Identifying Distinguishable Clinical Profiles Between Single Suicide Attempters and Re-Attempters

Abstract

More than 800,000 individuals die from suicide each year in the world, which has a devastating impact on families and society. Ten to twenty times more attempt suicide. Previous studies showed that suicide attempters represent a heterogeneous group regarding demographic characteristics, individual characteristics of a suicidal attempt, and the assumed clinical factors, e.g., hopelessness or impulsivity, thus differently contributing to the likelihood of suicidal behavior. Therefore, in the present study, we aim to give a comprehensive clinical description of patients with repeated suicide attempts compared to single attempters. We explored putative differences between groups in clinical variables and personality traits, sociodemographic information, and specific suicide attempt-related information. A sample of patients with a recent suicide attempt (n = 252), defined according to DSM-5 criteria for a suicidal behavior disorder (SBD), was recruited in four psychiatric hospitals in Thuringia, Germany. We used a structured clinical interview to assess the psychiatric diagnosis, sociodemographic data, and to collect information regarding the characteristics of the suicide attempt. Several clinical questionnaires were used to measure the suicide intent and suicidal ideations, depression severity, hopelessness, impulsivity, aggression, anger expression, and the presence of childhood trauma. Univariate and multivariate statistical methods were applied to evaluate the postulated risk factors and, to distinguish groups based on these measures. The performed statistical analyses indicated that suicide attempters represent a relatively heterogeneous group, nevertheless associated with specific clinical profiles. We demonstrated that the re-attempters had more severe psychopathology with significantly higher levels of self-reported depression, suicidal ideation as well as hopelessness. Furthermore, re-attempters had more often first-degree relatives with suicidal behavior and emotional abuse during childhood. They also exhibited a higher degree of specific personality traits, i.e., more “urgency” as a reaction to negative emotions, higher excitability, higher self-aggressiveness, and trait anger. The multivariate discriminant analysis significantly discriminated the re-attempters from single attempters by higher levels of self-aggressiveness and suicidal ideation. The findings might contribute to a better understanding of the complex mechanisms leading to suicidal behavior, which might improve the early identification and specific treatment of subjects at risk for repeated suicidal behavior.

Suicidal behavior-advances in clinical and neurobiological research and improvement of prevention strategies

“…A significant number of subjects with suicidal behavior have a history of early life adversities, which is therefore considered as a risk factor for future suicide attempts[ 50 ]. In our recent work (see above) we were able to show that especially patients with multiple suicide attempts had higher levels of early life adversities compared to single attempters[ 35 ].…”

“…, hopelessness or impulsivity. The authors recently conducted a study on this issue and compared single and multiple suicide attempters for this purpose[ 35 ]. A sample of patients with a recent suicide attempt ( n = 252) was recruited.…”

“…They also exhibited a higher degree of specific personality traits, i.e. , higher excitability and higher self-aggressiveness[ 35 ]. Multivariate discriminant analysis discriminated the re-attempters from single attempters by higher levels of self-aggressiveness[ 35 ].…”

“…, higher excitability and higher self-aggressiveness[ 35 ]. Multivariate discriminant analysis discriminated the re-attempters from single attempters by higher levels of self-aggressiveness[ 35 ]. Although suicidal behavior is a complex and multifaceted phenomenon, in the future individual factors such as self-aggressiveness could be suitable as an indicator in order to identify patients who are particularly at risk and to provide them with suitable therapeutic measures.…”

Investigating the Clinical Profile of Suicide Attempters Who Used a Violent Suicidal Means

“…The only clinically robust predictor for future SB until now is a personal history of previous suicide attempts [ 5 , 6 , 7 , 8 ]. Scientific research, as well as clinical experience, clearly recognize that suicide attempters cannot be seen as one homogeneous group because of the significant variability in clinical factors, sociodemographic aspects, and personality profiles, as well as regarding specific characteristics of the suicide attempt [ 9 , 10 ]. Therefore, a better understanding of SB requires more studies investigating the heterogeneity within the suicide attempters’ group, for example, by examining subgroup profiles.…”