The frequency of suicide attempts: a retrospective approach applied to college students

Suicide attempt rates are usually reported as an annual statistic. However, annual rates may underestimate the cumulative prevalence of attempters since they ignore people whose attempts occurred in years other than the one examined. The authors studied the prevalence of suicide attempters over several years through data gathered from retrospective reports of college students. They found that 15% of the total sample studied (N=293) reported having attempted suicide at one time. This unexpectedly high rate suggests that suicidal behavior is a serious problem among college students and underlines the need for further retrospective studies of the prevalence of suicide attempters.     

Hopelessness, impulsiveness and intent among suicide attempters with major depression, alcohol dependence, or both

The present study examined differences in hopelessness, impulsiveness and suicide intent between suicide attempters with either major depression or alcohol dependence, comorbid major depression and alcohol dependence, and those without these disorders. A sample of 114 patients from consecutive cases of attempted suicide referred to a general hospital in Helsinki was interviewed and diagnosed according to DSM-III-R. Suicide intent was measured by the Beck Suicide Intent Scale (SIS) and hopelessness was assessed by the Beck Hopelessness Scale (HS). Impulsiveness of the suicide attempt was measured by two items of the SIS. Suicide attempters with major depression without comorbid alcohol dependence had higher suicide intent and lower impulsiveness than attempters with non-depressive alcohol dependence. Suicide attempts may differ between subjects with major depression, alcoholism or both disorders in terms of impulsiveness and suicide intent.     

The contribution of environmental events and social support to serious suicide attempts in primary depressive disorder.

Interviewed patients (18–65 yrs old) about the events that occurred to them or their spouse in the 12 mo previous to the suicide attempt. Only primary depressive attempters (14 Ss) were selected, and for purposes of comparison, a primary depressive control group (14 Ss) was selected. Ss were administered the Hamilton Rating Scale for Depression. Moreover, seriousness of suicide attempts was quantified and assessed in each patient, and only moderately or severely serious attempters were chosen. Results show that the occurrence of serious suicide attempts is strongly associated with an increased rate of independent events (events not influenced by the patient's behavior, decisions, or disorder) in the year preceding the attempt, and that a particularly high density of such events between episodic onset and the attempt may serve as the direct initiator of an attempt. Data also suggest that exit events, where an important social support is lost to the patient, may play a significant role in initiating an attempt. Implications for the highest risk period of suicide are discussed. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Isolation and characterization of microsatellite markers in the nuclear genome of the brown alga Laminaria digitata (Phaeophyceae)

OBJECTIVE: The authors' goal was to investigate the treatment received by suicide attempters with major depression before and after the index attempt. METHOD: Forty-three patients with current unipolar DSM-III-R major depression were identified in a diagnostic study from a systematic sample of suicide attempters in Helsinki. All were comprehensively interviewed and investigated after the attempt, and their treatment was ascertained from psychiatric and other health care records and follow-up interviews. RESULTS: During the month just before the suicide attempt, seven (16%) of the patients had received antidepressants in adequate doses, seven had received weekly psychotherapy, and none had received ECT. Although almost all of the patients complied with the recommended aftercare following the suicide attempt, after 1 month only seven (17%) were receiving antidepressants in adequate doses, nine (22%) were receiving weekly psychotherapy, and none had been given ECT. CONCLUSIONS: It seems that few suicide attempters with major depression receive adequate treatment for depression before the suicide attempt and that, despite their well-known high risk for suicide, the treatment situation is not necessarily any better after the attempt. These findings suggest that the recognition of depression and the quality of treatment received for major depression among suicide attempters should be investigated and improved to prevent suicide.     

Clinical comparison of Black and White suicide attempters.

Compared clinical characteristics of Black and White suicide attempters. The sample consisted of virtually all (N?=?275) attempters aged 16 yrs and older brought to the Emergency Unit of the Yale-New Haven Hospital over a 1-yr period (1971–1972). Clinical ratings were made by on-duty resident psychiatrists using 42 variables dealing with mood, motivation, etc. Statistical analysis revealed few differences in Black and White profiles, a result contrary to theories asserting that Black psychology requires different principles from that of White psychology. A related incidental finding was that the frequency of suicide attempts appeared to be about the same among Blacks and Whites, which discredits the widely held belief that suicide is not an important psychiatric problem among Blacks. Rating areas in which the 2 groups did differ somewhat included extent of motivation to influence others, feelings of depression (hopelessness), and deliberateness of planning the attempt. In each of these areas, White attempters had higher scores. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk taking among suicide attempters.

