Long-term follow-up of unsuccessful violent suicide attempts: risk factors for subsequent attempts.
METHODS
Of 9046 consecutive trauma admissions, all suicide attempts (n = 156) were identified: 38 patients (24%) died in hospital; 118 (76%) were discharged and received long-term follow-up (mean = 2.8 years). Factors assessed included suicidal ideation and planning, reason for attempt; number of attempts, methods, dates of prior and subsequent attempts; psychiatric diagnoses, substance abuse history, treatment and medication compliance, hospitalizations, incidence of family depression and suicide; education level, job history, and living conditions.


RESULTS
104 (88%) patients were interviewed and 14 (12%) were lost to follow-up. Seventy-seven of the patients (74%) used guns in their attempt; their mean ISS was 14.2. Seven (6.7%) made repeat suicide attempts (all unsuccessful). Late mortality was 7% (one related to index suicide, five to chronic illness, one to motor vehicle crash). Most patients (96%) had psychiatric diagnoses at discharge, 77 of 93 (83%) had diagnosed depression. Sixty-six percent (69 of 104) had histories of alcohol abuse, 42% (42 of 101) histories of drug abuse. Thirty-five percent (34 of 96) were noncompliant with psychiatric follow-up and 70% (16 of 23) were noncompliant with alcohol abuse treatment.


CONCLUSIONS
(1) Repeat attempts were rare (7%) after failed suicide attempts. (2) No late deaths resulted from repeat suicide attempts. (3) Risk factors associated with repeat attempts were younger age (p = 0.002), prior attempts (p = 0.02), family history of suicide (p = 0.03), schizophrenia (p = 0.005), and not living at home (p = 0.04). (4) Identifying patients with these risk factors, ensuring that they receive inpatient alcohol abuse treatment, along with sustained psychiatric treatment and help in maintaining home environments, may prevent repeat suicide attempts.
van Aalst
J A
JA
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37212.
Shotts
S D
SD
Vitsky
J L
JL
Bass
S M
SM
Miller
R S
RS
Meador
K G
KG
Morris
J A
JA
D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000592:standards; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005190:Family; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D015601:Injury Severity Score; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data*; D013714:Tennessee / Q000453:epidemiology; D014478:Unemployment / Q000706:statistics & numerical data; D014754:Violence