Trends in US emergency department visits for suicide attempts, 1992-2001

This article describes trends in suicide attempt visits to emergency departments in the United States (US). Data were obtained from the National Hospital Ambulatory Medical Care Survey using mental-health-related ICD-9-CM, E and V codes, and mental-health reasons for visit. From 1992 to 2001, mental-health-related visits increased 27.5% from 17.1 to 23.6 per 1000 (p < .001). Emergency Department (ED) visits for suicide attempt and self injury increased by 47%, from 0.8 to 1.5 visits per 1000 US population (p(trend) = .04). Suicide-attempt-related visits increased significantly among males over the decade and among females from 1992/1993 to 1998/1999. Suicide attempt visits increased in non-Hispanic whites, patients under 15 years or those between 50-69 years of age, and the privately insured. Hospitalization rates for suicide attempt-related ED visits declined from 49% to 32% between 1992 and 2001 (p = .04). Suicide attempt-related visits increased significantly in urban areas, but in rural areas suicide attempt visits stayed relatively constant, despite significant rural decreases in mental-health related visits overall. Ten-year regional increases in suicide attempt-related visits were significant for the West and Northeast only. US emergency departments have witnessed increasing rates of ED visits for suicide attempts during a decade of significant reciprocal decreases in postattempt hospitalization. Emergency departments are increasingly important sites for identifying, assessing and treating individuals with suicidal behavior.     

Suicidal ideation and suicide attempts among Australian adults

Too little is known about suicidal thoughts and behaviors at a population level to recommend appropriate preventive strategies. Using data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB), this study examined rates of, and risk factors for, suicidal ideation and suicide attempts. For 10,641 respondents, the 12-month and lifetime cumulative incidence rates of suicidal ideation were 3.4% and 16.0%, respectively; the 12-month and lifetime cumulative incidence rates of suicide attempts were 0.4% and 3.6%, respectively. 12-month ideation was associated with anxiety disorders (relative risk ratio [RRR] = 3.51; population attributable risk percent [PAR%] = 19.6%), affective disorders (RRR = 11.94; PAR% = 38.8%) and substance abuse disorders (RRR = 1.85; PAR% = 6.1%). Attempts in the past 12 months were also associated with anxiety disorders (RRR = 7.06; PAR% = 37.0%), affective disorders (RRR = 12.24; PAR% = 39.5%), and substance abuse disorders (RRR = 2.09; PAR% = 7.7%). Age, marital status, and disability were associated with ideation; marital status and employment status with attempts. Approximately 12% of ideators in the sample progressed to making an attempt; employment status was the only significant predictor. Reducing suicidal ideation and attempts requires a multi-faceted approach that targets those with mental illness but also adopts population-based strategies that address other factors, such as unemployment.     

Personality and repeated suicide attempts in dependent adolescents and young adults

This study compared personality characteristics of subjects with dependence disorders who had previously made a suicide attempt. The population, recruited in France, Belgium, and Switzerland, was composed of 570 subjects (225 females, 345 males, mean age = 27.3, SD = 8.5). The subjects' psychological dimensions were investigated by means of several self-report questionnaires including: BDI-13 (Beck), Sensation-Seeking Scale (Zuckerman), Toronto Alexithymia Scale (Taylor), Interpersonal Dependency Inventory (Hirschfeld), MMPI-2, and some additional scales. For most dimensions, repeat attempters, both past and recent, but more specifically the recent repeaters, had a more severe psychological profile compared to the other suicide attempters.     

Cathartic effect of suicide attempts not limited to depression: a short-term prospective study after deliberate self-poisoning

The cathartic effect of suicide is traditionally defined as the existence of a rapid, significant, and spontaneous decrease in the depressive symptoms of suicide attempters after the act. This study was designed to investigate short-term variations, following a suicide attempt by self-poisoning, of a number of other variables identified as suicidal risk factors: hopelessness, impulsivity, personality traits, and quality of life. Patients hospitalized less than 24 hours after a deliberate (moderate) overdose were presented with the Montgomery-Asberg Depression and Impulsivity Rating Scales, Hopelessness scale, MMPI and World Health Organization's Quality of Life questionnaire (abbreviated versions). They were also asked to complete the same scales and questionnaires 8 days after discharge. The study involved 39 patients, the average interval between initial and follow-up assessment being 13.5 days. All the scores improved significantly, with the exception of quality of life and three out of the eight personality traits. This finding emphasizes the fact that improvement is not limited to depressive symptoms and enables us to identify the relative importance of each studied variable as a risk factor for attempted suicide. The limitations of the study are discussed as well as in particular the nongeneralizability of the sample and setting.     

An examination of emergency room physicians' practice of positive and negative defeivsive medicine

Substantial diversity exists in the estimates associated with the practice of defensive medicine. Physicians' efforts to limit legal liability have generally been grouped into risk reduction strategies (positive defensive medicine) and risk avoidance strategies (negative defensive medicine). This article examines the practice of these forms of defensive medicine in a ‘high-risk’ specialty -emergency medicine. A sample of North American emergency medicine. physicians provided data for the study at hand. The results, which failed to substantiate some popularly-held and previously untested suppositions associated with the practice of defensive medicine, point to the danger of making broad generalizations across physician specialities.     

Double suicide and homicide-suicide in Switzerland

Double suicide and homicide-suicide are infrequent and are different in psychopathology from that of a single suicide. However, precipitating factors for double suicide and homicide-suicide are similar to these found in single suicide. Depression, borderline disturbances, and narcissistic neuroses in combination with stressors such as physical illness, isolation, and social losses can lead to homicide-suicide. Epidemiological studies indicate that double suicide and homicide-suicide are influenced by ethnicity and cultural and social background. This study explores the situation in Switzerland between 1928-48 and 1971-1990.     

Social integration and suicide in South Korea

The increasing suicide rate in South Korea in recent decades was found to be associated with measures of social integration/regulation (birth and divorce rates).     

Body mass and suicide risk

Body mass has been neglected as a possible predictor of suicidal behavior. The present investigation explores the association between body mass index and completed suicide. Data are from the National Mortality Followback Survey and refer to 373 suicides, and 518 deaths from motor vehicle accidents as controls. The results of a logistic regression analysis indicated that, for females, the greater the BMI the greater the suicide risk. However, this relationship did not hold up under controls for race and other covariates of BMI. For males, the BMI was not significantly related to suicide risk either at the bivariate or multivariate levels of analysis. The best predictors of suicide were living alone for females, and alcohol abuse for males.