Prediction of Repetition of Parasuicide: With Special Reference to Unemployment

Abstract

Economically active male parasuicides admitted to the Regional Poisoning Treatment Centre, Edinburgh in 1984 were divided into two groups--those with a previous history of parasuicide and those without. The two groups were compared on a number of psychosocial and clinical characteristics to examine which were related to repetition. A further analysis (of economically active male admissions in 1985 and 1986) tested the predictive value of these discriminating characteristics. By stratification of the population, the interaction of unemployment (a discriminator and a predictor of repetition) with certain other variables was examined. A final analysis examined the risk of repetition by duration of unemployment. Unemployment discriminated those with a past history of repetition from those with no past history and also predicted repetition within a calendar year of the initial episode. The 35-64 age group were particularly vulnerable to repetition if unemployed as were those in social classes I-III and those with a past psychiatric history (inpatient or outpatient). The relationship between unemployment and parasuicide was no longer significant when the population was stratified by presence or absence of personality disorder and history of previous parasuicide, suggesting that these might be confounding variables in the relationship. The particular vulnerability of the long-term unemployed (greater than one year) to repetition was confirmed.

A retrospective descriptive study of the characteristics of deliberate self-poisoning patients with single or repeat presentations to an Australian emergency medicine network in a one year period

“…This is consistent with another Australian study [14]. Other studies have noted that RPP patients tended to be older than SPP patients [15,19]. It is possible that there are geographical and cultural differences between studies.…”

“…Similar to our study, previous studies have also found that RPP patients were more likely to be unemployed [13,18,19], single [14], live alone [20], or have a psychiatric history [13,18,19]; particularly personality disorder or schizophrenia [19] than SPP patients.…”

“…Our study shows that RPP had higher use of quetiapine associated DSP but the ingested dose was lower in this group. Repeat DSP is often associated with pre-existing mental health conditions, such as schizophrenia and bipolar affective disorder [19], which allows easier access to antipsychotic prescription medication such as quetiapine. Concerns about the trend of increased rates of quetiapine prescribing and ambulance call outs associated with quetiapine use in recent years have been raised in Australia [22].…”

Risk Factors for Repetition of Self-Harm: A Systematic Review of Prospective Hospital-Based Studies

“…Thirteen studies, twelve of which were high-/medium-quality, reported a statistically significant association, with univariate odds ratios ranging from 1.7 (95% CI: 1.4–2.0) [24] to 4.88 (95% CI: 1.27–18.72) [25] and exceptionally high odds ratio in one study of economically active men aged 16–64 years (OR = 7.25, 95% CI: 5.22–10.05) [26]. In contrast, two high-/medium-quality studies and two low-quality studies found no statistically significant association.…”

Distinguishing the relevant features of frequent suicide attempters

“…To date, most studies addressing the prediction of suicide re-attempts have used no measures of predictive accuracy (Bille-Brahe et al, 1997;Cedereke and Ojehagen, 2005;Colman et al, 2004;Morton, 1993;Sidley et al, 1999), limiting the clinical utility of their findings (Galfalvy et al, 2008). However, when the precision of the prediction is measured, the results are disappointing, finding roughly 39% sensitivity and 86% specificity in a study of socio-demographic risk factors of parasuicide (Kreitman and Foster, 1991), 28% sensitivity and 99% specificity in a sample of children after deliberate self-harm (Chitsabesan et al, 2003), or 85e94% sensitivity and 26e38% specificity when assessing self-harm in emergency settings (Cooper et al, 2007).…”