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Demesmaeker A, Chazard E, Hoang A, Vaiva G, Amad A. Suicide mortality after a nonfatal suicide attempt: A systematic review and meta-analysis. Aust N Z J Psychiatry 2022; 56:603-616. [PMID: 34465221 DOI: 10.1177/00048674211043455] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Deliberate self-harm and suicide attempts share common risk factors but are associated with different epidemiological features. While the rate of suicide after deliberate self-harm has been evaluated in meta-analyses, the specific rate of death by suicide after a previous suicide attempt has never been assessed. The aim of our study was to estimate the incidence of death by suicide after a nonfatal suicide attempt. METHOD We developed and followed a standard meta-analysis protocol (systematic review registration-PROSPERO 2021: CRD42021221111). Randomized controlled trials and cohort studies published between 1970 and 2020 focusing on the rate of suicide after suicide attempt were identified in PubMed, PsycInfo and Scopus and qualitatively described. The rates of deaths by suicide at 1, 5 and 10 years after a nonfatal suicide attempt were pooled in a meta-analysis using a random-effects model. Subgroup analysis and meta-regressions were also performed. RESULTS Our meta-analysis is based on 41 studies. The suicide rate after a nonfatal suicide attempt was 2.8% (2.2-3.5) at 1 year, 5.6% (3.9-7.9) at 5 years and 7.4% (5.2-10.4) at 10 years. Estimates of the suicide rate vary widely depending on the psychiatric diagnosis, the method used for the suicide attempt, the type of study and the age group considered. CONCLUSION The evidence of a high rate of suicide deaths in the year following nonfatal suicide attempts should prompt prevention systems to be particularly vigilant during this period.
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Affiliation(s)
- Alice Demesmaeker
- U1172-LilNCog-Lille Neuroscience & Cognition, Inserm, CHU Lille, Université de Lille, Lille, France.,Hôpital Fontan, CHU de Lille, Lille, France
| | - Emmanuel Chazard
- ULR 2694 Metrics, CERIM, Public Health Department, CHU Lille, Université de Lille, Lille, France
| | - Aline Hoang
- U1172-LilNCog-Lille Neuroscience & Cognition, Inserm, CHU Lille, Université de Lille, Lille, France
| | - Guillaume Vaiva
- U1172-LilNCog-Lille Neuroscience & Cognition, Inserm, CHU Lille, Université de Lille, Lille, France.,Hôpital Fontan, CHU de Lille, Lille, France.,Centre National de Ressources et de Résilience (CN2R), Lille, France
| | - Ali Amad
- U1172-LilNCog-Lille Neuroscience & Cognition, Inserm, CHU Lille, Université de Lille, Lille, France.,Hôpital Fontan, CHU de Lille, Lille, France
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Tang S, Reily NM, Arena AF, Sheanoda V, Han J, Draper B, Batterham PJ, Mackinnon AJ, Christensen H. Predictors of not receiving mental health services among people at risk of suicide: A systematic review. J Affect Disord 2022; 301:172-188. [PMID: 35032506 DOI: 10.1016/j.jad.2022.01.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/12/2021] [Accepted: 01/11/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND The majority of people who die by suicide are unknown to formal mental health services. The current review identified predictors of non-receipt of mental health services among individuals experiencing suicidal thoughts or behaviours. Such data provides insight into the needs and preferences of these individuals and inform improvements to existing services. METHODS PsycInfo, PubMed/Medline, CINAHL, and Web of Science were systematically searched from 1st January 1980 up to 20th September 2021. Included studies examined predictors of not receiving formal mental health services among people at risk of suicide. Study quality was assessed by adapting the Joanna-Briggs Institute Checklist for Analytical Cross-Sectional Studies. Findings were presented with narrative synthesis. PROSPERO registration: CRD42021256795. RESULTS Included studies (n = 35, sample range = 46-19,243) were predominately conducted in the United States. Non-receipt of services in nationally representative studies was varied (25.7-91.8%). Results indicate that non-receipt of mental health services among people with suicidality is associated with minority ethnicity, better perceived general health, lower psychological distress, lower severity of suicidality, no mental health diagnosis, lower perceived need for treatment and lower use of medical services. LIMITATIONS Limitations included few studies conducted in low-middle income countries, limited literature on key predictors of interest, and exclusion of informal sources of support. CONCLUSION Individuals with suicidality who are unknown to mental health services have diverse attributes. For some, non-use of services may result from low suicidal distress and perceived need for treatment. Further research is needed to understand why these predictors are associated with service non-use.
