title: The characteristics of the suicide attempter according to the onset time of the suicidal ideation.
abstract: OBJECTIVE
  To determine the timing of development of suicidal ideation and factors associated therewith in suicide attempters who required psychiatric emergency treatment.
  
  
  METHODS
  Of a total of 2818 suicide attempters in Japan who presented to the primary or secondary emergency department of Iwate Medical University Hospital (hereinafter, referred to as our hospital) or Iwate Prefecture Advanced Emergency and Critical Care Center (hereinafter, referred to as the emergency center), an affiliated institution to our hospital, during the 12-year period from April 1, 2002-March 31, 2014, 2274 patients for whom the timing of development of suicidal ideation was identified were included in the study. The study subjects were classified into three groups according to the timing of development of suicide ideation: the "same-day" group, those who developed suicidal ideation and attempted suicide on the same day; the "short-term" group, those who developed suicidal ideation 2-7 days before attempting suicide; and the "long-term" group, those who developed suicidal ideation more than 7 days before attempting suicide. Factors associated with the development of suicidal ideation in each group were analyzed by a multiple logistic regression analysis with background factors, the diagnosis according to the ICD and the situations before and after the suicide attempt as explanatory variables.
  
  
  RESULTS
  The same-day group was characterized by a high female ratio, high global functioning, low stress level, non-depressed status and a lack of seeking consultation. In contrast, the long-term group was characterized by low global functioning and a high stress level, suggesting that these patients exhibit consultation behavior, but have not received psychiatric services. In the short-term group, only male gender was identified as a significant factor.
  
  
  CONCLUSIONS
  For those patients who developed suicidal ideation and attempted suicide on the same day, treatment strategies focusing on the acquisition of coping skills and stress management are recommended. For those with suicidal ideation lasting for more than a week or recurrent ideation, early detection and subsequent early treatment of such ideation are essential. In intermediate cases, treatment strategies that make the full use of mental health management in the workplace and gate-keeping are likely to be effective.
authors.affiliation: Department of Disaster and Community Psychiatry, Iwate Medical University, Morioka, Japan ; Department of Neuropsychiatry, Iwate Medical University, Morioka, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Otsuka
authors.affiliation: Department of Neuropsychiatry, Iwate Medical University, Morioka, Japan.
authors.forename: Hikaru
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: Department of Disaster and Community Psychiatry, Iwate Medical University, Morioka, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kudo
authors.affiliation: Department of Disaster and Community Psychiatry, Iwate Medical University, Morioka, Japan.
authors.forename: Jin
authors.initials: J
authors.lastname: Endo
authors.affiliation: Department of Disaster and Community Psychiatry, Iwate Medical University, Morioka, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Sanjo
authors.affiliation: Department of Disaster and Community Psychiatry, Iwate Medical University, Morioka, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Fukumoto
authors.affiliation: Department of Disaster and Community Psychiatry, Iwate Medical University, Morioka, Japan.
authors.forename: Katsuhito
authors.initials: K
authors.lastname: Hoshi
authors.affiliation: Department of Disaster and Community Psychiatry, Iwate Medical University, Morioka, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Yagi
authors.affiliation: Department of Disaster and Community Psychiatry, Iwate Medical University, Morioka, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Sakai
keywords: Brief psychiatric rating scale (BPRS); Global assessment scale (GAS); Life change units of Holmes social readjustment rating scale (LCU); Suicidal attempt; Suicide ideation