Subsequent mortality in medically serious suicide attempts: a 5 year follow-up

OBJECTIVE: To document mortality in a consecutive series of 302 individuals who made medically serious suicide attempts and were followed-up for 5 years. METHOD: All sources of mortality were examined in a 5 year prospective study of 302 individuals who made medically serious suicide attempts. Mortality data were obtained by checks with the national mortality database and, for suicide and accidental deaths, were confirmed by review of coronial records. RESULTS: Within 5 years of making a medically serious suicide attempt, one in 11 (8.9%) participants had died. Most deaths (59.2%) were by suicide. Comparison of mortality in this series with rates expected in a comparable general population sample showed the excess mortality was attributable to death by suicide and by motor vehicle accidents. CONCLUSION: Mortality among those who make medically serious suicide attempts is high. These findings imply the need for the development of enhanced and long-term treatment, follow-up and surveillance programmes for those who make medically serious suicide attempts.     

Gender differences in medically serious suicide attempts: a study from south India

Studying gender differences in suicidal behaviour is important in developing specific need-based service provisions. We aimed to identify gender-specific characteristics associated with attempted suicide in a general hospital sample in south India. Two hundred and three patients admitted to medical wards following suicide attempts were assessed using a detailed clinical interview, measures of suicide intent (Suicide Intent Scale), lethality (Risk Rescue Rating), depression (Montgomery-Asberg Depression Rating Scale) and recent stress (Presumptive Stressful Life Events Scale). The majority of men attempting suicide were single. Men were more likely to use organophosphate poisons in their attempt to kill themselves and had higher rates of mental illness than women. As compared with men, women were more likely to come from rural areas, had a lower educational status, and had lower rates of employment outside the home. In women, the most common method of suicide attempt was by using plant poisons. Suicide attempt by self-immolation was significantly higher among women. Men had higher suicidal intent than women, although lethality, depression and stress were comparable between the genders. Rural women were more disadvantaged in education; however, in urban areas, men had higher psychiatric morbidity. Our results emphasise the need for a gender-specific approach among people who have attempted suicide.     

Risk and protective factors for medically serious suicide attempts: a comparison of hospital-based with population-based samples of young adults

OBJECTIVE: To investigate risk and protective factors for medically serious suicide attempts among young Australian adults. METHOD: The study used a case-control design. A clinical sample of 18-24 year olds was recruited via the emergency department of a large public hospital following a suicide attempt (n=95) and was compared to a sample of 18-24 year olds who participated in a population-based survey (n=380). RESULTS: Risk factors for medically serious suicide attempts included early school leaving, parental divorce (males only), distress due to problems with parents (females only), distress due to problems with friends, distress due to the break-up of a romantic relationship, tobacco use, high alcohol use, current depressive symptomatology and a previous diagnosis of depression. Protective factors included social connectedness, problem-solving confidence and locus of control. There was a trend for social connectedness to be more protective among those with high rather than low levels of depressive symptomatology, and among smokers rather than non-smokers. CONCLUSIONS: Results are discussed in terms of designing evidence-based suicide prevention activities for young adults.     

Suicide and serious suicide attempts in youth: a multiple-group comparison study

OBJECTIVE: This study compared risk factors for suicide and medically serious nonfatal suicide attempts among youth under 25 years of age. METHOD: Three groups were examined: individuals who committed suicide (N=60), individuals who made serious suicide attempts (N=125), and nonsuicidal community comparison subjects (N=151). Suicidal and nonsuicidal subjects were compared in terms of sociodemographic, childhood, family, psychosocial, and psychiatric factors. RESULTS: Suicides were characterized by male gender, lack of educational qualifications, mood disorder, history of mental health care, and stressful life events. Except for gender, similar risk factors were associated with serious suicide attempts. Suicides and serious suicide attempts were discriminated by gender and mood disorder. Gender differences between suicides and nonfatal suicide attempts were explained by gender differences in methods. CONCLUSIONS: The same risk factors (mood disorder, history of psychiatric care, educational disadvantage, stressful circumstances) play a similar role in suicide and serious suicide attempts. Suicide and suicide attempts are discriminated by mood disorder and gender differences in methods.     

Predictors of serious suicide attempts among patients with panic disorder

Of 74 panic disorder subjects followed up after 7 years, five reported serious suicide attempts and three had completed suicide. Compared with subjects who had not made serious attempts, the serious suicide attempters (including the three suicides) were younger, and fewer of them were married. Also, the serious attempt group had an earlier, more gradual onset of illness. More of the serious attempters had personality disorders and coexisting major depression. At the time of original assessment, the serious attempters had more severe symptoms. These data suggest that among patients with panic disorder, serious suicidal behavior is associated with more severe psychopathology.     