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Affiliation(s)
| | | | | | | | - Jin Han
- Black Dog Institute, UNSW Sydney, NSW, Australia
| | - Brian Draper
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, NSW, Australia
| | - Philip J Batterham
- Black Dog Institute, UNSW Sydney, NSW, Australia; Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
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Probert-Lindström S, Berge J, Westrin Å, Öjehagen A, Skogman Pavulans K. Long-term risk factors for suicide in suicide attempters examined at a medical emergency in patient unit: results from a 32-year follow-up study. BMJ Open 2020; 10:e038794. [PMID: 33130567 PMCID: PMC7783608 DOI: 10.1136/bmjopen-2020-038794] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The overall aim of this study is to gain greater knowledge about the risk of suicide among suicide attempters in a very long-term perspective. Specifically, to investigate possible differences in clinical risk factors at short (≤5 years) versus long term (>5 years), with the hypothesis that risk factors differ in the shorter and longer perspective. DESIGN Prospective study with register-based follow-up for 21-32 years. SETTING Medical emergency inpatient unit in the south of Sweden. PARTICIPANTS 1044 individuals assessed by psychiatric consultation when admitted to medical inpatient care for attempted suicide during 1987-1998. OUTCOME MEASURES Suicide and all-cause mortality. RESULTS At follow-up, 37.6% of the participants had died, 7.2% by suicide and 53% of these within 5 years of the suicide attempt. A diagnosis of psychosis at baseline represented the risk factor with the highest HR at long-term follow-up, that is, >5 years, followed by major depression and a history of attempted suicide before the index attempt. The severity of a suicide attempt as measured by SIS (Suicide Intent Scale) showed a non-proportional association with the hazard for suicide over time and was a relevant risk factor for suicide only within the first 5 years after an attempted suicide. CONCLUSIONS The risk of suicide after a suicide attempt persists for up to 32 years after the index attempt. A baseline diagnosis of psychosis or major depression or earlier suicide attempts continued to be relevant risk factors in the very long term. The SIS score is a better predictor of suicide risk at short term, that is, within 5 years than at long term. This should be considered in the assessment of suicide risk and the implementation of care for these individuals.
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Affiliation(s)
- Sara Probert-Lindström
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Region Skåne, Clinical Psychiatric Research Center, Lund, Sweden
| | - Jonas Berge
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Addiction Center Malmö, Malmo, Sweden
| | - Åsa Westrin
- Region Skåne, Clinical Psychiatric Research Center, Lund, Sweden
- Division of Psychiatry, Lund University Department of Clinical Sciences Malmo, Lund, Sweden
| | - Agneta Öjehagen
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Katarina Skogman Pavulans
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Child and Adolescent Psychiatry, Karlskrona, Sweden
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Wang M, Swaraj S, Chung D, Stanton C, Kapur N, Large M. Meta-analysis of suicide rates among people discharged from non-psychiatric settings after presentation with suicidal thoughts or behaviours. Acta Psychiatr Scand 2019; 139:472-483. [PMID: 30864183 DOI: 10.1111/acps.13023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To quantify the suicide rate among people discharged from non-psychiatric settings after presentations with suicidal thoughts or behaviours. METHOD Meta-analysis of studies reporting suicide deaths among people with suicidal thoughts or behaviours after discharge from emergency departments or the medical or surgical wards of general hospitals. RESULTS A total of 115 studies reported 167 cohorts and 3747 suicide deaths among 248 005 patients during 1 263 727 person-years. The pooled suicide rate postdischarge was 483 suicide deaths per 100 000 person-years (95% confidence interval (CI) 445-520, prediction interval (PI) 200-770) with high between-sample heterogeneity (I2 = 92). The suicide rate was highest in the first year postdischarge (851 per 100 000 person-years) but remained elevated in the long term. Suicide rates were elevated among samples of men (716 per 100 000 person-years) and older people (799 per 100 000 person-years) but were lower in samples of younger people (107 per 100 000 person-years) and among studies published between 2010 and 2018 (329 per 100 000 person-years). CONCLUSIONS People with suicidal thoughts or behaviours who are discharged from non-psychiatric settings have highly elevated rates of suicide despite a clinically meaningful decline in these suicide rates in recent decades.
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Affiliation(s)
- M Wang
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - S Swaraj
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - D Chung
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - C Stanton
- School of Psychiatry, University of NSW, Kensington, Sydney, NSW, Australia
| | - N Kapur
- Centre for Suicide Prevention, Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester and Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, UK
| | - M Large
- School of Psychiatry, University of NSW, Kensington, Sydney, NSW, Australia
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Borruso LD, Buckley NA, Kirby KA, Carter G, Pilgrim JL, Chitty KM. Acute Alcohol Co-Ingestion and Hospital-Treated Deliberate Self-Poisoning: Is There an Effect on Subsequent Self-Harm? Suicide Life Threat Behav 2019; 49:293-302. [PMID: 29498087 DOI: 10.1111/sltb.12443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 09/13/2017] [Indexed: 11/29/2022]
Abstract
The aim of this study was to determine the relationship between alcohol co-ingestion in an index deliberate self-poisoning (DSP) episode with repeated DSP and subsequent suicide. A retrospective cohort study was conducted involving 5,669 consecutive index presentations to a toxicology service following DSP between January 1, 1996, and October 31, 2010. Records were probabilistically matched to National Coronial Information System data to identify subsequent suicide. Index DSPs were categorized on co-ingestion of alcohol, and primary outcomes analyzed were repetition of any DSP, rates of repeated DSP, time to first repeat DSP, and subsequent suicide. Co-ingestion of alcohol occurred in 35.9% of index admissions. There was no difference between those who co-ingested alcohol (ALC+) and those who did not co-ingest alcohol (ALC-) in terms of proportion of repeat DSP, number of DSP events, or time to first repeat DSP event. Forty-one (1.0%) cases were probabilistically matched to a suicide death; there was no difference in the proportion of suicide between ALC+ and ALC- at 1 or 3 years. There was no significant relationship between the co-ingestion of alcohol in an index DSP and subsequent repeated DSP or suicide. Clinically, this highlights the importance of mental health assessment of patients that present after DSP, irrespective of alcohol co-ingestion at the time of event.
