Medically serious suicide attempts in ICU similar to those who take their own lives

For individuals who make medically serious suicide attempts, those that require admission to intensive care units should be considered similar to those which result in suicide, researchers wrote in a study published in BMC Psychiatry.

“Suicide occurs at all stages of life, being the fourth cause of death in people between 15 and 29 years,” Marta Quesada-Franco, MD, of the department of psychiatry at Vall d’Hebron University Hospital in Barcelona, and colleagues wrote. “Individuals who made a [medically serious suicide attempt] in the past are at higher risk of dying by suicide than those who make less serious lethal suicide attempts.”

Quesada-Franco and colleagues sought to describe the profile of individuals who made a highly severe medically serious suicide attempt (MSSA) and to compare those admitted to ICUs — including burn units — with other MSSA admitted to other medical and surgical units.

Their cross-sectional study sample included 168 individuals (mean age, 45 years; 47.6% male) consecutively admitted to non-psychiatric wards over a 3-year period at Vall d’Hebron (n = 68) and Clinic Hospital (n = 100) in Barcelona following an MSSA. Criteria to determine severe MSSA were expanded to a minimum hospital stay of 48 hours or more. The mean hospital stay for all participants was 23.68 days.

Individuals requiring ICU treatment (n = 99) were compared to other medically serious suicide attempters (MSSArs) (n = 69) who were admitted to other medical and surgical units, not requiring intensive care treatment, with an initial bivariant analysis followed by a logistic regression analysis using conditional entrance.

Results showed that MSSArs spent more time hospitalized, more frequently reported recent stressful life events, were more likely to have at least one prior suicide attempt and their current attempt was more frequently non-planned, compared with the profile of MSSArs reported in previous studies.

Data revealed that 62.5% of participants used only one method, and the most frequent of those were medication overdose (67.3%) and jumping from heights (23.2%), while 36.3% chose violent means. Among those who chose more than one method (37.6%), the most frequent combination was medication overdose and drug use.

In addition, researchers found that drug (37.6%) and alcohol use (26.2%) were the highest reported among substances used before suicide attempt. Affective disorders and personality disorders were the most frequent diagnoses. Higher educational level, history of previous mental disorders and prior lifetime suicide attempts were significantly more frequent among those admitted to ICU compared with other MSSArs. Patients needing admission to ICU less frequently used self-poisoning and cuts.

“Preventing MSSA should be considered a public health priority in order to reduce the negative impact on the patient’s wellbeing and to lessen the health care system’s expenditure on this type of suicidal behaviors,” Quesada-Franco and colleagues wrote.