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Suicide prevalence more than doubles when accounting for index attempt deaths
Including index suicide attempt deaths in analysis more than doubled suicide prevalence rates, suggesting inclusion of index and subsequent attempt deaths more accurately determines prevalence.
“One widely cited meta-analysis shows that 8.6% of individuals admitted to a psychiatric unit with suicidal ideation or after a suicide attempt will eventually die by suicide,” J. Michael Bostwick, MD, of Mayo Clinic, Rochester, Minnesota, and colleagues wrote. “However, as with this study, the data describing the risk of completed suicide after an initial attempt have been derived from studies with limited generalizability. Nearly all have focused on cohorts assembled from convenience samples, thus failing to accurately characterize the risk for the general population, let alone the subset with psychiatric illness.”
To compare suicide prevalence rates when including or omitting certain criteria (ie, previous attempts and first-attempt deaths) from analysis, researchers conducted an observational retrospective-prospective cohort study using data from the Rochester Epidemiology Project for 1,490 individuals making index suicide attempts from 1986 through 2007. The National Death Index identified suicides from enrollment through 2010, providing 3 to 25 years of follow-up.
Overall, 5.4% of the cohort died by suicide. Of these, 59.3% died at index attempt and 81.8% of those who did not die at index attempt died within a year.
Among participants who died at index attempt, 72.9% used guns, indicating an odds ratio of 140 (95% CI, 60-325) for gunshot death, compared with all other methods.
Analysis adjusting for covariates indicated significantly lower risk for subsequent suicide among survivors who received follow-up psychiatric appointments (OR = 0.212; 95% CI, 0.089-0.507).
“The implication of these findings is that suicide prevention efforts that commence after index attempt are too late for the nearly two-thirds who die on the first attempt. To be effective, therefore, future research initiatives should focus on identifying populations at risk of making a first attempt, and suicide prevention programs should redouble efforts to reduce the possibility of individuals, particularly males, of making a first attack on their lives. For index attempt survivors, our data support that the year following that first attempt is a critical period for mustering preventive resources to thwart a lethal repeat attack,” the researchers concluded. – by Amanda Oldt
Disclosure: The researchers report no relevant financial disclosures.