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Affiliation(s)
- Luca D Borruso
- Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Nicholas A Buckley
- Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Katharine A Kirby
- Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Gregory Carter
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, Australia
| | - Jennifer L Pilgrim
- Drug Harm Prevention Unit, Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Southbank, Vic, Australia
| | - Kate M Chitty
- Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Carter G, Milner A, McGill K, Pirkis J, Kapur N, Spittal MJ. Predicting suicidal behaviours using clinical instruments: systematic review and meta-analysis of positive predictive values for risk scales. Br J Psychiatry 2017; 210:387-395. [PMID: 28302700 DOI: 10.1192/bjp.bp.116.182717] [Citation(s) in RCA: 206] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 10/16/2016] [Accepted: 11/16/2016] [Indexed: 01/17/2023]
Abstract
BackgroundPrediction of suicidal behaviour is an aspirational goal for clinicians and policy makers; with patients classified as 'high risk' to be preferentially allocated treatment. Clinical usefulness requires an adequate positive predictive value (PPV).AimsTo identify studies of predictive instruments and to calculate PPV estimates for suicidal behaviours.MethodA systematic review identified studies of predictive instruments. A series of meta-analyses produced pooled estimates of PPV for suicidal behaviours.ResultsFor all scales combined, the pooled PPVs were: suicide 5.5% (95% CI 3.9-7.9%), self-harm 26.3% (95% CI 21.8-31.3%) and self-harm plus suicide 35.9% (95% CI 25.8-47.4%). Subanalyses on self-harm found pooled PPVs of 16.1% (95% CI 11.3-22.3%) for high-quality studies, 32.5% (95% CI 26.1-39.6%) for hospital-treated self-harm and 26.8% (95% CI 19.5-35.6%) for psychiatric in-patients.ConclusionsNo 'high-risk' classification was clinically useful. Prevalence imposes a ceiling on PPV. Treatment should reduce exposure to modifiable risk factors and offer effective interventions for selected subpopulations and unselected clinical populations.
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Affiliation(s)
- Gregory Carter
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Allison Milner
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Katie McGill
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jane Pirkis
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Nav Kapur
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Matthew J Spittal
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
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Lin Y, Lin C, Sun IW, Hsu CC, Fang CK, Lo MT, Huang HC, Liu SI. Resting respiratory sinus arrhythmia is related to longer hospitalization in mood-disordered repetitive suicide attempters. World J Biol Psychiatry 2016; 16:323-33. [PMID: 25839729 DOI: 10.3109/15622975.2015.1017603] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Our aims were (1) to measure respiratory sinus arrhythmia (RSA), a high-frequency spectrum component of heart rate variability (HRV) in mood-disordered suicide attempters and (2) to investigate the relationship of RSA to symptoms and length of hospitalization. METHODS Forty-nine female repetitive-suicide attempters with depressive disorder or bipolar disorder were recruited in a general hospital setting. Manic or psychotic patients were excluded. Resting RSA values were calculated from electrocardiogram data, and severity of clinical presentation shortly after admission and length of hospital stay were assessed. RESULTS RSA was positively associated with a higher Beck Scale for Suicidal Ideation score (r = 0.33 P = 0.019). Stepwise multiple regression analysis showed a significant correlation between RSA and hospitalization length after adjusting other variables (beta coefficient = 3.00; P = 0.030). Patients with a higher resting RSA had more prolonged hospitalizations (hospitalization beyond 30 days) after controlling for other variables (odds ratio = 5.08, P = 0.017). CONCLUSIONS Interaction between the environment and the autonomic nervous system is complex. Further and more comprehensive research is needed.
