Suicidal Career in Severe Depression among Long-Term Survivors: In a Followup after 37-53 Years Suicide Attempts Appeared to End Long before Depression

Prison Suicide in Comparison to Suicide Events in Forensic Psychiatric Hospitals in Germany

Background: There is limited international as well as national research on suicide events in prisons and in forensic psychiatric hospitals. This retrospective study compares completed suicide events within these two high-risk populations in state institutions over a time period of 5 years from 2000 to 2004. Material and Methods: Data was collected through a nationwide survey: all forensic psychiatric hospitals within Germany were contacted via postal mail and received a questionnaire concerning the suicide events from 2000 to 2004. All federal lands of Germany were similarly assessed by a survey endorsed by the respective federal ministries of justice. All prison institutions (100%) participated in the survey, while 84% (53 units) of the forensic psychiatric hospitals nationwide contributed. A comparative statistical analysis was conducted using Fisher's exact test or the Mann-Whitney U-test (age). A multivariate logistic regression analysis was done to assess adjusted effects. For the Kaplan-Meier analysis, the months until suicide were analyzed followed by a Cox-regression analysis. Results: There was no statistically significant difference between the mean suicide rate in forensic psychiatric hospitals (123/100.000, 95% confidence interval: [0.00103, 0.00147]) and in the prison system (130/100.000, 95% confidence interval: [0.00109, 0.00154]). Patients who committed suicide in the forensic hospitals were, in comparison to the prison system, more likely to have committed a violent offense and have had a prior history of suicide attempts. The duration from admission into the institution to the suicide event was significantly shorter in the prison group. Also, younger people commited suicide earlier during their stay in a forensic psychiatric hospital or prison. Conclusions: While the results suggest a necessity to optimize data collection in the prison system (prior suicide events and history of mental disorder), it is important to discuss the current discharge arrangements within the forensic hospitals.

[Suicide in psychiatric hospitals : Results, risk factors and therapeutic measures]

Suicide prevention is a core responsibility of psychiatry and psychotherapy. Periods of change in psychiatric inpatient treatment concepts are usually also accompanied by an increase in psychopathological behavior and with increased suicide rates in psychiatric hospitals, as seen in the 1970s and 1980s in Germany. That this represented a real increase of inpatient suicides during those years was confirmed and subsequently the number and rate of inpatient suicides has decreased from approximately 280 out of 100,000 admissions of patients in 1980 to approximately 50 in 2014. Death can also occur in psychiatric hospitals and an absolute prevention is not possible even under optimal conditions of therapy and nursing, communication and security. The suicide rate has clearly decreased over the last two decades in relation to admissions. The group of young male schizophrenic patients newly identified as having a high clinical suicide risk has decreased among the suicide victims whereas the percentage of severely depressed patients with delusions has increased. This reduction could be associated with the comprehensive improvements in educational and training programs in the field of suicide and suicide prevention, objectification of coping methods, development of diagnostic and therapeutic strategies, improvements in therapy and relationship possibilities and a general reduction in the number of suicides in Germany.

Taking care of oneself by regaining control - a key to continue living four to five decades after a suicide attempt in severe depression

BACKGROUND

Depression is a strong risk factor for suicide and suicide attempt. Several studies have examined the pathway to suicide attempt, but few studies have considered aspects important for overcoming being suicidal. The aim of the present study was to examine personal strategies to continue living after a suicide attempt.

METHODS

A qualitative grounded theory approach was used. Thirteen former inpatients diagnosed with severe depression (1956-1969) participated in a follow-up 42-56 years after their last suicide attempt, which occurred between the ages of 21 and 45. They were interviewed on one occasion between June 2013 and January 2014, using semi-structured interviews.

RESULTS

The pathway to a suicide attempt was defined as 'being trapped in an overwhelming situation'. Three categories described the recovery process: 'coming under professional care', 'experiencing relief in the personal situation', and 'making a decision to continue living'. These categories emerged in a core category, labelled 'taking care of oneself by regaining control'. Overcoming being suicidal occurred regardless of recovering from depression.

CONCLUSION

In the very long-term course following a suicide attempt, the process of recovery is multi-dimensional and fluctuating, and includes appropriate treatment, connecting with others, decision making, and overcoming existential issues.

Changes in Quality of Life After a Suicide Attempt

The aim of this follow-up study was to examine factors related to a suicide attempt within 3 months of a prior attempt. Participants were recruited from a suicide-prevention center. Of 96 suicidal individuals who had participated in the baseline study, only 51 completed all measures at follow-up assessment. Study results showed that suicidal individuals who reattempted suicide during the first 3 months of follow-up care exhibited lower mean scores on all four domains of the brief version of the World Health Organization Quality-of-Life Instrument at follow-up assessment than at baseline. In contrast, individuals who did not reattempt suicide had higher quality-of-life scores across all domains between baseline and 3 months. The reattempt and no-reattempt groups differed significantly in the physical health and environmental domains. These results can be used by nurses to develop their abilities to recognize and prevent suicide reattempts in high-risk groups.