A comparison of medically serious suicide attempters admitted to intensive care units versus other medically serious suicide attempters

Abstract

Background Medically serious suicide attempts (MSSA) represent a subgroup of clinically heterogeneous suicidal behaviours very close to deaths by suicide. A simple definition of an MSSA is a suicide attempt with life-threatening consequences, regardless of the severity of the attempter’s mental disorder. Few studies have specifically analysed the heterogeneity of MSSA. Therefore, the aim of this study is to describe the profile of individuals who made a highly severe MSSA and to compare those admitted to Intensive Care Units (ICU) – including Burn Units– with other MSSA admitted to other medical and surgical units. Methods The study sample consisted of 168 patients consecutively admitted to non-psychiatric wards from two public hospitals in Barcelona after an MSSA during a 3-year period. In order to select more severe MSSA, the minimum hospital stay was expanded from Beautrais’ definition of ≥ 24 h to ≥ 48 h. Mean hospital stay was 23.68 (SD = 41.14) days. Patients needing ICU treatment (n = 99) were compared to other MSSArs (n = 69) that were admitted to other medical and surgical units, not requiring intensive care treatment, with an initial bivariant analysis followed by a logistic regression analysis using conditional entrance. Results Medically serious suicide attempters (MSSArs) spent more time hospitalized, more frequently reported recent stressful life events, were more likely to have at least one prior suicide attempt (SA) and their current attempt was more frequently non-planned, compared to the profile of MSSArs reported in previous studies. The most frequent method was medication overdose (67.3%) and jumping from heights (23.2%). Among those who chose more than one method (37.6%), the most frequent combination was medication overdose and drug use. Affective disorders and personality disorders were the most frequent diagnoses. Higher educational level, history of previous mental disorders and prior lifetime suicide attempts were significantly more frequent among those admitted to ICU compared to other MSSArs. Patients needing admission to ICU less frequently used self-poisoning and cuts. Conclusions MSSA needing ICU admission can be regarded clinically as similar to attempts resulting in suicide. More research on this type of highly severe suicide behaviour is needed due to its serious implications both from a clinical and public health perspective.

Trends in medically serious suicide attempts before and after the COVID-19: a four-year retrospective analysis (2018-2022)

“…In contrast, anxiety disorders and social isolation predominated among patients with MSSA (19). Quesada-Franco et al 20 compared the MSSA's features requiring admission to an Intensive Care Unit (ICU) to less severe MSSA (considering only those hospitalized ≥ 48 hours after the attempt). They found that the former reported recent stressful life events more frequently, were more likely to have at least one prior SA and a history of mental disorders, and their current attempt was predominantly non-planned compared to the other group.…”

“…They de ned high-lethal attempts as those using different methods than drug poisoning, stabbing, and other chemical poisonings. However, their de nition does not include the need for hospitalization after the attempt resulting from the medical consequences of the MSSA (15,16,20).…”

Suicide Data in Trauma Centers: Implications of Imprecision

“…Level I trauma centers see patients with medically serious suicide attempts, defined as a suicide attempt that would have resulted in death if not for prompt medical care (Levi-Belz et al, 2022). Despite the high lethality of methods used by patients treated in this setting and the finding that medical seriousness of a suicide attempt is associated with a greater risk of future suicide (Quesada-Franco et al, 2022), there are minimal established best practices in suicide prevention and intervention for trauma centers.…”