Investigated the risk-taking nature of suicide attempts and determined if attempters have a high propensity to gamble on an experimental risk-taking procedure. 102 suicide attempters and 102 controls matched on sex, age, racial ethnic status, and education were Ss. Results show that (a) attempters took more risks than matched controls, (b) attempters whose suicide actions were judged to be gambles also took more experimental risks than nongambling attempters, and (c) a majority of suicide attempts were characterized by risk-taking behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of suicide studies in Turkey

Official statistics in Turkey show that 3.33 per 100,000 population aged 15 years or over commit suicide every year. Suicides are more frequent in the cities and in the western part of the country. Although suicide rates are much lower than in Western Europe, suicide attempt rates reached comparable levels, around 145 per 100,000, in Ankara in 1995. Studies on the attitudes among the public and among psychiatrists reveal reluctance to face this growing problem.     

Prison inmate characteristics and suicide attempt lethality: An exploratory study.

Working with suicidal inmates is among the most demanding elements of clinical practice in corrections, yet few studies regarding the characteristics of prison inmate suicide attempters or their attempts exist. This represents a significant gap as the method of attempt, the prison context, and the resulting lethality of these incidents may be different from attempts made outside of prison. This exploratory study is the first to apply a continuous scale rating of suicide attempt lethality to incidents where an inmate survived a suicide attempt. It describes the attempt incident dynamics and resulting range of lethality scores found within the study sample. It also examines the inmate adjustment and mental health characteristics that were associated with the lethality rating. Preliminary findings suggest that increases in suicide attempt lethality are associated with the presence of Axis II disorders, favorable staff interactions, and the decreased use of drugs other than marijuana, alcohol, cocaine, or depressants. A call for research to extend this exploration through replication is made and recommendations for clinical practice are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric diagnoses of previous suicide attempters, first-time attempters, and repeat attempters on an adolescent inpatient psychiatry unit

OBJECTIVE: To compare psychiatric diagnoses of hospitalized adolescents who (a) have made previous but no recent suicide attempts, (b) have recently made their first suicide attempt, (c) have recently made a second or subsequent attempt, or (d) have never made an attempt. METHOD: Semistructured psychiatric diagnostic interviews were used to determine psychiatric diagnoses and history of recent and previous suicidal behavior of 269 consecutively admitted adolescents to an inpatient psychiatric facility. Forty-nine previously suicidal youths, 28 first-time attempters, and 33 repeat attempters were compared with 159 nonsuicidal youths in prevalence of Axis I psychiatric disorders and psychiatric comorbidity with affective disorder. RESULTS: Previous attempters and repeat attempters both reported more affective disorders, whereas first-time attempters reported more adjustment disorders than nonsuicidal youths. Previous attempters and nonsuicidal youths reported the most externalizing disorders. CONCLUSIONS: Previous attempters on an inpatient unit have multiple psychiatric problems. Like repeat attempters, they often are depressed, but like nonsuicidal youths, they also exhibit significant externalizing behaviors. Interventions with these adolescents should focus not only on immediate presenting problems, but also on ameliorating their long-term risk of posthospitalization suicidal behavior.     

Prevalence of and risk factors for suicide attempts versus suicide gestures: Analysis of the National Comorbidity Survey.

Definitions and classification schemes for suicide attempts vary widely among studies, introducing conceptual, methodological, and clinical problems. We tested the importance of the intent to die criterion by comparing self-injurers with intent to die, suicide attempters, and those who self-injured not to die but to communicate with others, suicide gesturers, using data from the National Comorbidity Survey (n = 5,877). Suicide attempters (prevalence = 2.7%) differed from suicide gesturers (prevalence = 1.9%) and were characterized by male gender, fewer years of education, residence in the southern and western United States; psychiatric diagnoses including depressive, impulsive, and aggressive symptoms; comorbidity; and history of multiple physical and sexual assaults. It is possible and useful to distinguish between self-injurers on the basis of intent to die. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temperament characteristics of suicide attempters.

