, the Assessment for Repeated Suicide (ARS), to assess suicide risk and predict future suicidal attempts within psychiatric populations who have previously attempted suicide.MethodsA prospective case‐control study was conducted in a medical center between August 2004 and July 2007. Two stages were involved. Stage 1 involved the development of a 20‐item scale, the ARS, which was derived from 70 items based on expert validation. The 20‐item scale was then administered on suicide attempters enlisted from the emergency department (suicidal group) and non‐suicide attempters who were from the outpatient and inpatient units of the psychiatry department (control group). The factor structure of the new scale encompassing reliability and validity, were assessed. Stage 2 assessed the predictive validity of the ARS instrument at a one‐year follow‐up.ResultsPsychometric analyses indicated that the new scale, the ARS consisted of 19 items and had a four‐factor structure. Construct validity, concurrent validity and criterion validity were found to be good, and internal consistency and reliability were found to be satisfactory. The ARS itself and the subscale negative ideation were identified as useful predictors of suicide re‐attempts.DiscussionThe ARS is a valid instrument for assessing the risk of suicide attempts and re‐attempts. It has the advantage of integrating important psychological factors that are associated with suicide in the form of clinical interviews.

Community-Based Case Management for the Prevention of Suicide Reattempts in Kaohsiung, Taiwan

Although a previous suicide attempt constitutes a major risk factor for an eventual completed suicide, few interventions specifically designed to prevent suicide reattempt shave been evaluated. The aim of this study was to determine the effectiveness of case management for the prevention of suicide reattempts. A total of 4,765 subjects with a recent suicide attempt referred from medical and non-medical organizations were consecutively recruited from July 2006 to June 2008. The suicide prevention program of Kaohsiung Suicide Prevention Center (KSPC)provided case management and followed up suicide attempt cases for 6 months. Survival analysis showed that the risk of suicide reattempt was significantly lower in the case management group than in the non-contact group throughout a six-month follow-up period (hazard ratio =2.93; 95% CI = 2.47–3.47). The hazard ratio (HR) of the Cox proportional hazard model for sex was 0.77 (95%CI = 0.65–0.91). Case management appears to be effective in preventing suicide reattempts in patients with a recent prior attempt. In addition, case management appeared to be more beneficial in preventing suicide reattempts in male subjects.

Incidence and risk factors of suicide reattempts within 1 year after psychiatric hospital discharge in mood disorder patients

BackgroundThe incidence and risk factors of suicide reattempts within 1 year after psychiatric hospital discharge in mood disorder patients remain uninvestigated in Thailand.ObjectiveTo determine incidence and risk factors of suicide reattempts within 1 year after psychiatric hospital discharge in mood disorder patients.MethodsA retrospective cohort study was conducted by reviewing medical charts at Suanprung Psychiatric Hospital, Chiang Mai, Thailand. Mood disorder patients, diagnosed with the International Statistical Classification of Diseases and Related Health Problems 10th Revision codes F31.x, F32.x, and F33.x, who were admitted owing to suicide attempts between October 2006 and May 2009 were eligible. The influence of sociodemographic and clinical risk factors on suicide reattempts was investigated using Cox’s proportional-hazards regression analysis.ResultsOf 235 eligible mood disorder patients, 36 (15.3%) reattempted suicide (median 109.5 days, range 1–322), seven (3.0%) completed suicide (median 90 days, range 5–185), and 192 (84.2%) neither reattempted nor completed suicide during follow-up. Of all nonfatal suicide reattempts, 14 patients (38.9%) did so within 90 days. Among suicide completers, one (14.3%) did so 5 days after discharge, and four (57.1%) did so within 90 days. The following three risk factors explained 73.3% of the probability of suicide reattempts: over two previous suicide attempts before the index admission (adjusted hazard ratio [HR] 2.48; 95% confidence interval [CI] 1.07–5.76), being concomitantly prescribed typical and atypical antipsychotics (adjusted HR 4.79; 95% CI 1.39–16.52) and antidepressants, and taking a selective serotonin reuptake inhibitor alone (adjusted HR 5.08; 95% CI 1.14–22.75) or concomitantly with norepinephrine and/or serotonin reuptake inhibitors (adjusted HR 6.18; 95% CI 1.13–33.65).ConclusionApproximately 40% of suicide reattempts in mood disorder patients occurred within 90 days after psychiatric hospital discharge. For mood disorders and when there have been over two previous suicide attempts, prescribed antipsychotics or antidepressants may help predict suicide reattempts.

