Age and attempted suicide

Clinical and demographic factors associated with suicide attempts admitted to the West Midlands Poisons Unit over a 2-year period were compared by age group. Risk factors for future suicide (living alone, physical illness, psychiatric illness and high suicidal intent in the attempt) were significantly more common among elderly patients (65 years and over) than middle-aged patients (35-64 years) and significantly less common among young patients (under 35 years) than middle-aged patients. Elderly patients that attempted suicide resemble elderly patients that completed suicide and should be considered at high risk of future suicide.     

The prevalence of aborted suicide attempts among psychiatric in-patients

We report the prevalence of aborted suicide attempts in which the essential characteristics are (i) intent to kill oneself, (ii) a change of mind before making an actual suicide attempt and (iii) the absence of physical injury. The lifetime history of aborted suicide attempts was assessed by semi-structured interview of 733 patients, aged 18–59 years, who were consecutively admitted to a psychiatric hospital. In the study group, 46% of subjects had made a suicide attempt and 29% had made at least one aborted attempt during their lifetime. Subjects who had made aborted attempts were more likely to have made actual attempts. Approximately 11% of the subjects in the study group had a history of aborted attempts of potential high lethality, such as going to a height in order to jump, or holding a gun to the head. There were no major demographic differences between those with and without a history of aborted attempts. However, among those with no prior history of actual attempts, subjects with depression and a family history of suicide were more than twice as likely as those without such a history to have made an aborted attempt. Aborted suicide attempts are a common suicidal behaviour among psychiatric in-patients. Whether they predict actual attempts or suicide warrants prospective investigation.     

Attempted suicide predicts suicide risk in mood disorders

Suicide risk was studied in a sample of 346 mood disorder inpatients, 92 of whom were admitted after a current suicide attempt. The overall suicide mortality after a mean observation period of 6 years was 8%. The potential of attempted suicide to predict suicide risk in hospitalized patients with mood disorders was studied by survival analysis after subgrouping on the basis of whether a current suicide attempt had occurred or not. The suicide risk the first year after attempting suicide was 12% (11/92), compared with 2% (4/254) in the mood disorder subgroup with no current suicide attempt. The long-range suicide risk after a current suicide attempt in depression was 15% (14/92) as compared with 5% (13/254) among those without a current suicide attempt. It is concluded that a current suicide attempt in mood disorder inpatients predicts suicide risk particularly within the first year and should be taken very seriously.     

Survival analysis of suicide risk after attempted suicide

Survival analysis of suicide risk by sex and age after attempted suicide was studied in a cohort of 1573 suicide attempters referred to the psychiatric emergency room at the Karolinska Hospital from 1981 to 1988. The time course of suicide risk and the overall prognosis after attempted suicide and, in particular, the possible usefulness of sex and age as risk factors for the prediction of suicide risk after attempted suicide was analyzed. Nearly two thirds of the sample were women and most of the suicide attempters were young (in their twenties and thirties), and the median age was 35 years. The overall mortality after a 5-year mean observation period after attempted suicide was 11%, and the suicide mortality was 6 %. The suicide risk after attempted suicide among men (8.3%) was nearly twice the female suicide risk (4.3%). Age as a possible suicide risk factor was analyzed for each sex separately by median split subgrouping. It was concluded that both older and younger male suicide attempters are at high risk of suicide (7% and 10% respectively), and older women are at higher risk than younger (6%, vs 2%). The suicide risk is particularly high during the first year after the suicide attempt. The high suicide risk group of young adult male suicide attempters is one of the main feasible targets of psychiatric intervention research programs on suicidal behavior. Suicide among young men is a major cause of years of life lost.     

Personality disorder and suicide intent

Studies of suicide intent have found a link between seriousness of the attempt and personality. Following a parasuicide, 60 patients were assessed using measures of depression, suicide intent and personality. Personality disorder was found to be present in over 65% of these and was mainly of explosive type. It was significantly more common in men than women and the dimension measuring sociopathy was equivocally linked to male gender. There were no other associations between gender and the other dimensions measured. Using a categorical approach to personality, suicide intent was not significantly different between the categories of personality; there was no correlation between dimensional or categorical measures of personality and suicide intent, when the severity of depression was controlled. By itself personality did not contribute significantly in determining variance in intent but it did interact significantly with age.     