Administered temperament assessment measures to 45 suicide attempters (aged 15–67 yrs) to test the hypothesis that suicide attempters have arousable and submissive temperaments. Data support the hypothesis. A significant positive correlation between lethality of the suicide attempt and trait arousability reinforced the importance of high arousability as a temperament characteristic of suicide attempters. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic utility of video EEG monitoring in paroxysmal events

A total of 89 suicide attempters were diagnosed according to the DSM-III-R, and categorized according to suicide method as 'violent' and 'non-violent' attempters, and also as those who had made previous suicide attempts ('repeaters') and those who had not ('non-repeaters'). All of the subjects completed the MNT questionnaire. Our hypothesis was that the temperament patterns would reflect specific clinical characteristics, such as psychiatric diagnoses and type of suicidal behaviour. The 'validity' (ranging from fatiguableness to a high level of psychic energy) showed a bimodal distribution, suggesting the existence of two subgroups. The subjects with adjustment disorders displayed a significantly higher mean validity than the other patients. The lowest validity scores were found in subjects with bipolar depression. Men showed significantly higher 'stability' (reflecting emotional distance from others) than women. Subjects with major depression and those who were 'violent' suicide attempters showed somewhat higher 'solidity' (unchangeability, non-impulsiveness) compared with the other groups. Female 'non-repeaters' displayed significantly lower solidity than males or other females. In general, no clear temperament patterns were detected in patients categorized according to type of suicidal behaviour. In contrast to the findings of studies of normal populations, the intercorrelations between the dimensions were considerable, especially among the men. This prompted us to perform a cluster analysis procedure in which the subjects were allocated to five clusters according to the MNT dimensions. No distinct clinical characteristics appeared in these clusters, except in the cluster with the highest validity and the lowest stability, as 54% (P = 0.014) of the patients in this cluster had an adjustment disorder diagnosis. These temperament results reflect the clinical heterogeneity of patients who attempt suicide.     

Relationships among suicide ideators, attempters, and multiple attempters in a young-adult sample

The relationships among suicide ideators, attempters, and multiple attempters were explored in 332 psychiatric patients referred specifically for suicidal ideation or behavior. Previous researchers have subsumed multiple attempters under the general category of attempters. However, comparisons across a range of variables, including Axis I diagnoses from the revised 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987) depressive and anxiety symptoms, suicidal ideation, hopelessness, problem solving, and a range of personality features revealed that multiple attempters presented a more severe clinical picture and, accordingly, elevated suicide risk compared with attempters and ideators. Observed differences between groups were maintained when attempters with "questionable intent" (i.e., those making equivocal attempts) were excluded from the analyses.     

Lipid effects of an intrauterine levonorgestrel device or oral vs. vaginal natural progesterone in post-menopausal women treated with percutaneous estradiol

The clinical characteristics of 191 adolescent inpatients were examined in relation to frequency of previous suicide attempts, predictors of suicide attempts prior to hospitalization, and lifetime suicide attempts. Overall, more than 50% of the adolescent inpatients had attempted suicide during their lifetime, and of these more than half (58%) had made more than one attempt. Approximately half of the suicide attempters had made a serious attempt prior to hospitalization. Girls reported higher levels of depressive symptoms and suicidal ideation than boys, in addition to having attempted suicide prior to hospitalization (33%) or during lifetime (37%) more often than the boys (13% and 26%, respectively). Although about two thirds of the adolescent inpatients reported that they had received some help after a suicide attempt, approximately half of the repeaters had not received any help. The results of multivariate analyses showed that suicide attempts made prior to hospitalization were predicted by depressive symptom levels and a clinical diagnosis of depressive disorder, whereas frequency of lifetime suicide attempts was predicted by suicidal ideation levels and having a family member or a friend who had attempted (or committed) suicide. The high prevalence of lifetime and repeated suicide attempts among the psychiatric inpatients underscores the importance of identifying risk factors in the clinical evaluation of adolescent suicide attempters.     

Suicide attempts in a cohort of drug abusers: a 5-year follow-up study

A group of 125 drug abusers admitted consecutively for detoxification and short-term rehabilitation were followed up 5 years after discharge. They were asked about possible suicide attempts in a semi-structured face-to-face interview. Nearly half of the group (45%) reported having attempted suicide at some point in their life. The most common reasons given were the loss of a person whom they loved, and feelings of loneliness. Only three respondents reported using their drug of choice in the attempt(s). The suicide attempters were more often found to have been in child psychiatric treatment earlier, and to have experienced loss of significant others in childhood, than those who did not report attempting suicide. At follow-up the suicide attempters indicated that they experienced more depressive moods and more severe psychological problems than those who had never made a suicide attempt. The importance of assessing the risk of suicide attempts among drug addicts in order to be able to take measures to prevent future suicidal behaviour is emphasized.     