Factors associated with referral to mental health services among suicide attempters visiting emergency centers of general hospitals in Korea: does history of suicide attempts predict referral?

ObjectiveThis study examined whether a history of past suicide attempts was a critical factor for referral to mental health services among suicide attempters visiting emergency centers of general hospitals in Korea. MethodIn this cross-sectional study, a resident of emergency medicine at each emergency center interviewed 310 suicide attempters visiting five tertiary general hospitals located in Seoul, using standardized questionnaires, during 7 months in 2007. We examined associations between suicide attempt history and referral to mental health services via multiple logistic regressions. ResultsSubjects' rate of referral to mental health services was 47.3%. When we controlled for participant age, time of arrival at the emergency center, psychiatric treatment history, use of alcohol, suicide attempt lethality and subjective expectation to suicide attempts, past suicide attempts did not predict referral to mental health services (odds ratio=1.74; 95% confidence interval .88–3.43). ConclusionPsychiatric interventions for suicide reattempters visiting emergency centers are important for preventing suicide, but providers have not considered suicide attempt history as a critical factor for referral to mental health services. Therefore, we suggest that more effort is needed to systemize psychiatric interventions for suicide reattempters at emergency centers in Korea.

Outcomes of a Two-Tiered Multifaceted Elderly Suicide Prevention Program in a Hong Kong Chinese Community

Objectives1) To compare the 2-year completed suicide and reattempt rates in a preintervention group of Hong Kong Chinese suicide attempters (aged 65 years and older) who received standard care and a postintervention group enrolled in a regional elderly suicide prevention program (ESPP) that adopts a two-tiered multifaceted care management model and 2) to examine the trend of suicide rates in older adults aged 65 years and older in the pre- and postintervention periods.DesignThe first part is an observational cohort study with baseline, follow-up, and outcome data being identified from a clinical electronic registry. The second part examines changes in suicide rates from official mortality statistics.SettingA government-funded suicide intervention program serving catchment population (852,796 people aged 65 years and older) in Hong Kong, China.ParticipantsSuicide attempters (aged 65 years and older) presenting to old-age psychiatric service in the pre- and postintervention phases.Measurements1) Two-year rates of completed suicide and suicide reattempt and 2) changes in population suicide rates in the pre- and postintervention periods.ResultsThe 2-year completed suicide rate was 7.58% in the preintervention group (N = 66) and 1.99$% in the ESPP group (N = 351) χ2 = 6.192; p value: 0.028; df = 1). Reattempt rates were not different. At a population level, suicide rate dropped significantly only in women aged 85 years and older, relative to the preintervention period.ConclusionsThe ESPP was associated with a reduced rate of completed suicide in old-age suicide attempters and might have contributed to a fall of suicide rate in women aged 85 years and older.

P03-296 - Factors associated with psychiatric visit after emergency care at the emergency room following suicide attempt

