Alcohol Consumption and Nearly Lethal Suicide Attempts

W e conducted a case‐control study of the association between nearly lethal suicide attempts and facets of alcohol consumption; namely, drinking frequency, drinking quantity, binge drinking, alcoholism, drinking within 3 hours of suicide attempt, and age began drinking. Subjects were 13–34 years of age. In bivariable analyses, all measures were associated with nearly lethal suicide attempts. Odds ratios ranged from 2.4 for alcoholism to 7.0 for drinking within 3 hours of attempt. All exposure variables except age began drinking exhibited a J‐shaped relationship between alcohol exposure and nearly lethal suicide attempt. After controlling for potential confounders and other measures of alcohol exposure, drinking within 3 hours of attempt remained most strongly (odds ratios > 6) associated. Alcoholism remained significantly associated in most models, but at lower strength.     

Medical Conditions and Nearly Lethal Suicide Attempts

P hysical illness has been studied as a risk factor for suicidal behavior, but little is known about this relationship among younger persons. We conducted a population‐based, case‐control study in Houston, Texas, from November 1992 through September 1995. The final sample consisted of 153 case‐ and 513 control‐subjects aged 13 to 34 years. Case patients were identified at hospital emergency departments and met criteria for a nearly lethal suicide attempt. Control subjects were recruited via a random‐digit‐dial telephone survey. Case patients were more likely than controls to report having any serious medical conditions (crude OR = 3.23; 95% CI = 2.12–4.91). After controlling for age, race/ethnicity, alcoholism, depression, and hopelessness, the adjusted odds ratio for men was 4.76 (95% CI = 1.87–12.17), whereas the adjusted odds ratio for women was 1.60 (95% CI‐0.62–4.17), suggesting that young men with medical conditions are at increased risk for nearly lethal suicide attempts. Increased efforts to identify and appropriately refer these patients are needed.     

The Influence of Geographic Mobility on Nearly Lethal Suicide Attempts

T eenagers and young adults are very mobile and mobility has been identified as a potential risk factor for suicidal behavior. We conducted a population‐based, case‐control study of nearly lethal suicide attempts with 153 cases and 513 controls. Study participants were asked about changing residence over the past 12 months. Results indicate that moving in the past 12 months is positively associated with a nearly lethal suicide attempt (adjusted odds ratio of 2.1, with 95% confidence interval of 1.4–3.3), as are specific characteristics of the move (e.g., frequency, recency, distance, and difficulty staying in touch). These findings confirm and extend prior ecologic research by demonstrating a relationship, at the individual level, between the geographic mobility of adolescents and young adults and nearly lethal suicide attempts.     

Help‐Seeking Behavior Prior to Nearly Lethal Suicide Attempts

T he association between help‐seeking and nearly lethal suicide attempts was evaluated using data from a population‐based, case‐control study of 153 13‐ to 34‐year‐old suicide attempt case‐patients treated at emergency departments in Houston, Texas, and a random sample of 513 control‐subjects. Measures of help‐seeking included whether the participant sought help for health/emotional problems in the past month, type of consultant contacted, and whether suicide was discussed during the interaction. Overall, friends/family were consulted most frequently (48%). After controlling for potential confounders, case‐patients were less likely than control‐subjects to seek help from any consultant (OR = 0.5, 95% CI = 0.3–0.8) or a professional (e.g., physician, counselor) consultant (OR = 0.5, 95% CI = 0.29–0.8). Among those who sought help, case‐patients were more likely than to discuss suicide (OR = 2.6, 95% CI = 1.2–5.4), particularly with professionals (OR = 11.8, 95% CI = 3.2–43.2). Our findings suggest that efforts to better understand the role of help‐seeking in suicide prevention, including help sought from family and friends, deserves further attention.     

An Unmatched Case‐Control Study of Nearly Lethal Suicide Attempts in Houston,Texas: Research Methods and Measurements

T his article details the research methods and measurements used in conducting a population‐based, case‐control study of nearly lethal suicide attempts among persons aged 13–34 years, residing in Houston, Texas. From November 1992 to July 1995, we interviewed 153 case subjects presenting at one of three participating hospital emergency departments and used random digit dialing to identify 513 control subjects residing in the same catchment area in which cases were enlisted. Unlike most research in this area, this study was designed to extend our understanding of suicidal behavior and prevention activities beyond identification and treatment of depression and other mental illnesses. We discuss the overall strengths and weaknesses of our study design and conclude that this methodology is well suited for studying rare outcomes such as nearly lethal suicide.     