Immunogenetics of human IgE

The purpose of this study was to see whether and how the number of suicide attempters with alcohol problems and their drinking habits differ between the Nordic areas under study. Problem-drinkers were defined as persons who themselves felt that they had an alcohol problem. The analyses were based on data collected at five Nordic research centers participating in the WHO/Euro Multicentre Study on Parasuicide, namely: Helsinki (Finland); Ume? and Stockholm (Sweden); S?r-Tr?ndelag (Norway); and Odense (Denmark). The results showed that the frequency of problem-drinking among suicide attempters differed markedly between the areas under study; the Finnish male and the Danish female suicide attempters included the highest proportions of self-identified problem-drinkers. The pattern of drinking among the suicide attempters also differed between the areas. The analyses indicate that the point when alcohol becomes a problem to somebody, especially to a degree that it increases the risk of suicidal behavior, not only depends on how much and how often the person drinks alcohol; the prevailing drinking pattern, the attitudes towards drinking alcohol, and the level of social control are also important factors to take into consideration when relations between alcohol and suicidal behavior are under study.     

Prediction of suicide ideation and attempts among adolescents using a brief performance-based test.

Suicide is a leading cause of death that is difficult to predict because clinical assessment has relied almost exclusively on individuals' self-report of suicidal thoughts. This is problematic because there often is motivation to conceal such thoughts. The authors tested the ability of the Self-Injury Implicit Association Test (SI-IAT), a reaction-time measure of implicit associations between self-injury and oneself, to detect and predict suicide ideation and attempts. Participants were adolescents who were nonsuicidal (n = 38), suicide ideators (n = 37), or recent suicide attempters (n = 14). Analyses revealed large between-group differences on the SI-IAT, with nonsuicidal adolescents showing large negative associations between self-injury and themselves, suicide ideators showing small positive associations, and suicide attempters showing large positive associations on this performance-based test. The SI-IAT accurately predicted current suicide ideation and attempt status as well as future suicide ideation, and it incrementally improved prediction of these outcomes above and beyond the use of known risk factors. Future research is needed to refine this assessment method and to further develop and examine performance-based assessment of suicide risk in clinical settings (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Microanalysis of adolescent suicide attempters and ideators during the acute suicidal episode

OBJECTIVE: To compare psychological and event-related contingencies that characterize and differentiate adolescent suicidal ideation and attempts. METHOD: Thirty-five ideators and 32 attempters (aged 12 to 17 years) consecutively referred to the suicide disorders clinic were evaluated with a semistructured interview about current and past emotional, cognitive, and behavioral states. RESULTS: Before the precipitant stressor (baseline), attempters reported significantly more hopelessness than ideators (odds ratio [OR] = 4.2, p < .05). During the suicidal episode, attempters, relative to ideators, spent more time ideating (OR = 4.3, p < .05), were more likely to isolate themselves (OR = 5.8, p < .01), and were less likely to tell anyone what they were thinking (OR = 4.5, p < .05). In contrast, ideators reported significantly more residual anger after the episode than did attempters (OR = 4.0, p < .05). All the episodes of ideation and attempts were preceded by a stress event. No differences were found between the groups on Beck Depression inventory scores. CONCLUSIONS: Preexisting hopelessness, a tendency toward isolation, not talking about ideation, and longer length of time ideating during suicidal episodes discriminated suicide attempters from suicide ideators. Knowledge of these factors may be helpful in preventive and treatment efforts with suicidal adolescents.     

Classification of attempted suicide: a review of empirical studies, 1963-1993

A review was carried out on empirical studies on the classification of attempted suicide over the period 1963-1993. Our aim was to investigate whether there is research evidence for a valid classification of homogeneous subgroups of suicide attempters. After assessment of the research quality, 32 studies were selected for comparison. Although there is lack of consistency among the studies, indications were found for two clearly distinguished subgroups characterized by mild and severe suicide attempts, which constitute the opposite poles of a one-dimensional concept of severity.     

Cognitive characteristics of suicide attempters.

Contrasted cognitive characteristics of rigidity, impulsivity, and field dependence in a group of 49 19–59 yr old suicide attempters and a group of 48 19–64 yr old nonsuicidal psychiatric controls. All Ss were administered the same test battery consisting of the Embedded Figures Test, the Alternate Uses Test, and the Matching Familiar Figures Test. The suicide attempt group was characterized by greater rigidity in a divergent thinking task while controlling for age and diagnosis using multivariate analysis. Field dependence was more characteristic of the suicide attempters, but only in the 19–34 age group. Impulsivity did not differentiate the 2 groups. The results are interpreted as supporting a hypothesis of a cognitive predisposition to attempting suicide. (1 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)