Attempted and completed suicides have a significant impact on psychiatrists. The impact of an attempted suicide is usually less severe. The patterns of reaction differ between consultant and trainee psychiatrists.

Aims:The aim of this survey was to describe patients in care at a large mental health department in northern Italy who attempted suicide, and the clinical management adopted by their psychiatrists before the event.Methods: Data collection was based on a questionnaire administered to the reference psychiatrists.Results: Over a period of 12 months, 166 catchment area residents attempted suicide. Sixty-six (40%) had contacted the mental health department in the previous two years and completed data were obtained on 63. Twenty-nine (46%) suffered from mood, 26 (41%) from personality and 11 (18%) from schizophrenic disorders. Thirty-four attempts occurred within one year of psychiatric ward discharge, mostly in the first quarter. The reference psychiatrists reported that, at the last evaluation, 38 of 63 patients (60%) presented no change in clinical conditions, and 41 of 63 (68%) were considered at no immediate risk of suicide. Most of the attempted suicides in question (45, 72%) were judged to be unpreventable. In the two logistic regression analyses carried out, no independent variables were able to statistically significantly explain the variance in judged suicidal risk or the preventability of the index attempted suicide.Conclusions: According to the psychiatrists' descriptions of their last contact with the patients, most attempted suicides have not been preceded by a change in clinical conditions. Moreover, psychiatrists, irrespective of their age and gender, and of patient diagnosis, frequently judged the attempts to have been unpreventable.Key words: attempted suicide, psychiatric care, suicidal risk, suicide, suicide prevention. P SYCHIATRIC PATIENTS PRESENT high suicide behavior rates. Around 95% of suicides have been reported to suffer from psychiatric illness 1 and almost one quarter to have had at least one contact with mental health services in the year before death. Many suicide attempters (36%-60%) 3-5 also have a history of psychiatric treatment and several contacts with mental health services.Clinical management and appropriateness of psychiatric consultation after a suicide attempt have been variously evaluated. 4,6,7 Studies by Appleby and colleagues 2 have provided abundant information on features of clinical care of persons in contact with psychiatric services before completed suicide, but little research has concentrated on these features in patients who attempted suicide.The aim of this survey was to evaluate routine clinical management of patients by mental health department (MHD) psychiatrists in the period just prior to an attempted suicide (AS). Particular attention was paid to their opinion about suicide risk and the preventability of the AS in their patients, in addition METHODSThis survey was conducted in three stages: identification of people who attempted suicide, identification of those in the sample who had been in contact with the MHD and collection of data through the questionnaire administered to the reference psychiatrists.The catchment area was the city of Padua, in northeast...

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