IntroductionSuicide is a serious phenomenon associated with psychiatric disorders.ObjectivesIn the present study, we investigated factors that can predict follow-up at the psychiatric clinic after medical care at the emergency room (ER).MethodsMedical records of the 145 patients treated at the ER following suicide attempt from Jan 1, 2009 to July 31, 2009 were reviewed. Age, sex, past psychiatric history, impulsiveness and medical severity of suicide attempt, risk-rescue rating scores, reasons for suicide attempt and methods of suicide were examined. Psychiatric diagnoses were made by psychiatrists at the initial interview with patients at ER.ResultsThe mean age of the patients was 42.9 ± 15.7 years, and 68.3 % were women and 31.7% were men. Among the suicide methods, psychotropics were the most common (69%), and ingestion of pesticides was the second (19.3%). Interpersonal problems were the most common precipitating event (57.9%), and depression was the most common (89%). About a half had previous psychiatric disorders and about one third had previous suicide attempt. Fifteen patients (10.3%) attempted planned suicide and 124 patients (85.5%) attempted impulsively. Mean risk and rescue rating scores was 8.6 ±1.6 and 12.3 ± 2.2. About one third had a follow-up psychiatric visit. The most important predictor of psychiatric follow-up was risk rating scores.ConclusionsThis study suggests that women with interpersonal problems and depression should be carefully monitored to reduce suicide attempt. Patients commit less risky suicide attempts tend to more loss to psychiatric follow-up, thus, need more attention to prevent suicide re-attempts.

In This Issue

In This Issue

Psychiatric telephone contact following emergency department discharge reduces suicide re-attempts in people originally admitted for attempted suicide

Vaiva G, Ducrocq F, Meyer P, et al. Effect of telephone contact on further suicide attempts in patients discharged from an emergency department: randomised controlled study. BMJ 2006;332:1241–5. . ....

Alcohol problems, mental disorder and mental health among suicide attempters 5–9 years after treatment by child and adolescent outpatient psychiatry

Many studies report associations between alcohol problems, mental disorder, mental health and suicidal behaviour. Still, more knowledge is needed about possible differential characteristics of these factors in risk groups. This naturalistic and retrospective study included former patients who received emergency treatment in child and adolescent outpatient clinics for their mental health problems. One hundred patients were personally interviewed 5–9 years after treatment referral about alcohol problems and mental disorders. Also, they completed questionnaires about 11 indicators of mental health. At the follow-up, those who had attempted suicide during the follow-up period had more alcohol problems and mental disorders than the non-attempters. However, no association was found between suicide attempt in the follow-up period and the mental health indicators. Among the attempters, a high psychological burden as indicated by mental health disorders and poor mental health were associated with suicide re-attempt (lifetime) and an intention to die.

Child-Father Interaction May Predict Suicide Reattempts

Child-Father Interaction May Predict Suicide Reattempts

Long-term follow-up after severe suicide attempt by multiple blunt trauma

Objective. – After parasuicide there is a high risk of reattempts. However, it seems that patients who survived severe suicidal trauma recover well. Therefore, the outcome of patients with severe multiple blunt trauma as a result of a suicide attempt was investigated with respect to psychiatric and somatic health, quality of life (QOL) and suicide reattempt rates. Methods. – Patients who underwent a suicide attempt were isolated from a prospectively collected sample of trauma patients from a level I University Trauma Centre. Follow-up examination was performed 6.1 ± 3 years after the trauma. A physical and psychiatric examination was performed, using established psychiatric scales. Results. – Twelve percent of severely injured patients were identified as suicide attempters (male/female: 37/28, mean age 38 ± 18 years, mean Injury Severity Score (ISS) 40 ± 15 points). A psychiatric diagnosis was present in 90% at the time of the suicide attempt. Twenty-one patients died during the hospital stay (32%) and six subjects died thereafter, none due to suicide. Thirty-five individuals were eligible for examination. None of them had reattempted suicide. Seventeen (48%) had good outcomes reflected by absent or ambulatory psychiatric treatment, employment, normal psychiatric findings and good psychosocial ability. An indeterminate outcome was determined in 24%. Predictive variables for an adverse outcome (10 patients, 28%) were found to be a diagnosis of schizophrenia, continued psychiatric treatment and being without employment. Conclusion. – Despite the seriousness of the suicide attempt, survivors recovered well in about half the cases with no further suicide attempt in any patient. An early psychiatric consultation already on the Intensive Care Unit (ICU) is recommended.