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#11 - Suicide et RÉCIDIVE DE TENTATIVES DE SUICIDE - 13 mars 2012
Les tentatives antérieures de suicide représentent l’un des principaux facteurs de risque pour d’éventuelles récidives et même un suicide complété. Cette population serait 200 fois plus à risque de décéder par suicide. Dans certaines études, on rapporte que jusqu’à 25% des patients traités en urgence après une tentative de suicide vont s’y représenter dans l’année en cours suite à une nouvelle tentative. Un sujet qui préoccupe grandement les chercheurs du CRISE. Celui-ci, sous la direction du Pr Brian Mishara, mène présentement une vaste étude dans la région montréalaise, avec la collaboration de 10 hôpitaux, pour connaître et mieux comprendre ce qui a poussé des personnes à faire leur tentative de suicide et pour mieux intervenir et prévenir toutes récidives de tentatives (voir notre bulletin INFO-CRISE, vol. 1 no 1 pour un aperçu de la recherche). Les membres-chercheurs du CRISE, Marc Daigle, Louise Pouliot, François Chagnon, Brian Greenfield et Brian Mishara, viennent de publier une revue de littérature sur les avenues prometteuses en prévention des suicides à répétition.
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Daigle, M. S., Pouliot, L., Chagnon, F., Greenfield, B., & Mishara, B. (2011). Suicide attempts: Prevention of repetition. Canadian Journal of Psychiatry = Revue canadienne de psychiatrie, 56(10), 621-629.
Résumé: Objective: To present an overview of promising strategies to prevent repetition of suicidal behaviours. Method: This literature review on tertiary preventive interventions of suicide attempts was produced using the computerized databases PubMed and PsycINFO from January 1966 to September 2010, using French- and English-language limits Results: Thirteen of the 35 included studies showed statistically significant effects of fewer repeated attempts or suicides in the experimental condition. Overall, 22 studies focused on more traditional approaches, that is, pharmacological or psychological approaches. Only 2 of the 6 pharmacological treatments proved significantly superior to a placebo- a study of lithium with depression and flupenthixol with personality disorders. Eight out of 16 psychological treatments proved superior to treatment as usual or another approach: cognitive-behavioural therapy (CBT) (n = 4), (including dialectical behaviour therapy [n = 2]); psychodynamic therapy (n = 2); mixed (CBT plus psychodynamic therapy [n = 1]); and motivational approach and change in therapist (n = 1). Among the 8 studies using visit, postal, or telephone contact or green-token emergency card provision, 2 were significant: one involving telephone follow-up and the other telephone follow-up or visits. Hospitalization was not related to fewer attempts, and 1 of the 4 outreach approaches had significant results: a program involving individualized biweekly treatment. The rationale behind these single or multiple approaches still needs to be clarified. There were methodological flaws in many studies and some had very specific limited samples. Conclusions: There is a need for more research addressing the problem in definitions of outcomes and measurement of the dependent variables, gender-specific effects, and inclusion of high-risk groups. There is a need for the development and evaluation of new approaches that support collaboration with community resources and more careful assessment and comparisons of existing treatments with different populations.
Vaiva, G., Jardon, V., Vaillant, A., & Ducrocq, F. (2011). Prévention tertiaire du suicide: que faire pour éviter la récidive? La Revue du praticien, 61(2), 202-203, 206-207.
Résumé: Un individu ayant survécu à une tentative de suicide (TS) appartient en fait à un groupe à risque de suicide (40% de répétition à vie dont 20 à 25% au cours des 12 mois suivant le geste initial). Prévenir le risque de suicide en général est donc efficace sur la prévention de la répétition. Il semble d'abord important de traiter une pathologie somatique ou psychiatrique ayant pris part dans le contexte initial suicidaire: le traitement d'un trouble dépressif; de prescrire un stabilisateur de l'humeur d'un patient bipolaire; la gestion du traitement global d'un trouble de personnalité borderline, etc. Certaines stratégies ont été proposées dans un but précis de réduire ce taux de répétition suicidaire. Certaines interventions apparaissent coûteuses et difficiles à généraliser (à des interventions à domicile, aux psychothérapies intensives et brèves réalisées à partir de la salle d'urgence, etc.).
