No abstract

A patient who has attempted suicide presents the physician with an extremely important question, "What should be his action to prevent a possibly successful suicide in the immediate future?" This study was undertaken to obtain data that might help the physician decide what action to take. Specifically the following questions were investigated. What is the incidence of successful suicide following an unsuccessful suicide attempt, as ascertained by a short-term follow-up? What important clinical characteristics of the patient who has attempted suicide help in deciding whether he will be a serious suicidal risk in the near future? In this connection, is it important to make a diagnosis? Are the patient's statements reliable guides to what he will do in the near future? Do patients inform the physician (or someone close to them) of suicidal thoughts or plans often enough to permit preventive action? Is hospitalization necessary for most of these patients? Some psychiatrists have felt that these questions could not be answered by a conventional clinical work-up. This feeling has perhaps contributed to the relative frequency of studies utilizing data only from hospital records as compared with the paucity of studies utilizing direct inter¬ view and examination of the patient. Findings in studies that have used direct interviews have not been validated by a follow-up investigation. This study attempts to over¬ come these deficiencies by directly studying the patient and by utilizing a follow-up to check the interview findings. METHOD OF STUDYSelection of Patients.-During a five month period (Dec. 15, 1952, through May 15, 1953 120 patients who attempted suicide were brought to the St. Louis City Hospital receiving room. By prior agreement, all such patients were seen by the psychiatric resident who then reported on them to us. In order to assure that no case of attempted suicide was missed, we regularly reviewed receiving room notes, which are kept on every patient seen there, and requests for psychiatric consultation from other parts of the hospital.Of the total 120 patients, 109 were interviewed, 14 be¬ fore discharge from the receiving room, 89 during their hospitalization, and 6, who were mistakenly discharged from the receiving room before we were notified, were contacted and examined later. The remaining 11 patients, who were also mistakenly discharged before we examined them, were not seen by any of us. The following con¬ siderations determined whether a patient was acceptable for inclusion in the study. 1. If the patient stated that he had deliberately done something to himself that he felt was harmful or that others would interpret as harmful, he was included in the study (101 patients). 2. Patients who denied that their act was intentional were included, if there was sufficient reason to doubt their denial (8 pa¬ tients). 3. Patients were included regardless of the med¬ ical or surgical seriousness of the attempt. As a result many patients who had made only a feeble gesture were included. 4. If a patient had c...