Beyond the mental pain: A case-control study on the contribution of schizoid personality disorder symptoms to medically serious suicide attempts

BackgroundClinical and research findings have highlighted the role of interpersonal factors in suicidal behavior with high levels of intent and lethality. Schizoid personality disorder (SPD) is at the extreme end of interpersonal difficulties. Thus, we aimed to understand the contribution of SPD symptoms to suicide behavior and specifically to more lethal suicide attempts.MethodFour groups were investigated (N = 338): medically serious suicide attempters, medically non-serious suicide attempters, psychiatric and healthy controls. SPD symptoms, mental pain variants, and clinical characteristics were assessed.ResultsOverall, attempters were characterized by higher levels of most SPD symptoms. Solitary lifestyle and emotional detachment were higher among medically serious suicide attempters relative to less-serious attempters. Emotional detachment doubled the risk for high lethality, beyond mental pain variables.ConclusionsSPD symptoms of interpersonal difficulties and low levels of emotional expressions are important risk factors for more severe suicidal behavior. Implications for identification of at-risk groups for suicide are discussed.     

Fuzzy logic detection of medically serious suicide attempt records in major psychiatric disorders

Clinical prediction of suicide is a complicated task. The focus for improved suicide risk detection is on the subgroup of individuals whose high suicide risk remains unrecognized by clinicians. We sought to evaluate the accuracy of Fuzzy Adaptive Learning Control Network (FALCON) neural networks, a nonlinear algorithm, in identification of this subgroup. The study sample included the Computerized Scale for risk of Suicide, including 21 suicide risk factors (including the target variable) drawn from 987 patient records, completed by staff clinicians during face-to-face interviews of hospitalized patients. FALCON evaluated all records in two steps: a) 612 for training and 375 for validation, and b) 887 for training and 100 for validation. The existence of previous medically serious suicide attempts (MSSAs) was chosen as the target variable because it is generally recognized as the strongest suicide risk factor. Sensitivity, specificity, and unknown answers among MSSA and non-MSSA were as follows: 612/375 FALCON, 91%, 85%, 11%, 15%; 887/100 FALCON, 94%, 82%, 20%, 14.5%, respectively. Trained FALCON, a nonlinear neural network, achieves respectable accuracy in detecting MSSA patients based on 20 suicide risk factors. Trained FALCON may therefore assist in identification of subgroup of individuals who remain unrecognized by clinicians and contribute to prevention of suicide.     

Multiple suicide attempts

A sample of 157 persons who attempted suicide from 2 to 6 times was compared with a sample of 1,045 single attempted suicides on a number of personal and social characteristics and other factors related to the act itself. Suicide death rates, obtained through a follow-up of both groups for a year following the last attempt, were also compared. It is concluded (1) that the two groups are essentially similar in their general characteristics and in their risk of suicide and (2) that, among multiples, little change occurs from first to second attempt. However, it is pointed out that both groups are at considerably higher risk of suicide than those who have not made attempts.     

Suicide attempts and serious suicide threats in the city of Riga and resulting contacts with medical services

The acute treatment of persons attempting suicide is recognized as very important in a prevention context. The aim of this study is to describe the medical services available to patients who have made suicide attempts or serious threats to commit suicide (SAST) within the city of Riga, to trace their passage through the various medical facilities, and to estimate SAST rates. Data for 1999 were collected from electronic case reports of the Emergency Medical Service (EMS) in Riga and monitoring forms of suicide attempters in Riga Psychoneurological Hospital (RPH) and Narcological Hospital (NH). In 1999 the first contact with the medical service in Riga for 95% of all cases (1024) was the EMS. Of the cases, 51.8% were treated at the general and 17.0% at the orthopaedic hospital. Of all SAST patients 99% have been assessed by at least one psychiatrist, and 43.8% were admitted to the psychiatric hospital at some time. The overall rate of suicide attempts is 149 per 100 000. The male to female ratio for SAST in Riga for individuals aged 15 years and more was 1:0.9. The highest figures were for females aged 15-24 and men aged 25-34. Females used poisonings in 75% of cases, but males used violent suicide methods in 60% of cases, most often involving cutting and associated with the use of alcohol. Data from existing medical services provide reasonably good information on the SAST population in Riga City.     

