What’s New in the Patient Safety World
August 2010
Suicide Risk By Method Of First Attempt
Most studies show about a 10% risk
of suicide in a patient who has previously attempted suicide and that the risk
is highest in the year following the attempt. Therefore, most assessments of
patients after a suicide attempt focus on identification of risk factors for
current and future suicide. Such assessments focus on known risk factors like
male sex, older age in women, presence of a psychiatric disorder, and level of
suicidal intent (considering things like “was there a well-thought out plan?”).
Now a new study (Runeson 2010),
using data from linked databases in Sweden, has captured long-term data on the
risk of successful suicide after a prior attempted suicide. In this study, 12%
of patients committed suicide after a prior attempted suicide during a followup
period of 21-31 years.
The most important finding, however,
was that the risk varied significantly by the method used during the
first attempted suicide. Whereas poisoning (overdoses) and cutting are far and
away the most common methods of attempted suicide, the highest relative risk
for successful suicide was for those whose index attempt was by hanging,
strangulation, or suffocation/drowning and 87% of these suicides occurred
within one year of the initial attempt. The risks were also higher for those
whose index attempt involved firearms or explosives, gassing, or jumping from
heights. Most successful suicides also used the same method that had been tried
in the index attempted suicide.
The presence of a psychotic or
affective disorder were additional independent risk factors for suicide. So a
patient with such a severe psychiatric disorder and a suicide attempt by a
method such as hanging, drowning or firearms would be at particularly high
risk.
The implications of this study are
that method of attempted suicide should be included in the overall risk
assessment and that those patients deemed to be at the highest risk merit close
followup, especially during the first year. The editorial accompanying the
study (Hawton
2010) points out that the study was unable to determine whether the method
used in the index attempt may have simply reflected the degree of lethality or
intent on the part of the patient. It also notes that while these statistics
accurately describe a population, it is still difficult to apply them in
individual cases. Would you followup a patient who had attempted suicide by
overdose any less rigorously than one who attempted suicide by hanging?
Probably not. But you can expect the key points of this study to probably be
incorporated into some existing suicide risk assessment tools.
References:
Runeson B, Tidemalm D, Dahlin M, et al. Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort study.
BMJ 2010; 341: c3222
http://www.bmj.com/cgi/reprint/341/jul13_1/c3222
Hawton K. Completed suicide after attempted suicide. BMJ 2010; 341:c3064
http://www.bmj.com/cgi/content/extract/341/jul13_1/c3064
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