No Cathartic Effect in Suicide Attempters Admitted to the Emergency Department

Pompili, Maurizio; Innamorati, Marco; Casale, Antonio Del; Serafini, Gianluca; Forte, Alberto; Lester, David; Raja, Michele; Amore, Mario; Tatarelli, Roberto; Girardi, Paolo

doi:10.1097/01.pra.0000364284.78457.ea

Cited by 10 publications

(8 citation statements)

References 47 publications

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“…Such a high incidence of suicidal ideation just hours after the attempt is consistent with literature contesting the cathartic effect, i.e. the decrease in suicidal symptoms caused by the outward expression of suicidality via a suicide attempt [ 34 , 35 ]. Research by Beautrais found higher rates of further attempts and higher rates of subsequent suicide among patients who had made medically serious attempts and failed to be relieved to have survived, still wanting to die, and stating the intention to make a further attempt [ 36 ].…”

Section: Conclusion and Discussionsupporting

confidence: 86%

Acceptance of guidance to care at the emergency department following attempted suicide

Dekker¹,

Vergouwen²,

Buster³

et al. 2017

BMC Psychiatry

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BackgroundResearch, aimed at improving the continuity of care after hospital discharge following attempted suicide focuses on the effectiveness of the interventions. Little attention has been paid to patients who immediately decline guidance to advised post-discharge care. We aimed to identify differences between accepters and decliners of guidance to care (GtC) in relation to the characteristics of patients who presented at the emergency department (ED) of an urban hospital in the Netherlands after attempted suicide.MethodThis cross-sectional study included all patients who presented at the ED of OLVG-West Amsterdam with a suicide attempt or intentional self-harm and were referred for psychiatric evaluation. Data were collected over a period of twenty months using a semi-structured questionnaire. Subgroups were described in relation the acceptance of GtC using univariate and multivariate logistic regression analyses.ResultsIn total, 257 patients were included. GtC was accepted by 77%. Suicide attempters who reported loneliness as reason for the attempt showed a positive relation to acceptance. No indication was found that patients at higher risk for suicide are more reluctant to accept GtC. Suicide attempters with a non-Western ethnicity, especially patients with a Turkish/Moroccan ethnicity, declined contact by the GtC nurse significantly more often. In addition, patients who currently did not receive care were significantly more often of non-Western ethnicity and younger than 25.ConclusionAcceptance of GtC is high among patients who presented at the ED after attempted suicide. The patients who were the most reluctant to accept GtC were young suicide attempters of non-Western ethnicity who were not in current care. As this study is the first to address the acceptance of GtC, we point out two lines of inquiry for further research. First, reasons to accept or decline need to be investigated further since only interventions that are accepted by patients have a chance to improve clinically relevant outcome. Second, follow-up research is warranted comparing the adherence to advised post-discharge care and attempted or completed suicide among accepters versus decliners of GtC in various ethnic and sociodemographic subgroups.

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Section: Conclusion and Discussionsupporting

confidence: 86%

Acceptance of guidance to care at the emergency department following attempted suicide

Dekker¹,

Vergouwen²,

Buster³

et al. 2017

BMC Psychiatry

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“…Patients whose suicide attempt was recent presented significantly higher levels of depressive symptoms, an observation consistent with many other reports indicating that most patients remain depressed following a suicide attempt. The patient’s mood usually improves after a therapeutic intervention [ 38 , 66 ].…”

Section: Discussionmentioning

confidence: 99%

Personality differences in early versus late suicide attempters

et al. 2016

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BackgroundSuicidality is an individual behaviour caused by a complex framework of internal and external factors. The predictive values of personality traits for a suicide attempt have been demonstrated, especially in conjunction with Cloninger’s TCI and impulsivity. Two issues remain unsolved, namely whether these traits alter over time after a suicide attempt, and how they may be influenced by depressive symptoms.MethodsWe studied two patient cohorts: one sample of 81 patients after a suicide attempt no longer than 3 months previously (SA early) and another sample of 32 patients whose attempt had taken place more than 6 months previously (SA late). We carried out structured interviews with these subjects addressing diagnosis (MINI), suicidality (Scale for suicide ideation), depression (HAMD-17), temperament and character inventory (TCI), and impulsivity (BIS-10). Data analysis was done using SPSS 16.0.ResultsOur two groups did not differ significantly in sociodemographics or suicidality. However, patients in the SA early group were significantly more depressed (p < 0.001), and scored lower in reward dependence (p < 0.001) and persistence (p = 0.005) but higher in harm avoidance (p < 0.001); they did not differ significantly in impulsivity (p < 0.01). Reward dependence, persistence, and harm avoidance remained significantly different between the two groups after controlling for depressive symptoms.ConclusionsOur findings suggest that some personality traits vary after a suicide attempt. Further investigations are necessary to verify our results, ideally in longitudinal studies with larger, carefully-described cohorts. It would be also clinically important to investigate the influence of therapeutic strategies on the variability of personality traits and their impact on suicidal behavior.

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“…In the most recent Centers for Disease Control Surveillance for Violent Deaths, 13.4% of people who had committed suicide had a diagnosis of bipolar disorder [2]. Among patients admitted to an emergency room for suicide attempts, those attempting suicide were five times more likely to have bipolar disorder than those presenting to the emergency room for non-suicide related psychiatric issues [12]. …”

Section: Introductionmentioning

confidence: 99%

Suicidality and divalproex sodium: analysis of controlled studies in multiple indications

et al. 2011

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BackgroundRecent analyses of antiepileptic drugs have indicated an increase in the risk of suicidality. The objective of this report was to provide clinical information and an independent meta-analysis of divalproex sodium and suicidality events by analyzing data from 13 placebo-controlled studies and 1 low-dose controlled study.MethodsAdverse events considered to be possibly suicide related were identified using the Columbia Classification Algorithm of Suicide Assessment (C-CASA) methodology. Indications included epilepsy, bipolar disorder, migraine prophylaxis, impulsive aggression, and dementia. Narratives were produced for every event, and suicidality event ratings were performed by a third party blinded to treatment assignment. Statistical analyses were conducted using methodology similar to that reported by the US Food and Drug Administration (FDA).ResultsSuicidality events were identified in 5 of the 13 placebo-controlled studies. Of the 1,327 (0.83%) subjects taking divalproex sodium, 11 had suicidality events: 2 suicide attempts and 9 suicidal ideation. Of 992 (0.91%) subjects taking placebo, 9 had suicidality events: 1 preparatory act toward suicide, 2 suicide attempts, and 6 suicidal ideation. Across placebo-controlled studies, the overall estimated odds ratio (OR) of suicidal behavior or ideation was 0.72 (95% CI 0.29 to 1.84). The OR for suicidal behavior was 0.37 (95% CI 0.04 to 2.58), and the OR for suicidal ideation was 0.90 (95% CI 0.31 to 2.79).ConclusionsIn this meta-analysis, divalproex sodium does not appear to increase the risk of suicide-related adverse events relative to placebo in the populations studied. Clinicians should nonetheless remain vigilant in assessing suicidality, not only in patients treated for mental disorders with inherently high suicide risk, but also in patients taking antiepileptic medications.

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No Cathartic Effect in Suicide Attempters Admitted to the Emergency Department

Cited by 10 publications

References 47 publications

Acceptance of guidance to care at the emergency department following attempted suicide

Acceptance of guidance to care at the emergency department following attempted suicide

Personality differences in early versus late suicide attempters

Suicidality and divalproex sodium: analysis of controlled studies in multiple indications

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