Suicide Attempts and Dying by Suicide
March 10, 2017
Males made up 76.5 percent of those who died by suicide. Being male and being older were associated with dying on a subsequent attempt after surviving a first attempt. Among those who died on their first attempt, 72.9 percent used firearms.
A study found that 59.3 percent of people who died by suicide did so as a result of their first attempt (defined by the study as a first lifetime attempt that resulted in medical attention). The authors suggested that this finding reveals the importance of identifying people at risk before they attempt suicide for the first time. It also reveals a critical problem of using “prior suicide attempt” to identify people at risk of suicide—that is, this method fails to identify approximately 60 percent of the people who die by suicide, since they die as a result of their first attempt.
The study found that 5.4 percent of people who made a first-time suicide attempt requiring medical attention in Olmstead County, Minnesota between 1986 and 2007 died by suicide by 2010—either on their first attempt or on a subsequent attempt. Of the suicide attempters who survived their first attempt, but died as the result of a subsequent attempt, 81.8 percent died within 12 months of their first attempt. The authors suggested that this finding reveals that it is critical to ensure that people who survive a first attempt receive effective intervention immediately following that attempt.
Males made up 76.5 percent of those who died by suicide. Being male and being older were associated with dying on a subsequent attempt after surviving a first attempt. Among those who died on their first attempt, 72.9 percent used firearms. Very few (1.5 percent) of the people who used firearms on their first attempt survived that attempt. People who used firearms on their first suicide attempt had 140 times the risk of dying on their first attempt than people using other methods.
This research also found that “having a follow-up appointment scheduled on discharge from either the emergency department or an inpatient service, whether or not it was actually kept . . . significantly [reduced] the risk of dying on a subsequent attempt.” The authors noted that only 69.4 percent of people who survived a first attempt had a scheduled follow-up appointment. They suggested that the 30.6 percent of people treated for a suicide attempt and released without a follow-up appointment represents a lost opportunity for preventing suicides.
Source- Bostwick, J. M., Pabbati, C., Geske, J. R., & McKean, A. J. (2016). Suicide attempt as a risk factor for completed suicide: Even more lethal than we knew. American Journal of Psychiatry, 173(11), 1094–1100.
Suicides in Massachusetts
Preventing Suicide in the Emergency Department
August 25, 2017
Emergency departments (EDs) can reduce suicide attempts among high-risk patients by delivering a combination of interventions that includes suicide risk screening, discharge resources, and a brief intervention. A multi-site study found that when compared to treatment as usual, the combined interventions resulted in a five percent decrease in the proportion of patients who attempted suicide in the 52 weeks after their ED visit and a 30 percent drop in the total number of suicide attempts in that period.
The intervention targeted patients who were identified as being at risk through an initial universal screening, and included the following components:
A secondary screening that allowed ED physicians to better assess suicide risk.
A self-administered safety plan and information on suicide prevention provided to the patient by ED nursing staff.
A series of up to seven brief telephone calls to each patient and up to four brief telephone calls to a significant other identified by the patient, if available, in the 52 weeks after the first ED visit. These calls helped patients identify risk factors, clarify values and goals, engage in safety planning, assist with treatment engagement and adherence, and facilitate problem-solving with their significant other.
EDs that only implemented universal screening increased the number of patients identified as being at risk for suicide, but did not reduce the proportion of patients attempting suicide or the number of suicide attempts.
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Source- Miller, I. W., Camargo, C. A., Arias, S. A., Sullivan, A. F., Allen, M. H., Goldstein, A. B., . . . Boudreaux, E. D. (2017). Suicide prevention in an emergency department population: The ED Safe study. JAMA Psychiatry, 74(6), 563–570.