Chan-Chee, C., & Jezewski-Serra, D. (2011). Hospitalisations pour tentatives de suicide entre 2004 et 2007 en France métropolitaine. Analyse du PMSI-MCO. Bulletin épidémiologique hebdomadaire, (47-48), 492-496.
Résumé: Le Programme de médicalisation des systèmes d’information (PMSI) a été utilisé pour l’analyse des hospitalisations pour tentatives de suicide (TS). En France métropolitaine, entre 2004 et 2007, un total de 359 619 séjours pour TS ont été comptabilisés en médecine et chirurgie, correspondant à 279 843 patients, soit environ 90 000 hospitalisations pour 70 000 patients par an. Au cours des quatre années étudiées, 84,1% des patients ont été hospitalisés une seule fois et 15,9% des patients ont été hospitalisés plusieurs fois pour TS. Quelle que soit l’année, les séjours féminins ont représenté 65% de l’ensemble des séjours pour TS. L’absorption de médicaments était le mode opératoire des TS de loin le plus fréquent, concernant 79% des TS hospitalisées, soit entre 67 000 et 79 000 séjours hospitaliers par an. Le taux de séjours pour TS était de 16,9 pour 10 000 habitants (12,4 pour 10 000 hommes et 21,2 pour 10 000 femmes). Les séjours hospitaliers pour TS concernant les adolescentes de 15 à 19 ans présentaient les taux les plus élevés, avoisinant 43 pour 10 000. Les régions du Nord et de l’Ouest, à l’exception de l’Île-de-France et des Pays-de-a-oire, avaient des taux standardisés supérieurs au taux national chez les hommes et chez les femmes. Le taux de ré-hospitalisation pour TS progressait de 14,0% à 12 mois jusqu’à 23,5% à 48 mois sans différence selon le sexe ; il était plus élevé parmi les 30-49 ans et chez les patients ayant un diagnostic psychiatrique. Cette étude montre l’ampleur du phénomène suicidaire en France, souligne la nécessité de compléter la surveillance des TS et de mettre en place des actions de prévention et de prise en charge de certains groupes de population particulièrement vulnérables.
Lorillard, S., Schmitt, L., & Andreoli, A. (2011). Comment traiter la tentative de suicide? 1re partie: Efficacité des interventions psychosociales chez des patients suicidants à la sortie des urgences. Annales Medico-Psychologiques, 169(4), 221-228.
Résumé: La possibilité thérapeutique de diminuer le risque de récidive suicidaire a été largement étudiée ces dernières années, contribuant au développement de nouvelles techniques visant à réduire ce risque. Pourtant, demeure la question des indications et des modalités pratiques de ces techniques, les sujets faisant une tentative de suicide formant une population hétérogène en regard de leurs facteurs de risque, diagnostics, et comorbidités. Ce travail se propose donc de passer en revue les études randomisées contrôlées ayant évalué les traitements de la tentative de suicide, parmi les patients suicidants, dans cette première partie, et parmi la sous-population à risque supérieur des patients présentant un trouble de personnalité limite, dans une seconde partie. Plusieurs essais soutiennent l’efficacité de certaines interventions, allant des plus simples (cartes postales, coordonnées des urgences) aux plus structurées. L’une des principales limitations nous a semblé être l’hétérogénéité de la population des patients suicidants. Cette revue souligne donc la nécessité de mieux évaluer les patients dès les urgences, en ciblant les facteurs de risque, ainsi que de développer des prises en charge spécifiques en fonction des risques de récidive.
Arensman, E., Corcoran, P., & Fitzgeral, A. P. (2011). Deliberate self-harm: Extent of the problem and prediction of repetition. In R. C. O'Connor, S. Platt & J. Gordon (Eds.), International Handbook of Suicide Prevention: Research, Policy and Practice (pp. 119-131). Chichester, UK: John Wiley & Sons, Ltd.
Résumé: Deliberate self-harm (DSH) is a major public health problem in many countries and varies by age group, gender, and ethnicity. Having engaged in an act of DSH is the strongest predictor of future suicidal behaviour, both non-fatal and fatal. Development and implementation of effective assessment procedures for DSH patients are required in order to assess risk of repetition and prevent repeated suicidal behaviour. In this chapter we present the outcomes of a review of studies addressing the extent of the problem of deliberate-self-harm (DSH) and repetition, prediction of factors associated with repeated DSH including age, gender ethnicity, and assessment procedures for DSH patients presenting to hospital emergency departments.
