Estimating suicide risk among attempted suicides. II. Efficiency of predictive scales after the attempt.

We predicted that the closer the resemblance of attempted suicide to completed suicide, the greater the risk of patients later killing themselves after an unsuccessful attempt. Using two risk scales, one of 6 and the other of 18 socio-demographic and clinical items, weighted according to their value in discriminating between suicides and attempted suicides, and a rating of intent to die during the index suicide attempt, we followed up 1263 attempted suicides for two years. Ten of the twelve suicidal deaths in the first year occurred in patients scoring in the top quartile on the 6-item scale; and among high-risk scorers there was an excess of those defined as 'failed suicides' at the index attempt. The 18-item scale was superior to the shorter one, but both scales were improved by taking into account the rating of intent-to-die. The potential value of these findings is discussed in the light of some inherent problems of predicting suicide in the clinical setting.

Estimating suicide risk among attempted suicides: I. The development of new clinical scales.

A discriminant function analysis was carried out to separate a sample of 75 suicides from a sample of 146 attempted suicides, on which comprehensive clinical and social data were recorded on an identical schedule. Two sets of discriminating items (with 18 and 6 variables) correctly classified 91 per cent and 83 per cent of the two samples in their respective groups. The results provide a basis for examining the usefulness of these variables as predictors of future suicide in people who have attempted suicide.

Seriousness of suicide attempt in relation to personality.

From a sample of psychiatric referrals who had completed the MMPI the following three groups, matched for age and sex, were derived: 42 patients with a history of a serious suicide attempt, 42 patients with a history of a non-serious attempt, and 126 patients who had neither attempted nor contemplated suicide. Non-serious suicide attempters were shown to be the most deviant group and differed to a significant extent from each of the other two groups on the Dependency, Hostility and Unconventionality scales. Male non-serious attempters showed the most disturbed personality profile. This implies that there is, for males, a higher personality threshold for making a non-serious attempt, which may account for the fact that suicide attempts, most of which are non-serious, are commoner among females.

The value of assessing intent in attempted suicide.

Suicidal intent was assessed in a sample of 151 admissions to a general hospital for self-poisoning or self-inflicted injury. Severity of intent was associated with the act's medical seriousness and with the risk of suicide derived from a validated risk scale. Although high and low intent cases were comparable in respect of precipitating factors, patients rated high on suicidal intent were more likely to have experienced depressive symptoms in the previous month.

Personality and suicidal history in psychiatric patients.

The study sample comprised 575 psychiatric referrals for whom MMPI data were available. Patients were categorized according to suicidal history. The attempted suicide and nonsuicidal patients were differentiated significantly on the D, PD, MF, DY, ES, NE, EX, HO, SD, IP, ANX, and UNC scales. Important differences between the sexes emerged; whereas for men the profiles of the suicidal ideation and nonsuicidal patients were similar, for women those of the suicidal ideation and suicide attempt were similar. Male and female suicide attemptors correspond closely in the pattern and degree of deviation from the nonsuicidal patients of their own sex. The study indicates that patients who have a history of suicide attempts constitute a more psychologically disturbed group and points to a need for further examination of the meaning of suicidal ideation for men and women.

Excessive use of psychiatric services by suicidal patients.

The use of psychiatric services by patients with a suicidal history was examined to see if they placed a greater long-term burden on these services than other types of patient. Suicidal patients spent significantly more days in hospital and made more outpatient attendances; suicide attemptors in particular not only needed more emergency consultations but also spent more days in hospital. A more economical yet more effective treatment policy for the suicidal patient is needed.

Depression followed by suicide: a comparison of depressed suicides with living depressives.

The characteristics of 64 suicides with a retrospective diagnosis of depression and 128 depressives referred for psychiatric treatment were compared. The following items differentiated the suicide group: male sex, older age in females, single status, living alone, the symptoms of insomnia, impaired memory and self neglect, and a history of suicide attempts. The value of these items in assessing suicide risk in depressive illness is discussed.