Comparison of Clinical Characteristics between Single and Repeated Suicide Attempters Admitted to Emergency Room

Taehoon Koo; Kwanghun Lee; Wan Seok Seo; Jong Hun Lee; Hee-Cheol Kim; Sang Won Lee; Seunghee Won

doi:10.4306/jknpa.2016.55.3.224

Journal List > J Korean Neuropsychiatr Assoc > v.55(3) > 1017803

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Koo, Lee, Seo, Lee, Kim, Lee, and Won: Comparison of Clinical Characteristics between Single and Repeated Suicide Attempters Admitted to Emergency Room

Original Article

Journal of Korean Neuropsychiatric Association 2016; 55(3): 224-233.

Published online: 31 August 2016

DOI: https://doi.org/10.4306/jknpa.2016.55.3.224

Comparison of Clinical Characteristics between Single and Repeated Suicide Attempters Admitted to Emergency Room

Taehoon Koo, MD¹, Kwanghun Lee, MD, PhD², Wan Seok Seo, MD, PhD³, Jong Hun Lee, MD, PhD⁴, Hee-Cheol Kim, MD, PhD⁵, Sang Won Lee, MD, PhD¹, Seunghee Won, MD, PhD¹

¹Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea.

²Department of Psychiatry, College of Medicine, Dongguk University, Gyeongju, Korea.

³Department of Psychiatry, College of Medicine, Yeungnam University, Daegu, Korea.

⁴Department of Psychiatry, College of Medicine, Catholic University of Daegu, Daegu, Korea.

⁵Department of Psychiatry, College of Medicine, Keimyung University, Daegu, Korea.

Address for correspondence: Seunghee Won, MD, PhD. Department of Psychiatry, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea. Tel +82-53-200-5747, Fax +82-53-426-5361, wonsh864@knu.ac.kr

Received 3 June 2016 Revised 6 July 2016 Accepted 27 July 2016

Abstract

Objectives

This study compares single and repeat suicide attempts, and evaluates the risk factors associated with suicide re-attempts.

Methods

Two hundred and seventy-nine patients admitted to emergency rooms in four university hospitals in Daegu after suicide attempt were included in this study (n=179 single suicide attempters, n=100 repeated attempters). A structured interview focused on demographic, clinical, suicidal and psychological characteristics was administered to these patients after recovery from physical and psychological impairments.

Results

Individuals with repeated suicide attempts were younger, more highly educated, had more history of psychiatric treatments, took more psychiatric medications, and had more sustained suicidal ideations, bipolar disorders and personality disorders than individuals with single suicide attempt. Individuals with repeated suicide attempts marked significantly higher scores in the Childhood Trauma Questionnaire, Patient Health Questionnaire-9, and the Barratt Impulsiveness Scale. Multivariate logistic regression showed that below the sixties, history of psychiatric treatments, personality disorders, substance use disorders and sustained suicidal ideations were significantly associated with predictive factors for subsequent suicide attempt.

Conclusion

Our findings suggest that repeat suicide attempters have different clinical characteristics from single suicide attempters, and some risk factors raise the risk of further suicide attempts. It is necessary for suicidal prevention program planners to be aware of these risk factors, especially for first-time suicide attempters.

Keywords: Repeated suicide attempts, Clinical characteristics, Predictive factors, Emergency room

Figures and Tables

Table 1

Sociodemographic factors of single versus repeated suicide attempters

Values are mean±standard deviation or n (%)

Table 2

Characteristics of suicide attempt in single versus repeated suicide attempters

Values are mean±standard deviation or n (%)

Table 3

Psychiatric characteristics in single versus repeated suicide attempters

Values are mean±standard deviation or n (%). ^* : Chi-square test is used in each diagnosis. HDRS : Hamilton Depression Rating Scale, PHQ-9 : Patient Health Questionnaire-9, BIS : Barratt Impulsiveness Scale, CTQ : Childhood Trauma Questionnaire, LTE-Q : List of Threatening Experiences Questionnaire

Table 4

Multivariate logistic regression assessing independent predictors of repeated suicide attempts

SE : Standard errors, CI : Confidence interval

Notes

^{Conflicts of Interest} The authors have no financial conflicts of interest.