Identification of Nearly Fatal Suicide Attempts: Self-Inflicted Injury Severity Form

The Self-inflicted Injury Severity Form (SIISF) was developed as an epidemiological research tool for identifying individuals in hospital emergency departments who have life-threatening self-inflicted injuries. Data were collected from 715 patients with self-inflicted injuries in two large hospitals. In 295 of these cases, a second set of data was independently collected for assessment of interrater reliability. Validity was assessed by comparing the SIISF results with simultaneously collected Risk—Rescue Ratings. Assessment of interrater reliability found that only 2.4% of physicians disagreed on the suicide method used. The kappa statistic for method used was .94, indicating excellent agreement. The SIISF was found to distinguish between severe and less severe injuries. Thus, it appears to provide a simple method to distinguish patients who have life-threatening self-inflicted injuries.     

Adolescent Suicide Attempts: Some Significant Factors

ABSTRACT: A group of 108 adolescents who attempted suicide over a two-year period is described. Significant factors related to these attempts are presented and discussed. These adolescent suicide attempts are most significantly related to long-term family dysfunction. Some vegetative depressive symptoms are noted in a majority of patients. Implications are drawn for strengthening the mental health practitioner's role in detecting and preventing adolescent suicide.     

Assessing Motivations for Suicide Attempts: Development and Psychometric Properties of the Inventory of Motivations for Suicide Attempts

This study describes the psychometric properties of the Inventory of Motivations for Suicide Attempts (IMSA). The IMSA was designed to comprehensively assess motivations for suicide emphasized by major theories of suicidality. The IMSA was administered to two samples of recent suicide attempters, undergraduates (n = 66) and outpatients (n = 53). The IMSA exhibited a reliable two‐factor structure in which one factor represented Intrapersonal motivations related to ending emotional pain, and the second represented Interpersonal motivations related to communication or help‐seeking. Convergent validity and divergent validity of IMSA scales were supported by expected patterns of correlations with another measure of suicide motivations. In addition, the IMSA scales displayed clinical utility, in which greater endorsement of intrapersonal motivations was associated with greater intent to die, whereas greater endorsement of interpersonal motivations was associated with less lethal intent and greater likelihood of rescue. Findings suggest the IMSA can be of use for both research and clinical purposes when a comprehensive assessment of suicide motivations is desired.     

Temporal Variation in Adolescent Suicide Attempts

The purpose of this study was to examine the association between adolescent suicide attempts and temporal cycles in a multiethnic population. Medical records at two hospitals in the state of Hawaii were reviewed for all adolescents (ages 12–18) admitted for suicide attempts during the years 1987–1991. Results showed 296 adolescents attempted suicide, and as hypothesized, temporal factors were associated with the attempts. A significant increase in attempts was found during the afternoon/evening and on Mondays and Tuesdays, transition points between home and school. The results are discussed and implications for delivery and temporal theory development considered.     

Suicide Survivors Groups: Results of a Survey

Little is known about the nature of suicide survivors groups. Survey responses by 149 U.S. and Canadian groups are characterized as follows: (1) they are most often sponsored by mental health or social service agencies or have no sponsor; (2) groups have operated an average of 8 to 9 years; (3) fewer than 10 people typically attend monthly or twice monthly meetings; (4) group experience predominantly involves sharing personal experiences; (5) leadership generally involves either trained facilitators, mental health professionals, or both; (6) most groups are open ended; (7) all social/ethnic, income, and adult age groups are served, but few children and teenagers attend; and (8) referrals come predominantly by word-of-mouth or medical and religious sources. Further research is required regarding survivor group attributes and processes.     

Suicide Attempts in Preadolescent Child Psychiatry Inpatients

This paper describes a preliminary study examining the relative power of measures of perceived family support, hopelessness, and depression for the classification of suicide attempters and nonattempters in a series of 8- to 13-year-old psychiatric inpatients. Results of a stepwise discriminant-function analysis indicated that a measure of a child's perceived family support discriminated between suicide attempters and nonattempters with an 88% accuracy rate. The addition of measures of hopelessness and depression at later steps did not lead to improved classification. The results are interpreted as providing strong support for a link between suicide attempts in children and perceptions of low family support.     

Autobiographical Memory and Suicide Attempts in Schizophrenia

According to the cry of pain model of suicidal behavior, an over‐general autobiographical memory function is often found in suicide attempters. The model has received empirical support in several studies, mainly of depressed patients. The present study investigated whether deficits in autobiographical memory may be associated with an increased frequency of suicide attempts in patients with schizophrenia. We found support for our hypothesis that patients with schizophrenia and previous suicide attempts have an over‐generalized autobiographical memory compared to patients with schizophrenia without previous suicide attempts. Adjustment for sociodemographic and clinical variables did not change the results.     