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Affiliation(s)
- Ying Lin
- Department of Psychiatry, Mackay Memorial Hospital , Taipei , Taiwan
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Goldston DB, Daniel SS, Erkanli A, Heilbron N, Doyle O, Weller B, Sapyta J, Mayfield A, Faulkner M. Suicide attempts in a longitudinal sample of adolescents followed through adulthood: Evidence of escalation. J Consult Clin Psychol 2015; 83:253-64. [PMID: 25622200 DOI: 10.1037/a0038657] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study was designed to examine escalation in repeat suicide attempts from adolescence through adulthood, as predicted by sensitization models (and reflected in increasing intent and lethality with repeat attempts, decreasing amount of time between attempts, and decreasing stress to trigger attempts). METHOD In a prospective study of 180 adolescents followed through adulthood after a psychiatric hospitalization, suicide attempts, and antecedent life events were repeatedly assessed (M = 12.6 assessments, SD = 5.1) over an average of 13 years 6 months (SD = 4 years 5 months). Multivariate logistic, multiple linear, and negative binomial regression models were used to examine patterns over time. RESULTS After age 17-18, the majority of suicide attempts were repeat attempts (i.e., made by individuals with prior suicidal behavior). Intent increased both with increasing age, and with number of prior attempts. Medical lethality increased as a function of age but not recurrent attempts. The time between successive suicide attempts decreased as a function of number of attempts. The amount of precipitating life stress was not related to attempts. CONCLUSIONS Adolescents and young adults show evidence of escalation of recurrent suicidal behavior, with increasing suicidal intent and decreasing time between successive attempts. However, evidence that sensitization processes account for this escalation was inconclusive. Effective prevention programs that reduce the likelihood of individuals attempting suicide for the first time (and entering this cycle of escalation), and relapse prevention interventions that interrupt the cycle of escalating suicidal behavior among individuals who already have made attempts are critically needed. (PsycINFO Database Record
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Affiliation(s)
| | - Stephanie S Daniel
- Center for Youth, Family, and Community Partnerships, University of North Carolina at Greensboro
| | | | | | - Otima Doyle
- Jane Addams College of Social Work, University of Illinois
| | | | | | - Andrew Mayfield
- Center for Youth, Family, and Community Partnerships, University of North Carolina at Greensboro
| | - Madelaine Faulkner
- Center for Youth, Family, and Community Partnerships, University of North Carolina at Greensboro
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Wu CY, Huang HC, Wu SI, Sun FJ, Huang CR, Liu SI. Validation of the Chinese SAD PERSONS Scale to predict repeated self-harm in emergency attendees in Taiwan. BMC Psychiatry 2014; 14:44. [PMID: 24533537 PMCID: PMC3942520 DOI: 10.1186/1471-244x-14-44] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Past and repeated self-harm are long-term risks to completed suicide. A brief rating scale to assess repetition risk of self-harm is important for high-risk identification and early interventions in suicide prevention. The study aimed to examine the validity of the Chinese SAD PERSONS Scale (CSPS) and to evaluate its feasibility in clinical settings. METHODS One hundred and forty-seven patients with self-harm were recruited from the Emergency Department and assessed at baseline and the sixth month. The controls, 284 people without self-harm from the Family Medicine Department in the same hospital were recruited and assessed concurrently. The psychometric properties of the CSPS were examined using baseline and follow-up measurements that assessed a variety of suicide risk factors. Clinical feasibility and applicability of the CSPS were further evaluated by a group of general nurses who used case vignette approach in CSPS risk assessment in clinical settings. An open-ended question inquiring their opinions of scale adaptation to hospital inpatient assessment for suicide risks were also analyzed using content analysis. RESULTS The CSPS was significantly correlated with other scales measuring depression, hopelessness and suicide ideation. A cut-off point of the scale was at 4/5 in predicting 6-month self-harm repetition with the sensitivity and specificity being 65.4% and 58.1%, respectively. Based on the areas under the Receiver Operating Characteristic curves, the predictive validity of the scale showed a better performance than the other scales. Fifty-four nurses, evaluating the scale using case vignette found it a useful tool to raise the awareness of suicide risk and a considerable tool to be adopted into nursing care. CONCLUSIONS The Chinese SAD PERSONS Scale is a brief instrument with acceptable psychometric properties for self-harm prediction. However, cautions should be paid to level of therapeutic relationships during assessment, staff workload and adequate training for wider clinical applications.
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Affiliation(s)
- Chia-Yi Wu
- Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hui-Chun Huang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan,Mackay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan
| | - Shu-I Wu
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan,Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chiu-Ron Huang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shen-Ing Liu
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.
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10
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Larkin C, Di Blasi Z, Arensman E. Risk factors for repetition of self-harm: a systematic review of prospective hospital-based studies. PLoS One 2014; 9:e84282. [PMID: 24465400 PMCID: PMC3896350 DOI: 10.1371/journal.pone.0084282] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 11/22/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Self-harm entails high costs to individuals and society in terms of suicide risk, morbidity and healthcare expenditure. Repetition of self-harm confers yet higher risk of suicide and risk assessment of self-harm patients forms a key component of the health care management of self-harm patients. To date, there has been no systematic review published which synthesises the extensive evidence on risk factors for repetition. OBJECTIVE This review is intended to identify risk factors for prospective repetition of self-harm after an index self-harm presentation, irrespective of suicidal intent. DATA SOURCES PubMed, PsychInfo and Scirus were used to search for relevant publications. We included cohort studies which examining factors associated with prospective repetition among those presenting with self-harm to emergency departments. Journal articles, abstracts, letters and theses in any language published up to June 2012 were considered. Studies were quality-assessed and synthesised in narrative form. RESULTS A total of 129 studies, including 329,001 participants, met our inclusion criteria. Some factors were studied extensively and were found to have a consistent association with repetition. These included previous self-harm, personality disorder, hopelessness, history of psychiatric treatment, schizophrenia, alcohol abuse/dependence, drug abuse/dependence, and living alone. However, the sensitivity values of these measures varied greatly across studies. Psychological risk factors and protective factors have been relatively under-researched but show emerging associations with repetition. Composite risk scales tended to have high sensitivity but poor specificity. CONCLUSIONS Many risk factors for repetition of self-harm match risk factors for initiation of self-harm, but the most consistent evidence for increased risk of repetition comes from long-standing psychosocial vulnerabilities, rather than characteristics of an index episode. The current review will enhance prediction of self-harm and assist in the efficient allocation of intervention resources.
