Le devenir des suicidants admis à l'hÔpital général Etude comparative de deux formes de prévention des récidives et des suicides

Abstract

This is a comparative study of two groups of suicide attempters admitted in a general hospital, who were treated in different ways. The 143 attempters of the "systematically treated group (STG)" were proposed the classical therapeutic measures (supportive psychotherapy, psychiatric hospitalization, crisis interventions within couples or families, mixed interventions with the above treatments, psychoanalytically oriented psychotherapy, etc.), plus ambulatory controls (a few days after discharge from the general hospital, after one month, three months, six months, a year, and two years). The 145 attempters of the "reference group (RG)" were proposed the classical measures only. All the attempters of both groups had a follow-up after two years. The results suggest the controls to be probably responsible for the difference of relapses and committed suicides between the two groups. More indirectly, this study facilitated a further analysis of the relational problems between suicide attempters and staff, and among staff members themselves. The consequences were a modification of some attitudes of the staff toward the attempters and their significant others, and a new collaboration for an interdisciplinary clinical research.

Prädiktoren für weiteres suizidales Verhalten bei nach einem Suizidversuch hospitalisierten Patienten*

“…Auch Niskanen et al (1976) berichteten eine Beziehung zwischen Suizidrisiko und höherem Alter beim Suizidversuch. Wulliemier et al (1979) fanden eine Tendenz der männlichen Suizidenten in Richtung eines höheren Suizidrisikos, nicht jedoch eine erhöhte Neigung zur Wiederholung eines Suizidversuchs. Die von Katschnig et al (1981) beschriebene Subpopulation mit der höchsten Suizidinzidenz innerhalb von 5 Jahren (11 % gegenüber 4,2 % in der Gesamtpopulation) war charakterisiert durch ein hohes Durchschnittsalter von 63 Jahren (in der Gesamtpopulation 36 Jahre) und umfaßte alle sich im Ruhestand befindlichen Suizidenten der Stichprobe, also auch die Frührentner.…”

“…Lediglich Greer und Bagley (1971) fanden, daß männliche Suizidenten ihr suizidales Verhalten häufiger wiederholt haben. Alle übrigen katamnestischen Studien, die dieses Merkmal untersucht haben, fanden keine Korrelation zwischen männlichem Geschlecht und häufigerem Wiederholen suizidalen Verhaltens (Buglass und Horton 1974b, Buglass und McCul/och 1970, Kessel und McCul/och 1966Retterst(J1 1970, Wulliemier et al 1979.…”

“…Abgesehen von einigen methodisch unzulänglichen Arbeiten (z.B. legte Paerregaard (1974) einen kurzen Bericht ohne statistische Angaben vor, Udsen (1966) flihrte an seinem Zahlenmaterial keine Signifikanzprüfung durch) wurden Prädiktoren flir erneutes suizidales Verhalten in den Studien meist so bestimmt, daß die Merkmale herausgegriffen wurden, deren Häufigkeit oder Ausprägungsgrad innerhalb der Gruppe der Wiederholer und der der Nichtwiederholer signifikant unterschiedlich war (Buglass und Horton 1974aund 1974b, Buglass und McCulloch 1970, Schneider et al 1976, Ettlinger 1964, Greer und Bagley 1971, Morgan et al 1976, Retterstpl 1970, Garzotto et al 1976, Siani et al 1979, Niskanen et al 1976, Wulliemier et al 1979auch Pino et al 1979). Kessel und McCulloch (1966) verglichen die Gruppe der Wiederholer mit dem Gesamtkollektiv.…”

Intensive Follow‐up Does Not Decrease the Risk of Repeat Suicide Attempts

“…Interventions to decrease the risk of further attempts in persons who have already made (at least) one, evaluated in controlled trials and reported in peer-reviewed journals, range from having the initial evaluation done by a specially trained medical team (instead of a psychiatric one) followed by standard treatment (Gardner, Hanka, O'Brien, Page, & Rees, 1977): antidepressant medication (Montgomery, Roy, & Montgomery, 1983), social service (Gibbons, Butler, Urwin, & Gibbons, 1978), behavior therapy (Liberman & Eckman, 19811, to counseling by general practitioners (Hawton et al, 1987). However, the most common approach has been to offer an intervention of a similar nature but of greater intensity than the one usually available (Chowdhury, Hicks, & Kreitman, 1973;Ettlinger, 1975;Hawton et al, 1981;Moeller, 1989;Termansen & Bywater, 1975;Welu, 1977;Wulliemier, Bovet, & Meylan, 1979). This generally involves some combination of an explicit appointment schedule, measures to reinforce compliance with appointments, home visits, and greater emergency access to therapists.…”

“…Four trials gave positive results. These interventions consisted of (1) behavior therapy (versus insight-oriented therapy) (Liberman & Eckman, 1981); (2) adding extra encounters with the therapist, shortly after discharge from hospital and at 1, 3, 6, 12, and 24 months (Wulliemier et al, 1979); and (3) assessment in the emergency room by a mental health worker, with a 3-month follow-up by the worker (compared to follow-up by a volunteer, no follow-up, or even no assessment) (Termansen & Bywater, 1975), and a home visit soon after discharge from hospital, with a 4-month intervention plan emphasizing quantity and continuity of care (Welu, 1977). In the first of these studies, the effect appears to be nonsignificant, in spite of the authors' claim, and in the second, the comparison group was nonconcurrent (and therefore nonrandomized).…”