Second Suicide Attempts Increases Risk of Success
Individuals who make a second suicide attempt are at an elevated risk for achieving success. Those who suffer from unipolar depression, biopolar depression and schizophrenia are in the highest risk group and remain "at risk" for an extended period of time according to a 31-year study completed at the Karolinska Institute (Sweden). The highest risk group was individuals within the first year of hospitalization from their previous attempt. The study followed 39,685 individuals, ages 10 and older, who were hospitalized for a suicide attempt from 1973 until 2003. Men had the highest percentage of suicides in the first year period. Interesting, is that 68% of the individuals were not diagnosed with a psychiatric disorder at the time of their discharge from the hospital. The "diagnosis-free" group had a rate of attempts in the first year post-hospitalization at 45.1% for men and 39.6% for women; although the completed suicide rate was low at 5.1% for men and 2.8% for women. Over the course of the study, individuals with bipolar and unipolar disorders and schizophrenia had the highest risk of successfully completing suicide. Rates of suicide were found to be high for: other depressive disorders; anxiety disorder; alcohol abuse (women only); drug abuse and personality disorders. The suicide rate for individuals with adjustment disorders, post traumatic stress and men with alcohol abuse problems were not found to be elevated.
The study points to the need to make suicide prevention a priority in mental health treatment and policy development and to establish a continuum of services for individuals who attempt suicide following their discharge from inpatient hospitalization.The study further identified the need to involve family members of the person's social network in educational activities as part of the aftercare and prevention programs.
Suicide is a real risk which does not diminish following the initial hospital intervention unless continuing treatment occurs and the family and friends participate in educational and awareness programs. For individuals with chronic psychiatric problems we must maintain a high level of vigilance for future risk behaviors.
Tidelman, D et al "Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long-term follow-up" BMJ 2008; DOI:10.1136/bmj.a2205