Does an attempted suicide actually have a cathartic effect?

It has been suggested in empirical studies that an attempted suicide has a cathartic effect. However, only one study used a control group of depressives who had not attempted suicide. A replication of these results using more strictly defined patient groups and a more comprehensive assessment of the psychopathology during index treatment was not possible. Major depressives with and without suicide attempts before index admission displayed similar courses of their depressive symptoms and somatic complaints during index treatment. The cathartic effect of a suicide attempt may be restricted to a severe major depression or to a violent suicide attempt.     

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.     

抑郁症自杀未遂患者血清总胆固醇水平研究

目的:对抑郁症自杀未遂患者的血清胆固醇水平与自杀行为的关系进行研究。方法:对抑郁症患者进行血清胆固醇水平测定,其中伴自杀未遂行为者26例,不伴自杀行为者32例,以正常健康者30名为对照。结果:抑郁症伴自杀未遂行为组血清胆固醇水平明显低于无自杀行为组和正常对照组。血清胆固醇水平与自杀的严重程度呈明显负相关。结论:低血清胆固醇水平可增加抑郁症自杀的风险。推测低血清胆固醇导致的自杀行为可能与中枢5-羟色胺(5-HT)功能降低有关。     

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.     

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.     

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.     

Clinical correlates of intent in attempted suicide.

The seriousness of suicide attempts was evaluated in 62 consecutive referrals in 2 general hospitals. As measured by the Suicide Intent Scale (SIS) the majority of cases had a low to moderate intention to die. Increasing age, psychosis and deliberate self-injury were associated with high suicidal intent. Hopelessness and a sense of isolation are significantly more frequent antecedent ideo-affective states in cases with high intent and anger and frustration are more prevalent in cases with low intent. Two other measures of seriousness, the medical condition on admission and lethality of the method used, correlate significantly with the degree of intent. The SIS can distinguish between relatively homogeneous subgroups of suicide attempters for depth studies of aetiology and management.     

Temperamental vulnerability in attempted suicide

The aim of this study was to explore and describe features of suicidal temperament and to describe the psychological domains of vulnerability in attempted suicide. Thirty-two suicide attempters were compared with 32 sex- and age-matched convalescent surgical controls on self-report personality inventories; the Eysenck Personality Questionnaire, the Chapman Scales, the Beck Hopelessnes Scale and the Karolinska Scales of Personality. Suicide attempters showed higher scale scores on neuroticism, psychoticism, interpersonal aversiveness, perceptual aberration, nonconformity, hopelessness, somatic anxiety, muscular tension, indirect aggression, suspicion and lower socialization. The features of suicidal temperament include hopelessness and anhedonia, anxiety, hostility and undirected anger expression, psychosis proneness, antisocial traits and interpersonal difficulties. These temperamental features might render the suicidal individual particularly vulnerable to suicidal behavior.     

Suicide and attempted suicide in a general hospital in western Ethiopia

ABSTRACT Suicidal behaviour in western Ethiopia as seen in a general hospital is reported on. The suicide rate is at least 3–11 per 100,000 inhabitants per year (mean 4.5) which is higher than is usually reported from Africa. As many women as men seem to commit suicide and the incidence is highest in the age group 19–24 years and lowest in the oldest group. The incidence seems to be higher in urban areas. Hanging is the most frequent method used by both sexes.     

Ulcer, attempted suicide and suicide.

Attempted suicide and suicide have been investigated among 2,619 patients suffering from duodenal ulcer, gastric ulcer and ulcer dyspepsia without ulcer demonstrable by x-ray. There was no difference in the percentage of attempted suicides and suicides among the three ulcer groups or between the sexes. Within well-defined periods, there was a statistically significant greater excess of attempted suicides among patients operated on than among unoperated patients. The distribution according to psychiatric diagnosis was very similar to the one observed among persons in general in Copenhagen attempting suicide. The number of patients committing suicide exceeded the expected number significantly, for men as well as for women, but there was no difference between patients operated on and unoperated patients. The psychiatric diagnoses of those committing suicide were predominantly neuroses and psychopathy.     

