Impulsive suicide attempts among young people-A prospective multicentre cohort study in Sweden.

BACKGROUND: We aimed to compare the prevalence of impulsive suicide attempts (ISA) among young adults and those over 25 who present at hospital in connection with attempted suicide. We also aimed to identify factors associated with ISA in young adults and to assess medical severity as well as the probability of repeated suicide attempts in this age group. METHOD: A prospective multicentre cohort study included hospital known cases of suicide attempt (N = 666). The prevalence of ISA was compared between young adults (18-25) and adults aged > 26. We used logistic regression models to identify factors associated with ISA, associations of ISA with high medical severity and prediction of new fatal or non-fatal suicide attempts within 6 months. RESULTS: 43.7% of the young patients had made an ISA, and 30.2% among those aged > 26 (p = 0.001). Among the young, substance use disorder was associated with ISA; crude odds ratio (OR) 2.0 (1.0-4.2), and adjusted OR 2.1 (0.99-4.4). Affective disorder and unemployment/ sickness absence implied lower odds of ISA. ISA resulted in injuries of high medical severity as often as more planned attempts and non-fatal or fatal repetition within 6 months was equally common (30%) in both groups. LIMITATIONS: The study was set in psychiatric emergency services, which limits the generalizability. CONCLUSIONS: Clinicians should acknowledge that suicide attempts among youth often occur without previous planning and may result in medically severe injuries. The probability of new fatal or non-fatal suicide attempts should be kept in mind also after an impulsive suicide attempt.

Does Beck's Hopelessness Scale really measure several components?

BACKGROUND: Much of the interest in hopelessness stems from the key role it plays in the prediction of suicidal behaviour. To measure hopelessness. Beck el al. (1974) developed a 20-item scale (BHS), applied exploratory factor analysis and argued that the scale measures three specific components (affective, motivational and cognitive). Subsequent exploratory factor analyses identified two, three or more factors underlying the scale. METHODS: Several confirmatory factor analyses (LISREL) were run on data on 324 suicide attempters in Sweden in order to test the hypothesized factorial structures and to investigate the psychometric properties of the individual items. RESULTS: Neither three- nor two-factor models fitted the data. A simpler structure was sufficient to account for the observed correlations between most of the items. This led to the development of several variants of a one-factor model, each a combination of affective, motivational and cognitive items. The number of items varied between four and 15. CONCLUSIONS: Our findings suggest that most of the items (15) of Beck's Hopelessness Scale measure one factor. They further suggest that the number of items could considerably be reduced. A four-item scale produced an excellent fit. It includes positive and negative items describing the perception of the future in terms of success, darkness, lack of opportunity and faith. It might even be possible to replace the total scale with one item only, 'my future seems dark to me'.

Self-reported life-weariness, death-wishes, suicidal ideation, suicidal plans and suicide attempts in general population surveys in the north of Sweden 1986 and 1996.

BACKGROUND: The aims of present study were to assess the prevalence of suicidal expression in the general population, to compare prevalences over time, to identify risk groups and to examine the evidence regarding the proposition that there is a continuous sequence of suicidal expressions with an underlying gradient of severity. METHOD: Two postal questionnaire studies were conducted, in 1986 and in 1996, involving representative samples of about 700 and 1000 persons respectively, in the age range 18-65 years. Response rates of 76% and 64%, respectively, were obtained. RESULTS: A higher proportion (34%) reported some degree of suicidal expression during the past year in the 1996 survey, compared to 1986 (23%). This was mainly attributed to higher reporting of life-weariness and death-wishes, since there was a simultaneous lower reporting of suicidal ideation (12.5% vs 8.6%). The total lifetime incidence of suicidal expression was identical (52%) in both studies. Respective proportions of 0.6% and 0.2% reported that they had made a suicide attempt during the last year, and 2.6% and 2.7%, respectively, during their lifetime. Higher prevalences of combined suicidal expression during the previous year were reported by women, younger persons, those living alone and women living in urban areas. Concerning suicidal ideation during last year, no gender differences were found. For a total of 21% of those reporting some degree of suicidal expressions during the past year, no simple cumulative relationship between the different types of suicidal expression was found. CONCLUSIONS: It is possible to use a postal questionnaire approach for studies on suicidal expression in the general population, and the study indicates that such suicidal expression is fairly prevalent. The pronounced gender differences concerning most types of suicidal behaviours and expression are not valid for suicidal ideation, which is important to consider in a preventional context.

Suicide attempts and serious suicide threats in the city of Riga and resulting contacts with medical services.

The acute treatment of persons attempting suicide is recognized as very important in a prevention context. The aim of this study is to describe the medical services available to patients who have made suicide attempts or serious threats to commit suicide (SAST) within the city of Riga, to trace their passage through the various medical facilities, and to estimate SAST rates. Data for 1999 were collected from electronic case reports of the Emergency Medical Service (EMS) in Riga and monitoring forms of suicide attempters in Riga Psychoneurological Hospital (RPH) and Narcological Hospital (NH). In 1999 the first contact with the medical service in Riga for 95% of all cases (1024) was the EMS. Of the cases, 51.8% were treated at the general and 17.0% at the orthopaedic hospital. Of all SAST patients 99% have been assessed by at least one psychiatrist, and 43.8% were admitted to the psychiatric hospital at some time. The overall rate of suicide attempts is 149 per 100 000. The male to female ratio for SAST in Riga for individuals aged 15 years and more was 1:0.9. The highest figures were for females aged 15-24 and men aged 25-34. Females used poisonings in 75% of cases, but males used violent suicide methods in 60% of cases, most often involving cutting and associated with the use of alcohol. Data from existing medical services provide reasonably good information on the SAST population in Riga City.

A cross-cultural study of suicide intent in parasuicide patients.

As part of the WHO/EURO Multicentre Study on Parasuicide, the level of suicide intent among female and male parasuicide patients from various European regions was compared. From nine regions, a total of 1,212 parasuicide patients, 752 females and 460 males, were included in the study. Although some statistical significant differences in level of suicide intent between the regions and genders were found, the effect sizes of these relationships were so small that the differences have neither theoretical nor practical significance. As far as level of suicide intent is concerned, the WHO study has succeeded in recruiting a relatively homogeneous group of self-harming patients across borders of region, culture, and country.

On suicide and suicide prevention as a public health issue.

Suicide is becoming one of the major causes of death especially amongst men. In Europe suicide is the second most common cause of death in the ages of 15-44 years. For women in the same age group suicide is the fourth most common cause of death. Suicide causes a lot of suffering not only in the victim but also in persons close to him. As the causative factors are complex, and suicide also costs the community a lot of money suicide and self destructive behavior must be considered an important public health issue. A couple of models which are helpful when trying to develop treatment and preventive strategies for suicided persons are presented. The basic principles for contemporary suicide prevention programmes are also described.