Beghi, M., & Rosenbaum, J. F. (2010). Risk factors for fatal and nonfatal repetition of suicide attempt: a critical appraisal. Current Opinion in Psychiatry, 23(4), 349-355.
Résumé: PURPOSE OF REVIEW: To perform a critical appraisal of reports on suicide attempts published in 2009, looking for features and predictors of suicidal behavior. RECENT FINDINGS: We searched Psychinfo, Embase, and Pubmed in the period from 1 December 2008 to 31 December 2009 looking for papers on suicide attempt. Rates of suicide attempts are in line with previous data and confirm a north-south gradient in the suicide attempt rate. Previous attempts are the strongest risk factors for further attempt. Moreover, we point out the importance of mood disorders (in particular depression) and personality disorders, unemployment, and a medium age as risk factors. In adolescence, the repetition rate seems to overlap that of the adult population, though the samples are very small. Even in this case, the presence of a previous suicide attempt increases the risk for repeated suicide attempt. By contrast, the role of psychiatric and demographic variables is less clear. Studies on personality disorders confirm that having a personality disorder increases the risk for further attempt, but this correlation is significantly less strong for fatal repetition. In depressed patients, the presence of anxiety perhaps acts as a protective factor. SUMMARY: The risk for a suicide attempt is higher for people who had previously attempted. Having a psychiatric diagnosis and more specifically a mood disorder is also a strong predictor for both fatal and nonfatal suicide attempt.
Mehlum, L., & Mork, E. (2011). After the suicide attempt: The need for continuity and quality of care. In R. C. O'Connor, S. Platt & J. Gordon (Eds.), International Handbook of Suicide Prevention: Research, Policy and Practice (pp. 353-367). Chichester, UK: John Wiley & Sons, Ltd.
Résumé:Suicide attempters presenting at general hospitals are a high-risk patient population posing significant challenges to hospital staff and aftercare providers. However, due to lack of knowledge, high work stress and lack of coodination, clinicians frequently provide insufficient psychosocial assessments and treatments. This is problematic since suicide attempters are well known for their high risk of repeat suicide attempts and completed suicide. Most experts in suicide prevention would regard them as a key target group for preventive interventions and there is room for substantial improvement in this field. Over the years, various treatment approaches to improve the continuity of care have been developed, but with mixed outcomes. Based on experiences from these studies we have formulated a set of recommendations for the clinical management and care of suicide attempters. We propose a set of requirements that seem to be important to ensure the continuity of care in defined catchment areas over extended periods of time. We highlight results from some of our own recent studies of the Norwegian chain of care model and provide recommendations for policy and clinical practice.
Monnin, J., Thiemard, E., Vandel, P., Nicolier, M., Tio, G., Courtet, P., et al. (2011). Sociodemographic and psychopathological risk factors in repeated suicide attempts: Gender differences in a prospective study. Journal of Affective Disorders, 136(1-2), 35-43.
Résumé: BACKGROUND: The prevention of the repetition of suicide attempts is an important feature of the care of attempters but current data fail to give actual predictors of repetition. The aim of this study was to characterize sociodemographic and psychopathological features and risk factors associated with future repetition of suicide attempts in two years. The study focused on differences between men and women. METHODS: 273 participants selected in psychiatric emergency units after their admission for a suicide attempt (index) were included in the study. Subsequent suicide attempts occurring within a two year follow-up were identified from the regional observatory of suicide attempts. At inclusion, sociodemographic variables and psychopathological data were collected. In particular, psychometric evaluations were performed using the following scales: BDI-SF, SIS, BIS and BDHI. The lifetime history of suicide attempt was also noted. RESULTS: Repetition of suicide attempt in 2years was associated with current follow up and treatment, a personal history of multiple suicide attempt, post traumatic stress disorder, current recurrent psychotic syndrome and substance misuse. Specific features of men and women repeaters have been identified. Men repeaters were characterized by substance use disorders whereas the re-attempt in women was associated with current follow up and treatment, post traumatic stress disorder and higher BDI-SF score. CONCLUSIONS: Repeaters must be considered as a specific population among suicide attempters and gender differences must be taken into account in this particular population in order to promote more personalized prevention programs for suicidal recurrence and completed suicide.