中国农村严重自杀未遂危险因素的配对病例对照研究(英文)

背景中国农村的自杀率是城市自杀率的2~3倍,但造成城乡自杀率之巨大差异的原因并不清楚。目的评估国内农村严重自杀未遂者的特征及危险因素。方法精神科医生采用结构式问卷对山东郓城县人民医院急诊室收治的297例严重自杀未遂者(至少在医院6小时者)及其陪伴的家属分别进行访谈。该问卷内容详尽,完成问卷需要2~3h。对照组选取同一居住地中年龄、性别与自杀未遂组相匹配的、既往无自杀未遂史的居民及其同住家庭成员,分别进行同样的结构式访谈。使用Cox回归模型来识别自杀未遂的危险因素。结果 297例自杀未遂者中,74%为女性,78%是农民,平均(标准差)年龄为33.2(14.6),平均受教育年限为4.8(3.1)年,80%为口服农药自杀,57%的自杀未遂者报告在采取自杀行动之前考虑自杀只有或不足5分钟,76%的自杀意图量表中计划分量表得分不足50分(0~100分),11%有过自杀未遂史,只有38%存在符合DSM-IV诊断标准的精神障碍。在控制性别、年龄、居住地以及之前的自杀未遂史(在配对分析中控制该变量)后,通过多因素分析,自杀未遂的危险因素包括:受教育水平低、与有过自杀行为的人交往、之前1年中至少有4次负性生活事件、之前1个月中生活质量低且家庭不够和睦、之前2周内的抑郁症状得分高以及冲动性和攻击性高(最后一项仅在小样本中进行评估)。结论我国农村严重自杀未遂者多数不符合精神障碍的诊断标准,冲动性和攻击性高、自杀意图并不强烈,多采用口服农药的方式。这些特点与高收入发达国家的特点不同,因而需要采取不同的方法来预防自杀行为。这些方法应更多的关注如何降低获取农药的便利性,并教育冲动性个体如何自我调整情绪和行为,而不是过度地关注精神障碍的识别和治疗。     

双相情感障碍中的自杀及自杀企图研究进展

自杀行为是一种异质性的现象,是患者的素质因素和环境因素交互作用的结果。目前双相情感障碍的自杀行为越来越受到关注。已有的研究致力于探索双相情感障碍患者自杀及自杀企图的预测因素及干预手段。现从流行病学、风险因素、预防、神经影像学及分子生物机制 4 个方面对双相情感障碍患者的自杀及自杀企图进行综述。     

Serum lipid levels and suicide attempts

OBJECTIVE: To determine whether a correlation exists between lower serum lipid concentrations and increased suicide risk. METHOD: Serum lipid profiles were pair-matched for 60 patients who had recently experienced failed attempts at suicide and equal numbers of non-suicidal psychiatric patients, and normal controls. Suicide attempt severity was scored using Weisman and Worden's risk-rescue rating scale. RESULTS: (a). Total serum cholesterol and low density lipoprotein levels were found to be lower in the parasuicidal population at statistically significant levels (P < 0.01 and <0.05, respectively); (b). triglyceride concentrations were lower in suicide attempters with major depression compared with non-suicidal depressed patients; and (c). risk-rescue rating scores were negatively correlated with total serum cholesterol levels (r = -0.347, P = 0.007). CONCLUSION: Low lipid metabolism may be a potential biological marker in the assessment of suicide risk. Further investigations are necessary to elucidate the biological mechanisms of these findings.     

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.     

Adolescent suicide attempts: sex differences predicting suicide

Four hundred and twenty-two consecutive hospitalized suicide attempts made by 15-19 year old girls and boys in Helsinki area were investigated. One hundred and twenty suicide attempts were made by 115 boys and 302 by 247 girls. Differences between sex were analyzed. Boys had more severe adaptive problems. Their overall level of functioning was poorer than was that of the girls. Their physical health was not as good as that of the girls. Boys did not carry out more severe suicide attempts as concerns the estimated lethality and intent of the attempt, but their suicide attempts seemed to be connected with more severe physical, mental and social problems. Boys were more susceptible to alcohol provoked suicidal behaviour than girls, and they presented less appealing motives. The outcome of the boys was much worse than the outcome of the girls. Risk ratio for suicide during the 5-year follow-up was 2.0 for boys and 0.55 for girls. Risk ratio concerning violent death was 2.43 for boys and 0.33 for girls. Young male adolescents attempting suicide should be taken very seriously as a risk group for subsequent suicide.