Predicting Suicide Attempts among Treatment‐Seeking Male Alcoholics: An Exploratory Study

Documented risk factors for suicide among alcohol‐dependent patients are sensitive but insufficiently specific to effectively identify individuals who are prone to future suicide attempt. As a first step to assess factors not previously considered, this pilot study involved a group of male alcohol‐dependent patients (N = 175) coming to detoxification to examine the potential utility of adverse childhood experiences (ACE) along with other documented events to discriminate individuals with a history of attempted suicide from their detoxifying peers. Family health history questionnaires were used to evaluate their ACEs. Receiver operating characteristic (ROC) analysis was applied to examine the predictive power of ACEs, alone or in combination with documented risk factors, to lifetime history of attempted suicide. Among our participants, 48 (27.4%) had a history of a suicide attempt and 156 (89.1%) reported at least one out of the nine categories of ACEs. Modeling by ROC analysis, we found that a cutoff of four or more ACEs plus a history of personal violence achieved the best predictive power to a history of any suicide attempt, producing a sensitivity of 0.7, specificity of 0.81, and area under curve of 0.75. A prospective study to replicate and extend our findings is necessary.     

Suicide Attempts and Suicide among Marines: A Decade of Follow‐up

Suicidal behavior among military personnel is of paramount public health importance because of the increased risk of death from suicide in this population. Pre‐ and post‐Marine recruit training risk factors for suicide attempts among current and former Marines were examined in 10 years following recruit training. The characteristics of the subsample of current and former Marines who died by suicide during this time are also described. Stressful and traumatic life events (e.g., childhood physical, sexual, and emotional abuse, sexual harassment during recruit training) and pre‐recruit training suicide attempts emerged as having strong associations with post‐recruit training attempts. Half of those who died by suicide in the 10 years following recruit training endorsed at least one significant life stressor prior to joining the Marines. This study highlights the importance of screening for stressful and potentially traumatic experiences occurring both before and during military service as part of a comprehensive suicide risk assessment in military samples.     

Escaping the World: Linguistic Indicators of Suicide Attempts in Poets

The purpose of this study was to determine features of language use in the texts of poets who committed suicide and to identify psychological factors contributing to depression and suicide. Texts of suicidal and non-suicidal poets were analyzed via the Linguistic Inquiry and Word Count program. ANOVA and logistic regression analysis revealed predictors of suicide: higher percentage of words self-oriented, expressed negative emotions, ambiguity, exclusion attitude toward reality, and lower percentages of words related to others, world entitativity, and experiencing the world. The data support hypotheses that suicide is facilitated by weak social bonds, egocentrism, helplessness, and visions of an unordered, uncertain, and unsafe world.     

Comparative Psychopathology of Suicide Attempts and Assaults

ABSTRACT: Using the Katz Adjustment Scales to measure psycho-pathology, systematic samples of 108 suicide attempters and 42 persons arrested for assault were tested in Baltimore, Maryland. The subjects' scores were compared with ratings by third-party respondents, who knew the subjects well, and with scores of 450 controls. Both suicide attempters and assaulters displayed significantly more psychopathology than the controls. The suicide attempters were differentiated from the assaulters on six Katz items: Helplessness, Anxiety, Nervousness, Depression, Stability, and General Psychopathology. An attempt was made to refine prediction and control of these two different life-threatening behaviors by interpreting the data in terms of Henry and Short's concept of “internal restraint.”     

“自杀”：一个重要的伦理问题

自杀现已成为人类死亡十大原因之一 ,而且呈现出低龄化的趋势 ,越来越引起社会的关注。因而 ,从政治、经济、社会、疾病、文化等多视角来寻找自杀的外部原因 ,对探究这个重要的伦理问题是有益的。     

Characteristics of Impulsive Suicide Attempts and Attempters

S uicide attempts often are impulsive, yet little is known about the characteristics of impulsive suicide. We examined impulsive suicide attempts within a population‐based, case‐control study of nearly lethal suicide attempts among people 13–34 years of age. Attempts were considered impulsive if the respondent reported spending less than 5 minutes between the decision to attempt suicide and the actual attempt. Among the 153 case‐subjects, 24% attempted impulsively. Impulsive attempts were more likely among those who had been in a physical fight and less likely among those who were depressed. Relative to control subjects, male sex, fighting, and hopelessness distinguished impulsive cases but depression did not. Our findings suggest that inadequate control of aggressive impulses might be a greater indicator of risk for impulsive suicide attempts than depression.