Lopez-Castroman, J., Perez-Rodriguez, M. d. l. M., Jaussent, I., Alegria, A. A., Artes-Rodriguez, A., Freed, P., et al. (2011). Distinguishing the relevant features of frequent suicide attempters. Journal of Psychiatric Research, 45(5), 619-625.
Résumé: Background: In spite of the high prevalence of suicide behaviours and the magnitude of the resultant burden, little is known about why individuals reattempt. We aim to investigate the relationships between clinical risk factors and the repetition of suicidal attempts. Methods: 1349 suicide attempters were consecutively recruited in the Emergency Room (ER) of two academic hospitals in France and Spain. Patients were extensively assessed and demographic and clinical data obtained. Data mining was used to determine the minimal number of variables that blinded the rest in relation to the number of suicide attempts. Using this set, a probabilistic graph ranking relationships with the target variable was constructed. Results: The most common diagnoses among suicide attempters were affective disorders, followed by anxiety disorders. Risk of frequent suicide attempt was highest among middle-aged subjects, and diminished progressively with advancing age of onset at first attempt. Anxiety disorders significantly increased the risk of presenting frequent suicide attempts. Pathway analysis also indicated that frequent suicide attempts were linked to greater odds for alcohol and substance abuse disorders and more intensive treatment. Conclusions: Novel statistical methods found several clinical features that were associated with a history of frequent suicide attempts. The identified pathways may promote new hypothesis-driven studies of suicide attempts and preventive strategies. http://dx.doi.org/10.1016/j.jpsychires.2010.09.017
Beautrais, A. L., Gibb, S. J., Faulkner, A., Fergusson, D. M., & Mulder, R. T. (2010). Postcard intervention for repeat self-harm: randomised controlled trial. British Journal of Psychiatry, 197(1), 55-60.
Résumé: BACKGROUND: Self-harm and suicidal behaviour are common reasons for emergency department presentation. Those who present with self-harm have an elevated risk of further suicidal behaviour and death. AIMS: To examine whether a postcard intervention reduces self-harm re-presentations in individuals presenting to the emergency department. METHOD: Randomised controlled trial conducted in Christchurch, New Zealand. The intervention consisted of six postcards mailed during the 12 months following an index emergency department attendance for self-harm. Outcome measures were the proportion of participants re-presenting with self-harm and the number of re-presentations for self-harm in the 12 months following the initial presentation. RESULTS: After adjustment for prior self-harm, there were no significant differences between the control and intervention groups in the proportion of participants re-presenting with self-harm or in the total number of re-presentations for self-harm. CONCLUSIONS: The postcard intervention did not reduce further self-harm. Together with previous results this finding suggests that the postcard intervention may be effective only for selected subgroups.
Miret, M., Nuevo, R., Morant, C., Sainz-Cortón, E., Jiménez-Arriero, M. Á., López-Ibor, J. J., et al. (2011). The role of suicide risk in the decision for psychiatric hospitalization after a suicide attempt. Crisis, 32(2), 65-73.
Résumé: Background: Suicide prevention can be improved by knowing which variables physicians take into account when considering hospitalization or discharge of patients who have attempted suicide. Aims: To test whether suicide risk is an adequate explanatory variable for predicting admission to a psychiatric unit after a suicide attempt. Methods: Analyses of 840 clinical records of patients who had attempted suicide (66.3% women) at four public general hospitals in Madrid (Spain). Results: 180 (21.4%) patients were admitted to psychiatric units. Logistic regression analyses showed that explanatory variables predicting admission were: male gender; previous psychiatric hospitalization; psychiatric disorder; not having a substance-related disorder; use of a lethal method; delay until discovery of more than one hour; previous attempts; suicidal ideation; high suicidal planning; and lack of verbalization of adequate criticism of the attempt. Conclusions: Suicide risk appears to be an adequate explanatory variable for predicting the decision to admit a patient to a psychiatric ward after a suicide attempt, although the introduction of other variables improves the model. These results provide additional information regarding factors involved in everyday medical practice in emergency settings. http://dx.doi.org/10.1027/0227-5910/a000050
Oh, S. H., Park, K. N., Jeong, S. H., & Kim, H. J. (2011). Deliberate self-poisoning: factors associated with recurrent self-poisoning. American Journal of Emergency Medicine, 29(8), 908-912.