Attempted suicide in hospitalised schizophrenics

A group of 25 hospitalised schizophrenics who had attempted suicide within the past year was compared with another group of 30 hospitalised schizophrenics who had not attempted suicide, using the PSE symptoms. The former had a significantly higher number of symptoms indicative of a depressive disorder. It is concluded that suicidal risk in schizophrenia is significantly raised when there are concomitant depressive symptoms.     

Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review

Objective: Involvement of personality traits in susceptibility to suicidality has been the subject of research since the 1950s. Because of the diversity of conceptual and methodological approaches, the extent of their independent contribution has been difficult to establish. Here, we review conceptual background and empirical evidence investigating roles of traits in suicidal behaviors. Method: We selected original studies published in English in MEDLINE and PsycINFO databases, focusing on suicidal ideation, suicide attempts, or suicide completions, and using standardized personality measures. Results: Most studies focused on investigating risk for suicide attempts. Hopelessness, neuroticism, and extroversion hold the most promise in relation to risk screening across all three suicidal behaviors. More research is needed regarding aggression, impulsivity, anger, irritability, hostility, and anxiety. Conclusion: Selected personality traits may be useful markers of suicide risk. Future research needs to establish their contributions in relation to environmental and genetic variation in different gender, age, and ethnocultural groups.     

Two subtypes of adolescent suicide attempters

An empirical classification of 203 adolescent suicide attempters (mean age 17.3) was achieved using multiple correspondence analysis. The characteristics upon which the classification is based concern sociodemographic as well as psychological variables. Two groups are identified: the first is predominantly characterized by recent problematic behaviors, whereas the second group is primarily characterized by problematic circumstances. Analyzing related variables, the first group seems to have special clinical and preventive interest, because of its high risk for recidivism. The second group seems to have a satisfactory level of functioning.     

Attempted suicide and suicide in functional psychoses.

A total of 2,243 first admissions to Gaustad Hospital between 1938 and 1961 diagnosed as functional psychotics were either followed up to the time of their death within 5 years, or observed over a period of 5 years, and then reexamined. Of these patients, 325 had attempted suicide prior to their admission. The frequency of attempted suicide was equal in both sexes. Men appeared to use more dangerous methods, and to have more serious intentions. The psychosis appears to have been of importance when considering whether, but not how the suicide should be attempted. The greatest risk of attempted suicide was to be found amongst patients with psychoses of a depressive nature. Twenty-eight of the 2,243 patients in this study committed suicide within 5 years following their discharge, and a further 20 took their own lives prior to the reexamination. A certain connection can be seen between attempted suicide and psychotic symptoms.     

Suicide risk in female suicide attempters not responding to a follow-up study

The 95 patients not responding to a follow-up study of 227 female suicide attempters differed from the responders in that fewer of them were undergoing psychiatric treatment at the time of the suicide attempt and fewer were referred for psychiatric outpatient aftercare following the suicide attempt. Yet, the subsequent occurrence of suicide was no higher in the group of nonresponders than in the group of responders. This study again underlines the difficulty of predicting recurrent suicidal behavior, even in a high-risk group of suicide attempters.     

Rates and correlates of suicide attempts in first-admission psychotic patients

The relationship of attempted suicide to demographic characteristics, current and lifetime psychiatric diagnoses, clinical history, and current symptoms was assessed in a sample of 184 recently hospitalized psychotic patients. Forty-three patients (23%) had an attempt history, and 28 (15% of sample; 65% of attempters) made an attempt during the episode for which they were hospitalized. Demographic characteristics did not distinguish attempters from nonattempters. Variables significantly associated with having ever attempted suicide were current diagnosis of unipolar major depressive disorder but not bipolar; lifetime major depressive episode; a history characterized by a less acute onset, lower pre-admission psychosocial functioning, and episodes of physical violence; and a symptom picture characterized by greater depression, hopelessness, negative symptoms, hallucinations and less thought disorder. Those with a current attempt had significantly higher rates of lifetime history of major depression and less physical violence than those with past attempts only. The potential importance of the data for predicting future suicidal acts is discussed.     

