The literature provides support for the hypothesis that some major repeaters (individuals with ≥5 lifetime suicide attempts) are addicted to suicidal behavior (SB). This study explores whether major repeaters are addicted to SB or not using 7 criteria: tolerance (Criterion 1), withdrawal (Criterion 2), loss of control (Criterion 3), problems in quitting/cutting down (Criterion 4), much time spent using (Criterion 5), substantial reduction in activities (Criterion 6), and adverse physiological/physical consequences (Criterion 7). Total dependence on SB was indicated by the presence of 3 or more of the 7 criteria in the last 12 months. This cross-sectional study at Puerta de Hierro University Hospital (Madrid, Spain) recruited 118 suicide attempters including 8 major repeaters (7%, 8/118), who were all females. The association between each SB addiction criterion, physiological dependence and total dependence with major repeater status was tested for significance and for effect size with odds ratios (ORs) and their 95% confidence intervals. As hypothesized, major repeaters met significantly higher frequency of criteria for total dependence on SB, OR=62.9 (6.4-615). A backward stepwise logistic regression model was used to provide an OR between major repeater status and total dependence status corrected by confounding variables. Age, panic disorder without agoraphobia, borderline personality disorder, history of psychiatric inpatient admission, and total dependence on SB were introduced as independent variables with major repeater status as the dependent variable. The model selected total dependence and age as the remaining significant variables in the last step. Accordingly, major repeaters appear to be addicted to SB. Key words: major repeaters, suicidal behavior, addiction, borderline personality disorder. La escasa literatura existente sugiere que los "grandes repetidores" (individuos con 5 intentos de suicidio a lo largo de la vida) pueden ser considerados "adictos" a los comportamientos suicidas. Este estudio explora si los grandes repetidores sufren una adicción a los comportamientos suicidas usando 7 criterios: tolerancia (Criterio 1), abstinencia (Criterio 2), perdida de control (Criterio 3), problemas para dejar de tener o disminuir esos comportamientos (Criterio 4), uso de tiempo excesivo (Criterio 5), reducción importante de actividades (Criterio 6), y consecuencias físicas adversas (Criterio 7). La dependencia total a los comportamientos suicidas era diagnosticada si el sujeto cumplía 3 o más de los 7 criterios en los últimos 12 meses. Se trata de un estudio transversal realizado integramente en el Hospital Universitario Puerta de Hierro (Madrid, Spain), donde fueron recrutados 118 individuos que se presentaron en los servicios de urgencia por un intento de suicidio, incluyendo 8 grandes repetidores (7%, 8/118), siendo todos ellos mujeres. Se estimó si había asociaciones estadísticamente significativas y el tamaño del efecto con la razón de oportuniades y los intervalos de confianza (95%) entre cada un...
Introduction:There is a lack of accurate screening tools for suicide risk in the patients presenting to emergency departments. The Personality and Life Event (PLE) Scale, a set of the 27 most discriminative items from a collection of questionnaires usually employed in the assessment of suicidal behavior, demostrated an elevated accuracy, sensibility, and specificity in classifying suicide attempters.Objectives:To validate the self-administered PLE Scale.Material and methods:In order to examine its psychometric properties, the PLE scale was administered to 59 suicide attempters, 48 psychiatric controls, and 69 medical patients attending the Puerta de Hierro emergency department. To examine its reliability, we used: 1) Cronbach's coefficient α to evaluate the internal consistency; 2) test-retest reliability to assess if the scale is stable over time. Interrater reliability is not relevant as the PLE is a self-report. To assess its construct validity, we used some of Beck's Suicide Intent Scale (SIS). All analyses were carried out using SPSS v.20 (Macintosh).Results:The most frequent criteria for suicide attempters were item 4 (‘I often feel empty inside’; 88.1%) and 20 (‘I act on impulse’; 79,7%). Mean (± SD) of the PLE Scale in suicide attempters, psychiatric controls, and medical controls was 74.49 (± 32.44), 57.19 (± 29.63), and 17.48 (± 21.15), respectively. The PLE had an acceptable internal consistency (Cronbach's alpha =0,674).Conclusions:Our preliminary findings support the reliability, construct validity, and ussefulness of the PLE to identify suicide attempters to those attending to emergency departments.
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