+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Suicide Attempt as a Risk Factor for Completed Suicide: Even More Lethal Than We Knew



Suicide Attempt as a Risk Factor for Completed Suicide: Even More Lethal Than We Knew



American Journal of Psychiatry 173(11): 1094-1100



While suicide attempt history is considered to robustly predict completed suicide, previous studies have limited generalizability because of using convenience samples of specific methods/treatment settings, disregarding previous attempts, or overlooking first-attempt deaths. Eliminating these biases should more accurately estimate suicide prevalence in attempters. This observational retrospective-prospective cohort study using the Rochester Epidemiology Project identified 1,490 (males, N=555; females, N=935) Olmsted County residents making index suicide attempts (first lifetime attempts reaching medical attention) between January 1, 1986, and December 31, 2007. The National Death Index identified suicides between enrollment and December 31, 2010 (follow-up 3-25 years). Medical records were queried for sex, age, method, and follow-up care for index attempt survivors. Coroner records yielded data on index attempt deaths. During the study period, 81/1,490 enrollees (5.4%) died by suicide. Of the 81, 48 (59.3%) perished on index attempt; 27 of the surviving 33 index attempt survivors (81.8%) killed themselves within a year. Males were disproportionately represented: 62/81 (11.2% of men, 76.5% of suicides) compared with 19/81 (2.0% of women, 23.5% of suicides). Of dead index attempters, 72.9% used guns, yielding an odds ratio for gunshot death, compared with all other methods, of 140 (95% CI=60-325). When adjusted for covariates, survivors given follow-up psychiatric appointments had significantly lower likelihood of subsequent suicide (odds ratio=0.212, 95% CI=0.089-0.507). At 5.4%, completed suicide prevalence in this community cohort of suicide attempters was almost 59% higher than previously reported. An innovative aspect of this study explains the discrepancy: by including index attempt deaths-approximately 60% of total suicides-suicide prevalence more than doubled. We contend that counting both index and subsequent attempt deaths more accurately reflects prevalence. Our findings support suicide attempt as an even more lethal risk factor for completed suicide than previously thought. Research should focus on identifying risk factors for populations vulnerable to making first attempts and target risk reduction in those groups.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 058931933

Download citation: RISBibTeXText

PMID: 27523496

DOI: 10.1176/appi.ajp.2016.15070854


Related references

Antidepressants increase risk of suicide attempt, but not completed suicide, in people with previous suicide attempts. Evidence-BasedMentalHealth10(3):90, 2007

Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis. Plos one 10(5): E0126870, 2015

Are previous suicide attempts a risk factor for completed suicide?. Psicothema 30(1): 33-38, 2018

Racial Differences in Hopelessness as a Risk Factor for a Nearly Lethal Suicide Attempt. Journal of Black Psychology 32(3): 285-302, 2006

Method used in an unsuccessful suicide attempt predicts likelihood of future completed suicide. Evidence-BasedMentalHealth14(1):16, 2011

Hospitalization for suicide attempt and completed suicide: epidemiological features in a managed care population. Social Psychiatry and Psychiatric Epidemiology 35(7): 288-296, 2000

Last suicide attempt before completed suicide in severe depression: an extended suicidal process may be found in men rather than women. Archives of Suicide Research 17(4): 426-433, 2013

Completed suicide after a suicide attempt: a 37-year follow-up study. American Journal of Psychiatry 161(3): 562-563, 2004

Studying survivors of near-lethal suicide attempts as a proxy for completed suicide in prisons. Forensic Science International 220(1-3): 19-26, 2012

Religion as a Risk Factor for Suicide Attempt and Suicide Ideation Among Depressed Patients. Journal of Nervous and Mental Disease 204(11): 845-850, 2016

Risk of repetition of suicide attempt, suicide or all deaths after an episode of attempted suicide: a register-based survival analysis. Australian and new Zealand Journal of Psychiatry 41(3): 257-265, 2007

Risk Factors for Suicide Ideation Differ From Those for the Transition to Suicide Attempt: The Importance of Creativity, Rigor, and Urgency in Suicide Research. Clinical Psychology: Science and Practice 23(1): 31-34, 2016

Bereavement by suicide as a risk factor for suicide attempt: a cross-sectional national UK-wide study of 3432 young bereaved adults. Bmj Open 6(1): E009948, 2016

History of depression and previous suicide attempt predict increased risk of suicide attempt following diagnosis of first-episode psychosis. Evidence-BasedMentalHealth16(3):67, 2013

Completed suicide after a suicide attempt. American Journal of Psychiatry 162(3): 633-633, 2005