References

1. Statistics Korea. Causes of death statistics in 2014. cited 2015 Sep 23. Available from: http://kostat.go.kr/portal/korea/kor_nw/2/6/2/index.board?bmode=download&bSeq=&aSeq=348539&ord=1.

2. Park SH, Lim DO. Daily and monthly death pattern an Intentional Self-harm by Hanging, Strangulation and Suffocation in Korea, 2011. Health Policy Manag. 2013; 23:260–265.

3. Jeon HJ. Epidemiologic studies on depression and suicide. J Korean Med Assoc. 2012; 55:322–328.

4. Lim M, Lee S, Park JI. Characteristics of Korean suicide attempters. J Korean Neuropsychiatr Assoc. 2015; 54:209–215.

5. Hur JW, Choi KY, Lee BH, Shim SH, Yang JC, Kim YK. The psychosocial factors affecting suicide attempt. J Korean Neuropsychiatr Assoc. 2007; 46:129–135.

6. Kim J, Seo WS, Lee JH, Kim HC, Lee K, Won S. Characteristics of suicide attempters admitted to the emergency departments of university hospitals: demographic and psychosocial data. J Korean Soc Biol Ther Psychiatry. 2015; 21:95–104.

7. Owens D, Wood C, Greenwood DC, Hughes T, Dennis M. Mortality and suicide after non-fatal self-poisoning: 16-year outcome study. Br J Psychiatry. 2005; 187:470–475.

8. Brown MZ, Comtois KA, Linehan MM. Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder. J Abnorm Psychol. 2002; 111:198–202.

9. Tejedor MC, Díaz A, Castillón JJ, Pericay JM. Attempted suicide: repetition and survival--findings of a follow-up study. Acta Psychiatr Scand. 1999; 100:205–211.

10. Rudd MD, Joiner TE Jr, Rumzek H. Childhood diagnoses and later risk for multiple suicide attempts. Suicide Life Threat Behav. 2004; 34:113–125.

11. D'Eramo KS, Prinstein MJ, Freeman J, Grapentine WL, Spirito A. Psychiatric diagnoses and comorbidity in relation to suicidal behavior among psychiatrically hospitalized adolescents. Child Psychiatry Hum Dev. 2004; 35:21–35.

12. Talbot NL, Duberstein PR, Cox C, Denning D, Conwell Y. Preliminary report on childhood sexual abuse, suicidal ideation, and suicide attempts among middle-aged and older depressed women. Am J Geriatr Psychiatry. 2004; 12:536–538.

13. Walrath CM, Mandell DS, Liao Q, Holden EW, De Carolis G, Santiago RL, et al. Suicide attempts in the "comprehensive community mental health services for children and their families" program. J Am Acad Child Adolesc Psychiatry. 2001; 40:1197–1205.

14. Reynolds P, Eaton P. Multiple attempters of suicide presenting at an emergency department. Can J Psychiatry. 1986; 31:328–330.

15. Nelson VL, Nielsen EC, Checketts KT. Interpersonal attitudes of suicidal individuals. Psychol Rep. 1977; 40(3 Pt 2):983–989.

16. Linehan MM, Camper P, Chiles JA, Strosahl K, Shearin E. Interpersonal problem solving and parasuicide. Cogn Ther Res. 1987; 11:1–12.

17. Hur JM, Chun WC, Min YG, Jung YS. Analyses of suicide victims admitted via the emergency department-based on psychiatric histories, past suicidal attempts and psychiatric diagnoses-. J Korean Soc Clin Toxicol. 2004; 2:106–115.

18. Jung WY, Park JM, Kang CJ, Lee BD, Lee YM. Clinical characteristics of completed versus non-completed suicide and re-attempt rates in 2-4 years. J Korean Neuropsychiatr Assoc. 2009; 48:488–495.

19. Choi KH, Wang SM, Yeon B, Suh SY, Oh Y, Lee HK, et al. Risk and protective factors predicting multiple suicide attempts. Psychiatry Res. 2013; 210:957–961.

20. American Psychiartric Association. Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR). Washington, DC: American Psychiatric Association;2000.

21. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960; 23:56–62.