Résumé: OBJECTIVE: To investigate potential risk factors associated with the repetition of deliberate self-poisoning (DSP). METHODS: Retrospective medical record review of all patients who presented to the emergency department of a tertiary teaching hospital after DSP between January 1, 2000, and December 31, 2009. Repetition of a suicide attempt was determined from reported episodes before the index episode or from 2 visits to the same hospital during the study period. Demographic information, clinical variables, and other variables at the first suicide attempt were investigated for factors associated with repetition of DSP. RESULTS: Of the 967 patients, 203 (21%) presented with repeated suicide attempts. Patients with repeat suicide attempts differed in sex, occupation, living condition, method of DSP, history of psychiatric treatment, reversibility, and psychiatric diagnosis. In the multivariate regression analysis, the only reliable associated factors for repeat suicide attempt were sex, living condition, method of DSP, and history of psychiatric treatment. CONCLUSION: Early psychological intervention and close observation is required for patients who are female, living without a family, use antidepressants, and have a history of psychiatric treatment.
Wilcox, H. C. (2011). Method used in an unsuccessful suicide attempt predicts likelihood of future completed suicide. Evidence-Based Mental Health, 14(1), 16.
Résumé: Does the method used in an unsuccessful suicide attempt predict the likelihood of subsequent completed suicide?48 649 individuals (age 10 and over) admitted to hospital between 1973 and 1982 after definite or uncertain attempted suicide (International Classification of Diseases, Revision 8 (ICD-8) codes E950-9 and E980-9). All individuals who attempted suicide in this period were identified using Swedish national hospital discharge registers. For individuals with multiple suicide attempts, the first was considered the index event. People who immigrated within 2 years prior to the index event were excluded to avoid confounding by the stress of asylum seeking. General population, Sweden; 1973–2003. Method of index suicide attempt (identified using ICD codes). People attempting suicide by poisoning were used as the reference group as it was the most common method.
Yip, P. S., Hawton, K., Liu, K., Liu, K. S., Ng, P. W., Kam, P. M., et al. (2011). A study of deliberate self-harm and its repetition among patients presenting to an emergency department. Crisis, 32(4), 217-224.
Résumé: BACKGROUND: Marked differences have been found in the characteristics of people dying by suicide in Western and Asian countries. However, there is less information available on possible differences for deliberate self-harm (DSH). AIMS: To compare the characteristics of people presenting to hospital in Hong Kong and Oxford (UK) with DSH, and to assess the outcome of those persons in Hong Kong. METHODS: A sample of DSH patients admitted to the accident and emergency (A&E) department of a regional hospital in Hong Kong was assessed and followed up 6 months later to assess the risk of repetition of DSH, and was then compared with such patients in Oxford. RESULTS: The majority of patients in Hong Kong were female, young (59% were under 35), and had used self-poisoning (78%). Over one-third were single (37%) and one-fourth unemployed (26%). About half (49%) scored in the high or very high categories of the Beck's Suicide Intent Scale, considerably more so than in Oxford; 44.6% of patients defaulted psychiatric outpatient service during the 6-month follow-up period. The repetition rate within the following 6 months was 16.7%. The number of self-reported adverse life problems, history of childhood sexual and physical abuse, and repetitive self-mutilation were shown to be the factors most strongly correlated with the risk of re-attempt. Alcohol problems were much lower than in Oxford. CONCLUSIONS: The findings show that DSH patients in Hong Kong show some marked differences compared to those in Oxford. Implications for the prevention of repeated DSH in Hong Kong are discussed.
Bergen, H., Hawton, K., Waters, K., Cooper, J., & Kapur, N. (2010). Psychosocial assessment and repetition of self-harm: The significance of single and multiple repeat episode analyses. Journal of Affective Disorders, 127(1-3), [257-265].