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Affiliation(s)
- Celine Larkin
- National Suicide Research Foundation, Cork, Ireland
- * E-mail:
| | - Zelda Di Blasi
- School of Applied Psychology, University College Cork, Cork, Ireland
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Alonzo DM, Harkavy-Friedman JM, Stanley B, Burke A, Mann JJ, Oquendo MA. Predictors of treatment utilization in major depression. Arch Suicide Res 2011; 15:160-71. [PMID: 21541862 PMCID: PMC3775667 DOI: 10.1080/13811118.2011.566052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Suicide attempters with major depression are at risk for repeat attempts and often do not utilize treatment. Identifying predictors of treatment non-utilization could inform interventions to motivate treatment use and reduce suicide risk in major depression. Two hundred and seventy three participants with a major depressive episode as part of a major depressive disorder or bipolar disorder, were assessed for socio-demographic and clinical characteristics at baseline and again 1 year later to identify predictors of treatment utilization. Treatment utilization rate was high 1 year after initial evaluation (72.5%). Severity of baseline depression, baseline treatment status, and education were associated with treatment utilization at 1 year. Interventions focused on increasing knowledge about depression and treatment efficacy may improve treatment adherence when treating depression.
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Affiliation(s)
- Dana M Alonzo
- School of Social Work, Columbia University, New York, New York 10027, USA.
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12
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BATT FRANCIS EUDIER PASCAL LE VAOU AGNES. Repetition of parasuicide: Risk factors in general hospital referred patients. J Ment Health 2009. [DOI: 10.1080/09638239818102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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13
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Kristinsson J, Palsson R, Gudjonsdottir GA, Blondal M, Gudmundsson S, Snook CP. Acute poisonings in Iceland: A prospective nationwide study. Clin Toxicol (Phila) 2009; 46:126-32. [DOI: 10.1080/15563650701438268] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Abstract
This analysis drew from decades of published research to evaluate the Suicide Intent Scale (SIS), the dominant research tool for assessing intent to die in apparent suicide attempts. The review sought to 1) synthesize findings related to the scale's normative scores, reliability, and validity (factorial, convergent, and predictive), and 2) examine the objective and subjective subscales' performance. A literature search yielded 158 studies reporting findings for the SIS. Psychometric properties were summarized. Studies supported the scale's reliability, especially that of the subscale assessing self-reported (versus circumstantial indicators) of intent. Mixed findings emerged regarding convergent and predictive validity. The review identified shortcomings in factorial validity and the subscales' performance, especially for adolescents. The Suicide Intent Scale has some strengths, but the weaknesses require further investigation into how to better measure intent to die in attempted suicide.
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Affiliation(s)
- Stacey Freedenthal
- Graduate School of Social Work, University of Denver, Denver, Colorado 80210, USA.
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Cedereke M, Ojehagen A. Formal and informal help during the year after a suicide attempt: a one-year follow-up. Int J Soc Psychiatry 2007; 53:419-29. [PMID: 18018664 DOI: 10.1177/0020764007078345] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS The aims of this study are threefold: to investigate formal and informal help with clinical and social needs that patients who attempted suicide received during the year after their attempt; to examine whether help from services was estimated to be adequate; and to look at whether patients who repeated suicide attempt(s) during follow-up differed from those who did not. METHODS The Camberwell Assessment of Need instrument measuring 22 need areas was used in semi-structured interviews with 140 patients at 1 and 12 months after a suicide attempt. RESULTS Help given from services was rated as high at both 1 and 12 months in health-related areas, but lower in areas related to social needs. Informal help was initially frequent, with some exceptions. The amount of help from services did not decrease in any need area during follow-up, neither in repeaters nor in non-repeaters. There were no changes in informal help in repeaters, while in non-repeaters informal help decreased in some areas. At both 1 and 12 months, repeaters and non-repeaters mostly found help from services to be adequate. However, in the areas of information, intimate relationships, psychotic symptoms and sexual expression about half of the patients in both groups did not consider that they had received the right type of help. CONCLUSIONS The generally high level of formal help in health-related areas during the first year after a suicide attempt and the high rated adequacy of help given is satisfactory. However, in certain areas lack of formal help was evident. Informal caregivers contributed significantly to the help that patients received. The use of the Camberwell Assessment of Need instrument could improve observation on needs areas and whether help is available. Perhaps this kind of evaluation could be used earlier than after 1 year in such a vulnerable group as suicide attempters.
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Affiliation(s)
- M Cedereke
- Department of Health Sciences, Division of Nursing, University of Lund, Sweden.