22. Yi JS, Bae SO, Ahn YM, Park DB, Noh KS, Shin HK, et al. Validity and reliability of the Korean version of the Hamilton Depression Rating Scale (K-HDRS). J Korean Neuropsychiatr Assoc. 2005; 44:456–465.

23. Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann. 2002; 32:509–515.

24. Park SJ, Choi HR, Choi JH, Kim KW, Hong JP. Reliability and validity of the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Anxiety Mood. 2010; 6:119–122.

25. Barratt ES. Impulsivity: integrating cognitive, behavioral, biological, and environmental data. In : McCown WG, Johnson JL, Shure MB, editors. The impulsive client. Washington, DC: American Psychological Association;1993. p. 39–56.

26. Lee SR, Lee WH, Park JS, Kim SM, Kim JW, Shim JH. The study on reliability and validity of Korean version of the Barratt Impulsiveness Scale-11-revised in nonclinical adult subjects. J Korean Neuropsychiatr Assoc. 2012; 51:378–386.

27. Bernstein DP, Fink L. Childhood Trauma Questionnaire: a retrospective self-report: manual. San Antonio, TX: Harcourt Brace & Company;1998.

28. Yu JH, Park JS, Park DH, Ryu SH, Ha JH. Validation of the Korean Childhood Trauma Questionnaire: the practical use in counselling and therapeutic intervention. Korean J Health Psychol. 2009; 14:563–578.

29. Brugha T, Bebbington P, Tennant C, Hurry J. The list of threatening experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychol Med. 1985; 15:189–194.

30. Smith K, Conroy RW, Ehler BD. Lethality of suicide attempt rating scale. Suicide Life Threat Behav. 1984; 14:215–242.

31. Berman AL, Shepherd G, Silverman MM. The LSARS-II: Lethality of Suicide Attempt Rating Scale-Updated. Suicide Life Threat Behav. 2003; 33:261–276.

32. Weisman AD, Worden JW. Risk-rescue rating in suicide assessment. Arch Gen Psychiatry. 1972; 26:553–560.

33. Pierce DW. Suicidal intent in self-injury. Br J Psychiatry. 1977; 130:377–385.

34. Pagura J, Cox BJ, Sareen J, Enns MW. Factors associated with multiple versus single episode suicide attempts in the 1990-1992 and 2001-2003 United States national comorbidity surveys. J Nerv Ment Dis. 2008; 196:806–813.

35. Kochanski-Ruscio KM, Carreno-Ponce JT, DeYoung K, Grammer G, Ghahramanlou-Holloway M. Diagnostic and psychosocial differences in psychiatrically hospitalized military service members with single versus multiple suicide attempts. Compr Psychiatry. 2014; 55:450–456.

36. Kim JY, Hong JP, Hwang JW, Jhoo JH, Kyeon YG, Lee K. Retrospective recall study about psychological and behavioral characteristics in high lethality suicide attempters. J Korean Neuropsychiatr Assoc. 2015; 54:435–443.

37. McGirr A, Renaud J, Bureau A, Seguin M, Lesage A, Turecki G. Impulsive-aggressive behaviours and completed suicide across the life cycle: a predisposition for younger age of suicide. Psychol Med. 2008; 38:407–417.

38. Dube SR, Felitti VJ, Dong M, Chapman DP, Giles WH, Anda RF. Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics. 2003; 111:564–572.

39. Dube SR, Anda RF, Felitti VJ, Chapman DP, Williamson DF, Giles WH. Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study. JAMA. 2001; 286:3089–3096.

40. Ministry of Health & Welfare, Korea Suicide Prevention Center. 2015 white book of suicide prevention. Seoul: Korea Suicide Prevention center;2015.

41. Brodsky BS, Malone KM, Ellis SP, Dulit RA, Mann JJ. Characteristics of borderline personality disorder associated with suicidal behavior. Am J Psychiatry. 1997; 154:1715–1719.

42. Goldney RD, Smith S, Winefield AH, Tiggeman M, Winefield HR. Suicidal ideation: its enduring nature and associated morbidity. Acta Psychiatr Scand. 1991; 83:115–120.

TOOLS

Similar articles