Risk factors associated with suicide attempt in young French people

Demographic data, personal and familial characteristics, as well as DSM-III-R-based psychiatric diagnoses were collected in 369 adolescents and young adults aged between 15 and 29 years, referred to an Emergency Department for psychological problems. In total, 60% of them were suicide attempters. Separations before the age of 12 years and depression in the family emerged as the main features distinguishing the suicidal group from the psychiatric control group. Fifty per cent of suicide attempters were repeaters. Fostering during childhood, suicide attempts and depression in the family were found to be risk factors for repeated self-attempts. These results support the view that significant levels of dysfunction, together with increased psychiatric morbidity, especially suicidal behaviour, characterize the families of young self-attempters.     

Age-specific characteristics of attempted suicide in adolescence

A total of 422 suicide attempts of adolescents (15 to 19 years of age) were investigated and compared with 327 suicide attempts of young adults. Adolescents had more serious social problems than young adults. Their adaptive problems became worse while growing older until the age of 20. Adolescents made suicide attempts with serious intent more often than young adults, but their suicide attempts were not as often lethal as in young adults. Although repeated suicide attempts were relatively common in both groups, only 10 people were part of both materials. Adolescents were as often psychotic when attempting suicide as young adults were. Twenty-four percent of adolescents and 26% of young adults were admitted to a psychiatric hospital as treatment.     

Attempted suicide: repetition and survival--findings of a follow-up study.

OBJECTIVE: This was a prospective follow-up study of suicidal patients to assess the influence over time of different risk factors, whether on completed suicides or reattempts. Survival analysis makes it possible to weigh the influence of variables that increase or decrease a patient's life span or that make reattempts less likely. METHOD: A cohort of 150 patients admitted to a psychiatric department after a suicide attempt was followed up over 10 years. The study protocol used standardized criteria, and periodic controls were carried out in all patients. RESULTS: In total, 12% of patients completed suicide, 10% died from natural causes, 75% were still alive and 25% reattempted. In the survival analysis the risk for completed suicide or reattempting was highest during the first 2 years after the index attempt admission. Global Assessment of Functioning (GAF) was the factor that most increased survival time. The number of previous attempts decreased survival time and increased the risk of reattempts. CONCLUSION: Since suicidal risk varied over time, intensifying contact with patients during periods of psychopathological change or life events could prolong their survival.     

Attempted suicide and depression in schizophrenia

The relationships between symptoms and both prior suicide attempts and current suicidal thinking were examined in a sample of schizophrenics at 2 points in time. Fifty subjects meeting DSM-III criteria for schizophrenia were assessed within 1 week of admission, and 41 were reassessed at a 6-month follow-up. On admission, prior suicide attempts were significantly associated with current depression, female sex, lower education and more frequent hospitalization. The association with depression remained significant at follow-up. In addition, current suicidal thinking was associated with depression at both times but also with negative symptoms at time 1 and delusions and hallucinations at time 2. These findings confirm and strengthen prior reports of an association between depression and attempted suicide.     

Suicide and violent death among adolescent suicide attempters

A total of 422 subsequent suicide attempts commited by 362 people 15-19 years old in the Helsinki area in 1973-1982 were investigated to find risk factors for subsequent suicide or violent death. By the end of 1982, 8.7% of 115 boys and 1.2% of 247 girls had died. Eight (2.2%) had committed suicide. The mean annual mortality for suicide and violent death was 20-fold compared with the mortality for suicide and violent death among people 15-19 years old in Finland at that time. The risk ratios of the boys for suicide (2.0) and for violent death (2.4) were greater than that of the girls (0.6 and 0.3 respectively). The risk ratio of psychotic persons for suicide was 4.2 and for violent death 4.1. Seriousness of intent heightened the risk, whereas degree of lethality did not influence it. The people who expressed clear-cut difficulties as a reason for their suicide attempt seemed to have a smaller risk for suicide or violent death than people whose reasons remained unclear. Attempted suicide among boys is a serious symptom for predicting subsequent suicide that should be addressed in suicide prevention.     