Résumé: BACKGROUND: Self-harm is a common reason for presentation to the Emergency Department. An important question is whether psychosocial assessment reduces risk of repeated self-harm. Repetition has been investigated with survival analysis using various models, though many are not appropriate for recurrent events. METHODS: Survival analysis was used to investigate associations between psychosocial assessment following an episode of self-harm and subsequent repetition, including (i) one repeat, and (ii) recurrent repetition (</=5 repeats) using (a) an independent episodes model, and (b) a stratified episodes model based on a conditional risk set. Data were from the Multicentre Study on Self-harm in England, 2000 to 2007. RESULTS: Psychosocial assessment following an index episode of self-harm was associated with a 51% decreased risk of a repeat episode in persons with no psychiatric treatment history, and 26% decreased risk in those with a treatment history. For recurrent repetition, assessment was associated with a 57% decreased risk of repetition assuming independent episodes, and 13% decreased risk accounting for ordering and correlation of episodes by the same person (stratified episodes model). All models controlled for age, gender, method, history of self-harm, and centre differences. LIMITATIONS: Some missing data on psychiatric treatment for non-assessed patients. CONCLUSIONS: Psychosocial assessment appeared to be beneficial in reducing the risk of repetition, especially in the short-term. Findings for recurrent repetition were highly dependent on model assumptions. Analyses should fully account for ordering and correlation of episodes by the same person.
Bilen, K., Ottosson, C., Castren, M., Ponzer, S., Ursing, C., Ranta, P., et al. (2011). Deliberate self-harm patients in the emergency department: Factors associated with repeated self-harm among 1524 patients. Emergency Medicine Journal,28(12), 1019-1025.
Résumé: Objectives: (1) investigate risk factors associated with repeated deliberate self-harm (DSH) among patients attending the emergency department due to DSH, (2) stratify these patients into risk categories for repeated DSH and (3) estimate the proportion of repeated DSH within 12 months. Design: A consecutive series of individuals who attended one of Scandinavia's largest emergency departments during 2003-2005 due to DSH. Data on sociodemographic factors, diagnoses and treatment, previous DSH at any healthcare facility in Sweden (2002-2005) and circumstances of the index DSH episode were collected from hospital charts and national databases. A nationwide register based on follow-ups of any new DSH or death by suicide during 2003-2006. Main outcome measure: Repeated DSH episode or suicide. Results: 1524 patients were included. The cumulative incidence for patients repeating DSH within 12 months after the index episode was 26.8%. Risk factors associated with repeating DSH included previous DSH, female gender, self-injury as a method for DSH and if the self-injury required a surgical procedure, current psychiatric or antidepressant treatment and if the patient suffered from a substance use disorder or adult personality disorder or did not have children under the age of six. Conclusion: Patients attending an emergency department due to DSH have a high risk of repeating their self-harm behaviour. We present a model for risk stratification for repeated DSH describing low-risk (18%), median-risk (28% to 32%) and high-risk (47% to 72%). Our results might help caretakers to direct optimal resources to these groups.
Gordon, K. H., Selby, E. A., Anestis, M. D., Bender, T. W., Witte, T. K., Braithwaite, S., et al. (2010). The reinforcing properties of repeated deliberate self-harm. Archives of Suicide Research, 14(4), 329-341.
Résumé: The current study tested hypotheses derived from Joiner's (2005) interpersonal theory of suicide, which proposes that deliberate self-harm (DSH) becomes increasingly more reinforcing with repetition. One hundred six participants with a history of DSH completed questionnaires about their emotions and experience of physical pain during their most recent DSH episode. Consistent with prediction, people with more numerous past DSH episodes felt more soothed, more relieved, and calmer following their most recent episode of DSH. Contrary to prediction, greater numbers of past DSH episodes were associated with more intense physical pain during the most recent episode. The findings suggest that the emotion regulation functions of DSH may become more reinforcing with repetition.
Pompili, M., Innamorati, M., Szanto, K., Di Vittorio, C., Conwell, Y., Lester, D., et al. (2011). Life events as precipitants of suicide attempts among first-time suicide attempters, repeaters, and non-attempters. Psychiatry Research,186(2-3), 300-305.
Résumé: The aims of this study were to investigate risk factors for suicide attempts and propose a model explaining the associations among life events and suicide status. We assessed 263 subjects admitted following a suicide attempt to the Division of Psychiatry of the Department of Neurosciences of the University of Parma and compared them with 263 non-attempter clinical control subjects. Attempters reported significantly more adverse life events both in the last 6 months, and between the ages of 0–15 years than non-attempters. A multinomial logistic regression analysis with stepwise forward entry indicated that the best model to explain suicide status was one which included life events in the last 6 months, life events during age 0–15 years, and their interaction. First-time attempter status (vs. non-attempters) was more likely to be linked to life events in the last 6 months, the interaction between life events in the last 6 months and life events during age 0–15 years, and low social support. Those attempters with one or more prior attempts (repeat attempters) were more likely than non-attempters to be linked to the interaction between life events in the last 6 months and life events during age 0–15 years, and to higher rates of psychopharmacological treatment before the index admission. Guided by these findings, monitoring the impact of early-life and recent events in vulnerable individuals should be part of risk assessment and treatment.
