Correlates of Relative Lethality and Suicidal Intent among Deliberate Self‐Harm Patients

Abstract

Conflicting findings have been reported regarding the relationship between the potential lethality of acts of deliberate self-harm (DSH) and suicidal intent, and how each relates to patient characteristics. This study examines the relationship of suicidal intent of DSH to lethality, the relationship of both to patient characteristics, and determines if intent or lethality are risk factors for repetition of DSH. Potential lethality and Suicide Intent Scale (SIS) scores for DSH episodes were examined in a representative sample of 150 patients presenting to a general hospital. Follow-up interviews were completed 12 to 20 months later. Lethality was strongly associated with high intent. Both lethality and intent were associated with male gender. Suicidal intent but not lethality was associated with the presence of psychiatric disorder and depression. Intent was significantly correlated with hopelessness scale score. Although intent was correlated with both depression and self-esteem scale scores, these correlations became nonsignificant when the effect of hopelessness was removed. Repetition of DSH during the follow-up period was related to neither lethality nor intent scores for the original episodes. Lethality and suicidal intent, although related, have somewhat different correlates. Both should be considered when assessing DSH patients, but their relationship to further suicidal behavior does not appear to be straightforward.

Method Choice in Nonfatal Self-Harm as a Predictor of Subsequent Episodes of Self-Harm and Suicide: Implications for Clinical Practice

“…1,6 Consistent with others, we did not find a significant association between repetition of nonfatal self-harm and the potential lethality of index events (assessed in our work by the method used and in previous work by physicians' estimation of the lethality of an index event had it not been treated). 39 Our multivariate finding that intentional self-harm with methods other than drug overdose, cutting, or piercing at any time during the study period was associated with an increased risk of subsequent suicide is similar to observations from studies that analyzed the method used in the index event 3,40 and in the penultimate episode of self-injury. 25 Our finding that cutting or piercing (relative to drug overdose) was associated both with an increased risk of nonfatal repetition (HR = 1.3) and of suicide (HR = 1.7), though not statistically significant, is consistent with some studies 4,25 but not others.…”

Correlation between Bipolar Affective Disorder and Suicide reviewing by the risk factors: a systematic review

“…For assessment of suicide attempters, medical lethality and intent to die are two essential concepts [100,101]. We found no association between intent to die (measured using the SIS) and any of the mood disorders.…”

Staff attitudes towards inpatients with borderline personality disorder

“…However, some of these studies also looked at patient's intent to die using the Suicidal Intent Scale (SIS) (Beck et al 1974). Haw et al (2003) found that patients presenting to a general hospital having self harmed were more likely to have a high intent to die if they had a diagnosis of depression, and a low intent to die if they had a diagnosis of PD. Findings like these may be a basis to the negative attitudes due to clients being seen as wasting the time of health care professionals (Jeffery 1979).…”

“…However, the Haw et al (2003) study consisted of a small sample size which may not be representative of the population as a whole. The study also only contained a very small number of patient's who had seriously self harmed; this may have caused a bias in the results (Haw et al 2003). Mind (2007) (B)) recognises that self harm may not always be done with the intent to die; it is often used as a mechanism to cope with emotions and release stress.…”