Premenstrual symptoms and luteal suicide attempts

Abstract. Objective: If premenstrual symptoms (PMS) are temporally and specifically associated with suicidal attempts, suicide attempts in women with PMS should occur more frequently in the luteal phase. Method: In a general hospital, 125 fertile female suicide attempters (and 83 blood donors as controls) with regular menstrual cycles were prospectively studied. A retrospective DSM-IV diagnosis of Premenstrual Dysphoric Disorder (PMDD) was made. Results: Attempts during the luteal phase were not more frequent in females with PMDD (34%,23/68) than in those without PMDD (35%, 20/57). The sample had enough power to detect medium and large effect sizes. As expected, there was a significantly higher frequency of PMDD in suicide attempters than in the controls (54% vs 6%; Fishers exact test, p 0.001). Conclusion: This study was limited by the use of retrospective PMDD diagnosis but suggests that PMDD may not be associated with suicidal acts during the luteal phase,when PMS are present.     

A unique monthly distribution of suicide and parasuicide through firearms among Israeli soldiers

The monthly distribution of completed suicide and parasuicide by Israeli soldiers was analyzed during the 7-year period of 1984–1990. Although parasuicide in general showed a constant incidence throughout the year, the monthly rate of suicide as well as parasuicide through firearms varied during the year in a similar way. The seasonal pattern of completed suicides, the vast majority of which occur with firearms, was correlated with the seasonal pattern of parasuicides through firearms. The combined variability of the two seasonal patterns was found to be significantly different from a pattern of a constant monthly incidence with a peak in December and a nadir in October. The monthly incidence of suicide and parasuicide through firearms was found to be negatively correlated with the duration of the daily photoperiod, when the latter was phase-advanced by 1–2 months. This unique pattern of seasonal incidence of suicide and parasuicide through firearms is different from most of the patterns reported in the Northern Hemisphere.     

The dexamethasone suppression test and completed suicide

The present study was undertaken to further explore the relationship between the dexamethasone suppression test (DST) and suicide. Depressed inpatients who had undergone the DST at index admission and later committed suicide (n = 13) were matched for age, gender, diagnosis, and type of DST (1 mg, 2 mg) with depressed inpatients from the same hospital and study time period to form 2 groups: a suicide attempter group (n = 25) and a nonattempter group (n = 28). The suicide completers group had significantly higher 1600 postdexamethasone cortisol levels than the suicide attempters group and a significantly higher 1600 rate of DST nonsuppression compared with the suicide attempter + nonattempter combined group. Although the rate of DST nonsuppression did not differ between the suicide attempter and nonattempter groups, serious attempters had significantly higher 1600 cortisol levels and a statistically higher proportion of patients who completed suicide than nonserious attempters.(ABSTRACT TRUNCATED AT 250 WORDS)     

The validity of proxy-based data in suicide research: a study of patients 50 years of age and older who attempted suicide. I. Psychiatric diagnoses

OBJECTIVE: To investigate the validity of best-estimate methodology for making psychiatric diagnoses among individuals who attempted suicide. METHOD: Subjects were 80 patients admitted for treatment following a suicide attempt. Psychiatric diagnoses based on structured interviews with subjects were compared with diagnoses made based on interviews with proxy respondents. In both cases, interview information was supplemented with pre-admission psychiatric and medical records to inform diagnoses. RESULTS: Diagnostic agreement, based on kappa coefficients, was substantial for major depression and bipolar disorders, and moderate for non-affective psychoses, organic mood and anxiety disorders. Agreement was substantial for substance dependence but poor for substance abuse disorders. CONCLUSION: Results support best-estimate methodology for making mood and substance dependence diagnoses in research of suicidal behavior in this age group, with potential implications for interpreting postmortem research of completed suicide.