Psychosocial intervention following suicide attempt: a svstematic review of treatment interventions

Repeated suicide attempts are a common problem. However, few randomized controlled studies on the treatment of suicide attempters have been described. Although some of these studies showed beneficial effects on measures of well-being, none of them demonstrated lasting positive effects on repeated suicidal behaviour. In an attempt to analyse the results obtained, a systematic review of randomized controlled trials of interventions for suicide attempters is presented. The literature was gathered by means of a CD-ROM literature reference search (MEDLINE/PSYCLIT). Subsequently, information on study design and treatment efficacy was abstracted. Studies that were homogeneous with regard to therapeutic principles were reviewed accordingly, and pooled analyses were performed. Meta-analyses accounted for inter-study variance (random-effects model) to estimate a commmon-effect measure (relative risk). Systematic review of the data showed considerable differences in both study design and therapeutic protocols. In view of these differences, a single pooled analysis of all studies appeared to be unfeasible. A pooled analysis of studies that focus on psychiatric management of poor compliance showed no significant effect on the repetition of suicide attempts. Similarly, studies of psychosocial crisis intervention, as well as studies of guaranteed in-patient shelter in cases of emergency, did not show a significant reduction in repeated suicide attempts. However, the pooled results of four studies on cognitive-behavioural therapies showed a significant preventive effect on repeated suicide attempts. At present, only the cognitive-behavioural approach appears to have a beneficial effect on repeated suicide attempts. However, because of methodological variability, the results obtained may be too optimistic. Additional research is required to establish the merits of this type of intervention.     

Selection of patients who attempted suicide for psychiatric consultation.

A total of 1018 self-poisoned patients were treated during one year (1983) at the emergency room of Helsinki University Central Hospital for 1207 suicide attempts; 46% were left without psychiatric consultation. Women were consulted more frequently than men. Patients with previous psychiatric treatment were referred more often for psychiatric consultation. The use of alcohol was more frequently present in suicide attempts that did not lead to psychiatric consultation. Somatic seriousness was also less severe in this group. It was assumed that those left without consultation were not in mortal danger. There were no differences in the suicide mortality of these 2 groups during a 5-year follow-up.     

Mental disorders and comorbidity in attempted suicide

The present study examined the prevalence and comorbidity of mental disorders according to DSM-III-R among male and female suicide attempters. A systematic sample of 114 patients from consecutive cases of attempted suicide referred to a general hospital in Helsinki between 1 January and 31 July 1990 was interviewed. In 98% of the cases at least one Axis I diagnosis was made. Depressive syndromes were more common among females (85%) than males (64%), and alcohol dependence was more common among males (64%) than females (21%). A high proportion of suicide attempters (82%) suffered from comorbid mental disorders. Comorbidity appears to play an important role in parasuicide.     

Outcome of attempted suicide and psychiatric consultation: risk factors and suicide mortality during a five-year follow-up.

A total of 1018 self-poisoned patients were treated during the year 1983 in the emergency room of Helsinki University Central Hospital. By the end of a 5-year follow-up period, 3.2% of these had committed suicide, making annual suicide mortality 589 per 100,000. During the first year after the index attempt, suicide mortality was 1768 per 100,000, a 50-fold risk compared with that of the total population in Helsinki. Risk factors were being male of advancing age, having mental disorders, previous suicide attempts, a nonimpulsive index suicide attempt, moderate to very serious lethality and severe intention to die during the index suicide attempt. When the lethality was assessed as being very serious or intention to die as certain, 21% later committed suicide. The relative risk for those left without psychiatric consultation was 0.6 when the lethality was mild and 1.6 when it was severe. Results indirectly indicate that psychiatric consultation seemed to have a positive effect on the outcome of these attempted suicides.     

