Multiple Attempters of Suicide Presenting at an Emergency Department

Abstract

As part of a study involving seven hundred and forty-seven (747) consecutive cases of self-injury presenting at the emergency department of an inner city hospital, data pertaining to a multiple attempt group of ninety-nine subjects were compared with the data pertaining to first attempters. All subjects were rated on Beck's Lethality Scales, Intent Scale and Hopelessness Scale. In addition, a standard interview was conducted to provide psychosocial information. Of the total suicide attempt population, 14% can be considered chronic. The multiple attempters were found to show more chronicity in their symptomatology, poorer coping histories, a positive family history of suicidal behaviour and a positive history of alcohol and drug abuse, all at a statistically significant level compared with first-time attempters. The multiple attempters also tend to show higher lethality and depression ratings, less impulsiveness and are significantly more often admitted to the in-patient unit following the attempt, than first attempters. Their intent scores were significantly related to their sense of hopelessness, which may be a reflection of their basic feelings of inadequacy. It was concluded that the multiple or "chronic" attempter differed sufficiently from the first-time attempter to warrant special intervention strategies.

Single versus Multiple Suicide Attempts: A Prospective Examination of Psychiatric Factors and Wish to Die/Wish to Live Index

“…Moreover, genetic vulnerability may also impact an individual's frequency of attempting suicide. Specifically, the CDC has identified a family history of suicide as a risk factor for eventual death by suicide and several studies have found that a family history of suicide and/or suicide attempt are more prevalent among individuals with more than one suicide attempt (Forman et al, 2004;Jeglic, Sharp, Chapman, Brown, & Beck, 2005;Reynolds & Eaton, 1986). Family psychopathology may also play a role in an individual having multiple suicide attempts versus a single attempt.…”

“…Other psychiatric risk factors of suicide also shown to be higher amongst individuals with more than one suicide attempt are depression (Filinto da Silva Cais et al, 2009;Forman et al, 2004;Reynolds & Eaton, 1986) and suicidal ideation (Filinto da Silva Cais et al, 2009;Forman et al, 2004). Such individuals may be postulated to have more difficulty coping with internal and external stressors resulting in increased levels of hopelessness, depression, and suicidal ideation and eventual suicide attempt(s).…”

“…In fact, there is some evidence to suggest that individuals with multiple suicide attempts may have more difficulty effectively managing internal and external stressors. Reynolds and Eaton (1986) found that individuals with three or more suicide attempts versus those with a single attempt who present to the emergency department have a poor coping history as assessed through clinical interview. Internally, individuals with two or more suicide attempts demonstrate more psychological distress (Kaslow et al, 2006) (Forman et al, 2004), and demonstrate more disruptive behavior after multiple attempts (Miranda et al, 2008).…”

“…Individuals with multiple attempts have been found to have a higher number of overall symptoms (Kaslow et al, 2006) and longer duration of symptoms (Reynolds & Eaton, 1986), lower global assessment of functioning scores (Forman et al, 2004), more diagnoses (Forman et al, 2004;Miranda et al, 2008), higher levels of psychiatric comorbidity (Osváth et al, 2003), and long-term usage of psychiatric services (Stephens, 1987).…”

“…Evidence suggests that alcohol and drug abuse are also more commonly correlated to individuals with multiple suicide attempts than individuals with a single suicide attempt. As determined by clinical interview or validated substance abuse screening measure, individuals with multiple suicide attempts are more likely to abuse alcohol (Kaslow et al, 2006;Osváth et al, 2003;Reynolds & Eaton, 1986;Stephens, 1987) or abuse drugs (Kaslow et al, 2006;Reynolds & Eaton, 1986;Stephens, 1987). Additionally, based on self-report questionnaires, individuals with multiple attempts are more likely to report a history of substance abuse diagnosis (Forman et al, 2004), or to have participated in substancerelated treatment (Kaslow et al, 2006).…”