Stability in the choice of method during the period preceding a suicide attempt and in attempt repeaters

Background and Objectives: Understanding the mental processes preceding a suicidal act is important for the potential to intervene. This study investigates stability and possible changes of suicide methods considered during the time immediately preceding a suicide attempt. Methods: Patients who had attempted suicide were interviewed shortly thereafter with regard to whether there was a change in the conception of the method to be used during the period preceding the attempt. In addition, the course of methods applied in previous suicide attempts was assessed in attempt repeaters. Results: In total, 130 patients were included. In 63.1% one method only was envisaged during the entire suicidal crisis, in 26.9% the initial and the actual method differed. Stability rate was higher in those older than 40 years, if the duration of the suicidal crisis was less than or equal to 60 minutes and if a non violent suicide method was initially intended. Of repeaters, 46.5% used the same method in all recorded attempts. Use of a non-violent method in the first suicide attempt predicted method stability in subsequent attempts. Conclusions: Focusing on one single suicide method during the time immediately preceding a suicide attempt is common. Reduced flexibility to rapidly switch mentally to another method may contribute to explain the effectiveness of limiting access to suicide means for suicide prevention (AU)

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The duration of the suicidal process: how much time is left for intervention between consideration and accomplishment of a suicide attempt?

OBJECTIVE: A history of suicide attempts is a major predictive factor for completed suicide with repeated self-harm constituting a particularly high risk. This study was undertaken to investigate suicide attempters' reports on the length of the period between consideration and accomplishment of a suicide attempt. METHOD: Eighty-two patients referred to a psychiatric university hospital after a suicide attempt were approached within 3 days after the act. A semistructured interview focusing on the duration and related aspects of the suicidal process, the Barratt Impulsiveness Scale, the Beck Suicide Intent Scale, and the Montgomery-Asberg Depression Rating Scale were administered. Data were collected from July 2004 to December 2005. RESULTS: Nearly half of the patients (47.6%; N = 39) reported that the period between the first current thought of suicide and the actual attempt had lasted 10 minutes or less. Those patients in which this process had taken longer showed a higher suicidal intent (p < .001). Impulsivity was not associated with the duration of the suicidal process. Although the majority of the patients were alone during the suicidal process, 76.8% (N = 63) reported having had any kind of interpersonal contact. CONCLUSION: The process from the emergence of suicidal thoughts to the accomplishment of a suicide attempt, and thus the time for intervention, generally is short. However, in a considerable number of suicide attempters, there is at least some readiness for interpersonal contact with partner, family, or friends. Professional helpers appear to have limited potential for intervention during this phase. Thus, spreading information on signs of suicidality and interventional measures among the general population should be incorporated into suicide prevention strategies.