Risk factors of suicide mortality among multiple attempters: A national registry study in Taiwan.
OBJECTIVE
Little is known about the risk factors of suicide mortality among multiple attempters. This study aims to investigate the predictors of suicidal mortality in a prospective cohort of attempters in Taiwan, focusing on the time interval and suicide method change between the last two nonfatal attempts.


METHODS
The representative data retrieved from the National Suicide Surveillance System (NSSS) was linked with National Mortality Database to identify the causes of death in multiple attempters during 2006-2008. Cox-proportional hazard models were applied to calculate the hazard ratios for the predictors of suicide.


RESULTS
Among the 55,560 attempters, 6485 (11.7%) had survived attempts ranging from one to 11 times; 861 (1.5%) eventually died by suicide. Multiple attempters were characterized by female (OR = 1.56, p < 0.0001), nonrecipient of national aftercare service (OR = 1.62, p < 0.0001), and current contact with mental health services (OR = 3.17, p < 0.0001). Most multiple attempters who survived from hanging (68.1%) and gas poisoning (61.9%) chose the same method in the following fatal episode. Predictors of suicidal death were identified as male, older age (≥ 45 years), shorter interval and not maintaining methods of low lethality in the last two nonfatal attempts. Receipt of nationwide aftercare was associated with lower risk of suicide but the effect was insignificant.


CONCLUSIONS
The time interval of the last two nonfatal attempts and alteration in the lethality of suicide method were significant factors for completed suicide. Risk assessment involving these two factors may be necessary for multiple attempters in different clinical settings. Effective strategies for suicide prevention emphasizing this high risk population should be developed in the future.
Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
I-Ming
IM
Chen
Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
Shih-Cheng
SC
Liao
Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Department of Psychiatry, National Taiwan University College of Medicine, Taipei, Taiwan; National Suicide Prevention Centre, Taipei, Taiwan. Electronic address: mingbeen@ntu.edu.tw.
Ming-Been
MB
Lee
School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan.
Chia-Yi
CY
Wu
Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
Po-Hsien
PH
Lin
Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Wei J
WJ
Chen
D000328:Adult; D000368:Aged; D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D009026:Mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D013624:Taiwan
case registry; multiple attempters; population-based study; risk factor; suicide method