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Vaiva G, Vaiva G, Ducrocq F, Meyer P, Mathieu D, Philippe A, Libersa C, Goudemand M. Effect of telephone contact on further suicide attempts in patients discharged from an emergency department: randomised controlled study. BMJ (CLINICAL RESEARCH ED.) 2006. [PMID: 16735333 DOI: 10.1136/bmj.332.7552.1241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To determine the effects over one year of contacting patients by telephone one month or three months after being discharged from an emergency department for deliberate self poisoning compared with usual treatment. DESIGN Multicentre, randomised controlled trial. SETTING 13 emergency departments in the north of France. PARTICIPANTS 605 people discharged from an emergency department after attempted suicide by deliberate self poisoning. INTERVENTION The intervention consisted of contacting patients by telephone at one month or three months after discharge from an emergency department for attempted suicide to evaluate the success of recommended treatment or to adjust treatment. Control patients received treatment as usual, in most cases referral back to their general practitioner. MAIN OUTCOME MEASURES The primary outcome measures were proportion of participants who reattempted suicide, number of deaths by suicide, and losses to follow-up at 13 months' follow-up. Secondary outcome measures were types and number of contacts with health care. RESULTS On an intention to treat basis, the three groups did not differ significantly for further suicide attempts, deaths by suicide, or losses to follow-up: contact at one month (intervention 23% (34/147) v controls 30% (93/312), difference 7%, 95% confidence interval - 2% to 15%), three months (25% (36/146) v 30%, difference 5%, - 4% to 14%). Participants contacted at one month were less likely at follow-up to report having reattempted suicide (12% v 22% in control group, difference 10%, 2% to 18%). CONCLUSION Contacting people by telephone one month after being discharged from an emergency department for deliberate self poisoning may help reduce the number of reattempted suicides over one year.
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Vaiva G, Vaiva G, Ducrocq F, Meyer P, Mathieu D, Philippe A, Libersa C, Goudemand M. Effect of telephone contact on further suicide attempts in patients discharged from an emergency department: randomised controlled study. BMJ 2006; 332:1241-5. [PMID: 16735333 PMCID: PMC1471935 DOI: 10.1136/bmj.332.7552.1241] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the effects over one year of contacting patients by telephone one month or three months after being discharged from an emergency department for deliberate self poisoning compared with usual treatment. DESIGN Multicentre, randomised controlled trial. SETTING 13 emergency departments in the north of France. PARTICIPANTS 605 people discharged from an emergency department after attempted suicide by deliberate self poisoning. INTERVENTION The intervention consisted of contacting patients by telephone at one month or three months after discharge from an emergency department for attempted suicide to evaluate the success of recommended treatment or to adjust treatment. Control patients received treatment as usual, in most cases referral back to their general practitioner. MAIN OUTCOME MEASURES The primary outcome measures were proportion of participants who reattempted suicide, number of deaths by suicide, and losses to follow-up at 13 months' follow-up. Secondary outcome measures were types and number of contacts with health care. RESULTS On an intention to treat basis, the three groups did not differ significantly for further suicide attempts, deaths by suicide, or losses to follow-up: contact at one month (intervention 23% (34/147) v controls 30% (93/312), difference 7%, 95% confidence interval - 2% to 15%), three months (25% (36/146) v 30%, difference 5%, - 4% to 14%). Participants contacted at one month were less likely at follow-up to report having reattempted suicide (12% v 22% in control group, difference 10%, 2% to 18%). CONCLUSION Contacting people by telephone one month after being discharged from an emergency department for deliberate self poisoning may help reduce the number of reattempted suicides over one year.
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Holmstrand C, Niméus A, Träskman-Bendz L. Risk factors of future suicide in suicide attempters--a comparison between suicides and matched survivors. Nord J Psychiatry 2006; 60:162-7. [PMID: 16635937 DOI: 10.1080/08039480600583597] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The objective of this study was to find risk factors for suicide by looking for clinical and care/treatment consumption differences between 15 hospitalized suicide attempters, who later committed suicide ("completers"), and 15 suicide attempters who did not ("non-completers"), matched according to sex, age and principal diagnosis. Completers had significantly more often attempted suicide after the index admission. After index, completers had received more psychiatric care and treatment than non-completers. Comorbidity was common in both groups of patients. Personality disorders according to the DSM III-R, axis II, Cluster B, however, tended to be more common in the completer group. Increased comorbidity over time could also be seen to a larger extent in completers. In spite of the matching of principal diagnosis, completers tended to have higher Montgomery-Asberg Depression Rating Scale ratings than non-completers. They also had significantly higher Suicide Assessment Scale (SUAS) scores. From this study, it is apparent that suicide attempters at risk of future suicide have major and multiple psychiatric problems, which cause difficulties in the care and treatment.
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Cedereke M, Ojehagen A. Prediction of repeated parasuicide after 1-12 months. Eur Psychiatry 2005; 20:101-9. [PMID: 15797693 DOI: 10.1016/j.eurpsy.2004.09.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2003] [Revised: 04/09/2004] [Accepted: 08/25/2004] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED To investigate predictors for repetition of suicide attempts 1-12 months after a suicide attempt. SUBJECTS AND METHODS Two hundred and sixteen patients who had made a suicide attempt were investigated after 1 month, and 178 were followed up again after 12 months. RESULTS During 1-12 months after the suicide attempt, 30 patients reattempted suicide (repeaters). During 0-1 month 13 patients had reattempted suicide (early repeaters), and nine of them also repeated between 1 and 12 months. Repeaters had more often made three or more attempts before index attempt, they more often were in treatment at the index attempt and at 1 month they had lower global functioning and higher suicide ideation. In a Cox Regression analysis two predictors for repetition between 1 and 12 months remained significant; early repetition (OR 6.7, 95% CI, 3.0-14.9) and having GAF-scores below 49 (median cut-off) (OR 3.4 (95% CI, 1.5-7.5). CONCLUSION Our findings suggest that repetitive behaviour in itself is a strong predictor of future attempts. Strategies focusing on the repetitive behaviour are warranted.