Rasmussen, S. A., Fraser, L., Gotz, M., Machale, S., Mackie, R., Masterton, G., et al. (2010). Elaborating the cry of pain model of suicidality: testing a psychological model in a sample of first-time and repeat self-harm patients. British Journal of Clinical Psychology, 49(Pt 1), 15-30.
Résumé: Objectives: Few studies have specifically tested the Cry of Pain model (CoP model; Williams, 2001). This model conceptualizes suicidal behaviour as a behavioural response to a stressful situation which has three components: defeat, no escape potential, and no rescue. In addition, the model specifies a mediating role for entrapment on the defeat-suicidal ideation relationship, and a moderating role for rescue factors on the entrapment-suicidal ideation relationship. This is the first study to investigate the utility of this psychological model in a sample of first-time and repeat self-harm (SH) patients. Method: One hundred and thirteen patients who had been admitted to hospital following an episode of SH (36 first-time, 67 repeat) and 37 hospital controls completed measures of defeat, entrapment/escape potential, rescue (social support and positive future thinking), as well as depression, anxiety, and suicidal ideation. Results: Analyses highlighted differences between the three participant groups on all of the CoP variables. Hierarchical regression analysis confirmed that total entrapment and internal entrapment mediated the relationship between defeat and suicidal ideation, whilst impaired ability to think positively about the future (but not social support) moderated the relationship between total and internal entrapment and suicidal ideation. Conclusions: The findings provide further empirical support for the CoP Model. The findings are discussed in relation to theory and practice and we recommend that the findings are replicated within a prospective design.
Verwey, B., van Waarde, J. A., Bozdag, M. A., van Rooij, I., de Beurs, E., & Zitman, F. G. (2010). Reassessment of suicide attempters at home, shortly after discharge from hospital. Crisis, 31(6), 303-310.
Résumé: Background: Assessment of suicide attempters in a general hospital may be influenced by the condition of the patient and the unfavorable circumstances of the hospital environment. Aims: To determine whether the results of a reassessment at home shortly after discharge from hospital differ from the initial assessment in the hospital. Methods: In this prospective study, systematic assessment of 52 suicide attempters in a general hospital was compared with reassessment at home, shortly after discharge. Results: Reassessments at home concerning suicide intent, motives for suicide attempt, and dimensions of psychopathology did not differ significantly from the initial hospital assessment. However, patients' motives for the suicide attempt had changed to being less impulsive and more suicidal, worrying was significantly higher, and self-esteem was significantly lower. A third of the patients had forgotten their aftercare arrangements and most patients who initially felt no need for additional help had changed their mind at reassessment. Conclusions: Results from this group of suicide attempters suggest that a brief reassessment at home shortly after discharge from hospital should be considered.
Murphy, E., Kapur, N., Webb, R., Purandare, N., Hawton, K., Bergen, H., et al. (2011). Risk factors for repetition and suicide following self-harm in older adults: multicentre cohort study. British Journal of Psychiatry, [Epub].
Résumé: BACKGROUND: Older adults have elevated suicide rates. Self-harm is the most important risk factor for suicide. There are few population-based studies of self-harm in older adults. AIMS: To calculate self-harm rates, risk factors for repetition and rates of suicide following self-harm in adults aged 60 years and over. METHOD: We studied a prospective, population-based self-harm cohort presenting to six general hospitals in three cities in England during 2000 to 2007. RESULTS: In total 1177 older adults presented with self-harm and 12.8% repeated self-harm within 12 months. Independent risk factors for repetition were previous self-harm, previous psychiatric treatment and age 60-74 years. Following self-harm, 1.5% died by suicide within 12 months. The risk of suicide was 67 times that of older adults in the general population. Men aged 75 years and above had the highest suicide rates. CONCLUSIONS: Older adults presenting to hospital with self-harm are a high-risk group for subsequent suicide, particularly older men.
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