Attitudes of psychiatric nursing personnel towards patients who have attempted suicide

The aim of this study was to examine the attitudes towards suicidal patients of a group of psychiatric nursing personnel (n=197) and to establish a baseline of attitudinal measures against which the effects of a subsequent educational programme can be assessed. A scale, known as the Understanding of Suicide Attempt Patient Scale (USP Scale) was developed for this purpose. The reliability of the scale was satisfactory, and its correlation with visual analogue scale (VAS) scores based on clinical vignettes suggests that it has validity. Women tended to be more sympathetic than men, and older personnel were more favourably disposed than the younger nurses. Differences between personnel working in different settings were found, which might be explained by differences in the frequency of contact with suicide-prone patients, more frequent exposure being associated with more positive attitudes.     

The prospectively observed course of illness among depressed patients who commit suicide

OBJECTIVE: These analyses were conducted to describe the course of illness among patients with major affective disorders who commit suicide. METHOD: Twenty-nine patients who entered a long-term, high-intensity follow-up study of major affective disorders and who later committed suicide within 1 year of their last follow-up interview were individually matched to other patients by age, sex, the presence or absence of lifetime drug or alcohol abuse, time to last interview and polarity. Those who suicided were compared with their controls by depressive and substance abuse morbidity during follow-up, treatment resistance, treatment compliance, suicidal behavior and psychosocial adjustment. RESULTS: Among the various measures used to characterize the course of illness during a mean follow-up of 4.3 years, only those pertaining to suicidal behavior robustly separated the suicide group from their controls. Suicidal behavior in the remote past seemed as predictively important as suicidal behavior during follow-up. CONCLUSION: Of the various features monitored over time in patients with major affective disorder, suicidal behavior itself was the clearest correlate of risk for completed suicide.     

Comparison of completed and attempted suicide in Akita, Japan

To determine the factors underlying suicide in Akita prefecture, a questionnaire survey was conducted among members of the Akita Prefectural Medical Association (APMA), regarding suicide cases they attended. During the investigation period (1 July 2001-30 June 2002), the total number of suicide cases was 243 (138 completed, 105 attempted). Significant differences were identified between completed and attempted suicide groups in terms of gender, age distribution, and suicidal methods. Specifically, in the completed suicide group, the number of male completers exceeded that of female completers, the number of middle-aged or elderly completers was high, and the majority of completed suicide cases involved hanging as the suicide method. Conversely, in the attempted suicide group, the number of female attempters exceeded that of male attempters, younger attempters were frequent, hanging was rare, and drug overdose or cutting was common. In addition, the number of cases involving a history of previous suicide attempts was significantly higher in the attempted suicide group than in the completed suicide group. The results of the present study support the concept that the completed and attempted suicide groups are essentially of a different nature. Furthermore, the number of cases involving a history of previous suicide attempts was found to be significantly lower in the completed suicide group than in the attempted suicide group. This result indicates the difficulty in decreasing the number of completed suicides by simply providing intervention and care for individuals who have attempted suicide.     

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.     

Suicide and attempted suicide reported by general practitioners in Belgium, 1990–1991

In 1990–1991 the Belgian sentinel network of general practitioners recorded suicide and suicide attempts within their practices. The annual attempted suicide rate is estimated at 13.0 cases per 10,000 inhabitants. The highest incidence rates are found among women and young people. The annual suicide rate is estimated at 2.3 cases per 10,000 inhabitants, with the highest rates in men and in elderly people. The highest incidence rates of suicide attempts as well as of suicide are found among divorced people. About 30% of the attempters and committers made at least one earlier attempt. Drug overdose and hanging are the most frequently used methods, respectively when attempting and committing suicide. About 60% of both committers and attempters contacted their general practitioner within a period of 1 month preceding the attempt. Nearly half of the attempters and of the committers were treated for a mental disorder in the year preceding the attempt.