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Affiliation(s)
- M Cedereke
- Department of Clinical Neuroscience Division of Psychiatry, Lund University Hospital, SE-221 85 Lund, Sweden.
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Abstract
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.
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Affiliation(s)
- Annette L Beautrais
- Canterbury Suicide Project, Christchurch School of Medicine & Health Sciences, New Zealand
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Abstract
BACKGROUND Non-fatal self-harm frequently leads to non-fatal repetition and sometimes to suicide. We need to quantify these two outcomes of self-harm to help us to develop and test effective interventions. AIMS To estimate rates of fatal and non-fatal repetition of self-harm. METHOD A systematic review of published follow-up data, from observational and experimental studies. Four electronic databases were searched and 90 studies met the inclusion criteria. RESULTS Eighty per cent of studies found were undertaken in Europe, over one-third in the UK. Median proportions for repetition 1 year later were: 16% non-fatal and 2% fatal; after more than 9 years, around 7% of patients had died by suicide. The UK studies found particularly low rates of subsequent suicide. CONCLUSIONS After 1 year, non-fatal repetition rates are around 15%. The strong connection between self-harm and later suicide lies somewhere between 0.5% and 2% after 1 year and above 5% after 9 years. Suicide risk among self-harm patients is hundreds of times higher than in the general population.
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Affiliation(s)
- David Owens
- Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, 15 Hyde Terrace, Leeds LS2 9LT, UK
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22
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Cedereke M, Monti K, Ojehagen A. Telephone contact with patients in the year after a suicide attempt: does it affect treatment attendance and outcome? A randomised controlled study. Eur Psychiatry 2002; 17:82-91. [PMID: 11973116 DOI: 10.1016/s0924-9338(02)00632-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
UNLABELLED Ambivalence to treatment and repeated suicidal behaviour are well-known problems in suicide attempters. A randomised controlled study was performed to investigate the influence of repeated telephone contacts on treatment attendance, repetition of suicidal behaviour and mental health the year after a suicide attempt. SUBJECTS AND METHODS One month after their suicide attempt 216 patients were randomised to either two telephone interventions in addition to treatment as usual, or no such intervention during the subsequent year. The interventions included motivational support to attend and/or to stay in treatment. At 1 month and again after 12 months the following measurements were used: GSI (SCL-90), GAF and SSI. RESULTS At follow-up treatment attendance was high and did not differ between the randomised groups. Among those with an initial treatment contact other than psychiatric, more patients in the intervention group had such contact at follow-up. The randomised groups did not differ in repetition of suicide attempts during follow-up or in improvement in GSI (SCL-90), GAF and SSI. In individuals with no initial treatment the intervention group improved more in certain psychological symptom dimensions (SCL-90). CONCLUSION Telephone interventions seem to have an effect on patients who at their suicide attempt had other treatment than psychiatric and in those with no treatment.
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Affiliation(s)
- M Cedereke
- Department of Clinical Neuroscience, Division of Psychiatry, Lund University Hospital, SE-221 85, Lund, Sweden.
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McMahon GT, McGarry K. Deliberate self-poisoning in an Irish county hospital. Ir J Med Sci 2001; 170:94-7; discussion 90. [PMID: 11491059 DOI: 10.1007/bf03168817] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In 1997, 433 people committed suicide in Ireland, one-quarter of whom were less than 24 years of age. AIM To determine demographics, agent choice and source, suicidality and follow-up care of deliberate self-poisoning patients. METHOD Details of 111 patients admitted to one hospital in 1997 following drug overdose were studied retrospectively. Eleven had been accidental ingestions, the remaining 100 were deliberate self-poisoning. RESULTS Men accounted for 38% of the presentations and were more likely to have suicidal intent than women. An average of 2.3 different agents were used. Paracetamol was taken by 37%, hypnotics/anxiolytics by 33% and nonsteroidal anti-inflammatories by 17%. Alcohol was consumed synchronously by 51% and 17% fulfilled criteria for alcohol dependency. One-third of patients were clinically depressed. All six patients requiring ventilation had consumed a combination of tricyclic antidepressants and alcohol. There were no deaths. CONCLUSION Deliberate self-poisoning remains a significant problem. Paracetamol and alcohol use are particularly marked in this population. The combination of tricyclic antidepressant drugs and alcohol were the most dangerous.
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Affiliation(s)
- G T McMahon
- Department of Medicine, Our Lady's Hospital, Navan, Co Meath, Ireland
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Niméus A, Alsén M, Träskman-Bendz L. The suicide assessment scale: an instrument assessing suicide risk of suicide attempters. Eur Psychiatry 2000; 15:416-23. [PMID: 11112934 DOI: 10.1016/s0924-9338(00)00512-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The Suicide Assessment Scale (SUAS), a scale constructed to measure suicidality over time, was administered to 191 suicide attempters. Its predictive validity was tested. SUAS ratings were compared to ratings from other scales, and related to age and psychiatric diagnoses including co-morbidity. Eight patients committed suicide within 12 months after the SUAS assessment. Apart from advanced age, high scores in the SUAS were significant predictors of suicide. From a receiver operating characteristic (ROC) analysis, we identified cutoff SUAS scores which alone and in combination with certain diagnostic and demographic factors are of apparent value in the clinical evaluation of suicide risk after a suicide attempt.
