Treatment Online

Suicidal Behavior Needs Long Term Solutions
> 7/24/2006 10:44:22 AM

Crisis intervention response to suicide attempts, the standard practice in most areas, may address the short term problem, but often fails to meet the long term needs of those in danger. Speaking in a lecture at the annual conference of the American Association of Suicidology, Dr. Annette L. Beautrais of New Zealand's Christchurch School of Medicine, presented information relating to two longitudinal studies that she had completed recently. In each of the studies, Dr. Beautrais conducted interviews with populations that had made suicide attempts, one group of those considered medically serious attempts and the other, a larger group whose suicidal behavior was considered less lethal.

The results from the serious attempt group paint a picture of the long term struggles of those who deal with suicidal ideation and behavior.

Within 5 years [of their initial attempts], 8.9% of subjects were dead. Fifty-nine percent of deaths were by suicide, and another 15% were deemed probable suicide. This equated to a confirmed suicide rate 48 times higher than in the general New Zealand population, and a total mortality five times greater than expected. Most completed suicides involved a switch to a more highly lethal method than used in the index medically serious attempt, suggesting a hardening of intent.

By 10 years, mortality was 14.2%, with 70% of deaths from suicide or suspected suicide. Fifty-nine percent of all deaths occurred within 18 months of the index suicide attempt, although mortality remained elevated throughout the full 10 years.

The larger study, focusing on less lethal attempts, confirmed this data. In this population, 28% were readmitted to a hospital for a suicide attempt within 10 years, and another 5% were dead from a successful attempt. The study also found a high rate of self-harm in the 2 years following the initial hospitalization.

In the hours and days immediately following a suicide attempt, a crisis intervention approach makes the most sense because the person we are dealing with is indeed facing a crisis. But this action should not be at the expense of a long term plan for care that addresses the moods and symptoms at the root of the suicidal behavior. Especially in older adults, depression has been tied to suicide attempts, and failure to get treatment for such depression can lead to an increased risk. After an attempted suicide there needs to be a greater awareness of the risks for future attempts on the part of caretakers and health care providers. With an eye toward a longer term care strategy, we should be able to reduce the incidence of future attempts and overall fatality from suicide.

The American Association of Suicidology has devised this mnemonic to help people remember the warning signs of suicide. The key is IS PATH WARM?

I Ideation
S Substance Abuse
P Purposelessness
A Anxiety
T Trapped
H Hopelessness
W Withdrawal
A Anger
R Recklessness
M Mood Changes

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