Risk Factors for Serious Suicide Attempts: Difference Between Older and Younger Attempters in the Emergency Department

Abstract

Objective: Suicide attempts of the older adults are known to be more serious than that of the younger adults. Despite its major social impact in South Korea, the behavioral mechanism of serious suicide attempt (SSA) in old people remains to be elucidated. Thus, we investigated the risk factors for SSA in older and younger suicide attempters in the emergency department.Methods: Demographic data, clinical information, and the level of seriousness of suicide with Risk Rescue Rating Scale were compared between older (age ≥65) and younger (age <65) adults who visited the emergency department for a suicide attempt. Regression analyses were performed to identify the risk factors for SSA in these two groups.Results: Among 370 patients, 37 were older adults (10%; aged 74.41 ± 6.78), more likely to have another medical disease (p < 0.001), and a higher suicide completion rate (16.2 vs. 5.4%, p = 0.023). In the younger group, old age (B = 0.090, p < 0.001), male sex (B = −0.038, p = 0.019), and impression of schizophrenia (B = 0.074, p = 0.027) were associated with a higher risk-rescue ratio and interpersonal stress condition was associated with a lower risk-rescue ratio (B = −0.045, p = 0.006). In the older group, however, no variables were included significant in the regression model for the Risk Rescue Rating Scale.Conclusions: Demographic and clinical factors such as old age, male sex, interpersonal stress, and impression of schizophrenia were associated with lethality in the younger suicide attempters. However, no factors were associated with SSA in the older adult group. Different mechanisms may underly the lethality in old age suicide.

Association of the COVID-19 Pandemic and Low-rescue Suicide Attempts in Patients Visiting the Emergency Department after Attempting Suicide

“… 12 One study of the RRRS reported that old age, male sex, alcohol intoxication, the presence of interpersonal stress, and a history of schizophrenia were independent factors associated with the risk-rescue ratio in individuals younger than 65 years of age. 15 In this study, age was also an independent factor associated with low-rescue suicide attempts, which was consistent with previous studies. The pandemic may not have had an equal effect on the whole population of suicide attempters; for instance, it may have had more negative effects on some vulnerable individuals related to social isolation and social lockdown.…”

“…These variables are known clinical factors with significant correlations with suicide attempt lethality or risk-rescue ratio on the basis of a previous studies. 12 13 14 15 The Hosmer–Lemeshow test was confirmed for goodness of fit for logistic regression models. The results are presented as odds ratios (ORs), 95% confidence intervals (CIs), and P values.…”

“…There have been reports in previous studies of a high lethality rate of suicide in older individuals. 15 21 Earlier studies indicated that depressive disorder, physical illness, and high suicidal intent were associated with high-lethality suicide attempts in older age groups. 22 23 In another study, patients who attempted suicide by ingesting poison were older in the low-rescue group than in the high-rescue group.…”

Perceptions of Therapeutic Intervention in Suicide Crisis Counseling in Experienced Korean Counselors: A Concept Mapping Study

“…Therefore, this study defined the term "suicidal crisis" as "clients with suicide attempts with suicide intention" as the client's intention has been inspected as the crucial variable in suicide attempts (51). Also, suicide attempts in one's history have been the most predictive variable for later completed suicide, and it has been a strong indicator of increasing the risk of actual suicide with more fatal methods at a later stage (23,24,(52)(53)(54)(55).…”

Testing the Psychometric Properties of the Risk-Rescue Rating Scale: A Lethality Measure for Suicide Attempts

“…However, to our knowledge, no such study has been published. In recent years, the RRRS has occasionally been used as an outcome measure of the severity of suicidal attempts (Oh et al, 2015;Kim et al, 2021), but no recent studies have assessed its reliability and validity.…”