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Affiliation(s)
- A Niméus
- University Hospital, Department of Clinical Neuroscience, Division of Psychiatry, University Hospital, S-221 85 Lund, Sweden
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Carter GL, Whyte IM, Ball K, Carter NT, Dawson AH, Carr VJ, Fryer J. Repetition of deliberate self-poisoning in an Australian hospital-treated population. Med J Aust 1999; 170:307-11. [PMID: 10327971 DOI: 10.5694/j.1326-5377.1999.tb127783.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe the hospital-treated prevalences for repeat deliberate self-poisoning (RDSP) and the demographic characteristics of the RDSP group, and to compare the RDSP and non-RDSP groups. DESIGN Prospective longitudinal cohort study, with a one- to four-year follow-up. SETTING The Hunter Area Toxicology Service (HATS), a regional toxicology treatment centre in New South Wales. SUBJECTS 1238 consecutive DSP patients referred to hospital, 1992-1994, with follow-up through 1995. OUTCOME MEASURES Deliberate self-poisoning (DSP) admissions within one year (RDSP-1), within six months (RDSP-6m), and within 28 days (RDSP-28d) of any other DSP admission by the same patient; length of stay; demographic characteristics; and drugs ingested. RESULTS 175 patients (14.1%) repeated DSP during the study; 165 (13.3%) were classified as RDSP-1, giving a patient prevalence of hospitalisation in the range of 14.6 to 20.7 per 100,000 per year. Fifty-six RDSP-28d patients (33.9% of RDSP-1) accounted for 49.8% of the RDSP-1 admissions, and 123 RDSP-6m patients (74.5% of RDSP-1) accounted for 83.5% of RDSP-1 admissions. For RDSP-1, the male:female ratio was 1:1.9, with 35.7% unemployed, 29.1% pensioners and 15.8% married or in de facto relationships. RDSP-1 patients had a shorter length of stay (3 h), which was not clinically important. RDSP was more likely for the 25-34 years age group (odds ratio [OR], 2.24; 95% confidence interval [CI], 1.17-4.29) and the 35-44 years age group (OR, 2.12; 95% CI, 1.02-4.39) than the 10-18 years group, and more likely for women than men (OR, 1.69; 95% CI, 1.17-2.46). Being married/de facto reduced the risk for repetition (OR, 0.55; 95% CI, 0.31-0.96) compared with being single. Medications indicated for psychiatric illness were most commonly used for DSP. CONCLUSIONS Many patients who repeat DSP do so after a very brief interval and account for a disproportionate number of hospitalisations. Availability of psychiatric medications for DSP patients is a possible area of intervention.
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Affiliation(s)
- G L Carter
- Newcastle Mater Misericordiae Hospital, Waratah, NSW.
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Bayard-Burfield L, Alling C, Blennow K, Jönsson S, Träskman-Bendz L. Impairment of the blood-CSF barrier in suicide attempters. Eur Neuropsychopharmacol 1996; 6:195-9. [PMID: 8880079 DOI: 10.1016/0924-977x(96)00020-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In a patient group of 90 suicide attempters, 18% showed an impaired blood-CSF barrier; of these 16 patients, all but one were younger than 45 years. When compared with 105 healthy controls, a significant difference in impairment of the blood-CSF barrier, between patients and controls, was seen only in those younger than 45 years (z = -2.66; P < 0.01). Paracetamol intoxication was more common among those with an impaired blood-CSF barrier than among those without an impairment (Fisher's exact test, P = 0.00029). Paracetamol intoxication was the most common method of suicide attempt in patients with adjustment disorders. There was no significant association between alcohol and/or drug abuse and an impaired blood-CSF barrier (Fisher's exact test, P = 0.91977). There were no differences in IgG index between patients and controls. The hypothesis that a blood-CSF barrier leakage may be a confounding factor when assessing the levels of monoamine metabolites in the CSF did not receive any support.
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Abstract
Seventy-five patients were admitted to the ward of the Lund Suicide Research Center following a suicide attempt. After 5 years, the patients were followed up by a personal semistructured interview covering sociodemographic, psychosocial and psychiatric areas. Ten patients (13%) had committed suicide during the follow-up period, the majority within 2 years. They tended to be older at the index attempt admission, and most of them had a mood disorder in comparison with the others. Two patients had died from somatic diseases. Forty-two patients were interviewed, of whom 17 (40%) had reattempted during the follow-up period, most of them within 3 years. Predictors for reattempt were young age, personality disorder, parents having received treatment for psychiatric disorder, and a poor social network. At the index attempt, none of the reattempters had diagnoses of adjustment disorders or anxiety disorders. At follow-up, reattempters had more psychiatric symptoms (SCL-90), and their overall functioning (GAF) was poor compared to those who did not reattempt. All of the reattempters had long-lasting treatment ( > 3 years) as compared to 56% of the others. It is of great clinical importance to focus on treatment strategies for the vulnerable subgroup of self-destructive reattempters.
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