Repeated self-poisoning: increasing severity of self-harm as a predictor of subsequent suicide

Abstract

BackgroundPrediction of suicide risk is difficult in clinical practice.AimsTo identify changes in clinical presentation predictive of suicide in patients treated for repeated episodes of self-poisoning.MethodA nested case–control study used the Hunter Area Toxicology Service database to identify exposure variables and the National Death Index to identify suicide. Cases were patients who had hospital treatment on more than one occasion between 15 January 1987 and 31 December 2000.ResultsThere were 31 cases, for which 93 controls were selected. Study variables associated with an increased risk of subsequent suicide were an increase in the number of drugs ingested (odds ratio 2.59, 95% CI 1.48–4.51), an increase in the dose ingested (OR1.33, 95% CI 1.01–1.76), an increase in coma score (OR 1.71, 95% CI 1.11–2.66), a decrease in Glasgow Coma Score (OR 1.21, 95% CI 1.03–1.43) and an increase in drug or alcohol misuse (OR 2.33, 95% CI 1.06–5.10).ConclusionsPatients who have escalating severity of self-poisoning episodes are at high risk of completed suicide.

Distinguishing the relevant features of frequent suicide attempters

“…Likewise, the risk of an increased intensity of the medical treatment required (intensive care compared to ER/medical admission) among frequent attempters would be explained if repetition escalates the severity of subsequent SAs (Haw et al, 2007).Repeated deliberate self-harm (Zahl and Hawton, 2004) or SA (Christiansen and Jensen, 2007;Nordentoft, 2007) has been frequently associated with a higher risk of suicide death. Epidemiological data also supports that the severity of the SA increases with repeat attempts, possibly explaining the increased risk for subsequent completed suicide (Carter et al, 2005;Malone et al, 1995).…”

“…Accurate identification of high-risk suicide attempters is crucial to the development and implementation of targeted interventions to be provided according to the potential for reattempt and the available resources (Carter et al, 2005). In this study, we used a variable selection technique, Causal Discovery (CD), which is useful for both interpretation and prediction of relationships between variables (Pearl, 2000;Spirtes et al, 2000).…”

Predicting and Preventing Suicide: Do We Know Enough to Do Either?

“…If one follows a sample with multiple, medically severe attempts, the rate of completion is higher. For example, in a study of 31 cases of completion after repeated self-poisoning, Carter and colleagues 28 reported that multiple attempts with increasing severity were associated with a significantly higher rate of suicide.…”

Prevalência de transtornos mentais nas tentativas de suicídio em um hospital de emergência no Rio de Janeiro, Brasil

“…Outros estudos demonstram que a associação entre a história de tentativa de suicídio anterior e transtornos mentais aumentam em 5 a 6 vezes o risco para novas tentativas e suicídio, principalmente nos casos com maior letalidade 48,54,55,56,57 .…”