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Predicting suicide, a very infrequent event, is extremely difficult. The best predictor of successful suicide is a history of a previous attempt. However, the hypothesis that more-severe methods of attempted suicide confer greater risk has been infrequently studied. Now, researchers in a prospective cohort study have analyzed Swedish hospital and death registries on 48,649 individuals hospitalized between 1973 and 1982 after a suicide attempt (84% by poisoning).
The researchers controlled for relevant demographics and psychiatric disorders (i.e., affective, psychotic, or other) and compared various suicide-attempt methods to poisoning, the index method. During follow-up (range, 21–31 years), 11.8% of individuals died by suicide, most using the method of their original attempt. Previous attempt methods that posed the highest risks for later completed suicide were hanging, strangulation, or suffocation (hazard ratio [HR], 6.2) followed by drowning, jumping, and shooting (HRs, 3.2–4.0). Cutting and other methods conferred a risk similar to poisoning. Over half the individuals in the highest-risk group ultimately committed suicide, 87% within 1 year of the attempt. The diagnosis with the highest independent risk was psychosis (HR, 2.5); 84% of psychotic patients who tried to hang themselves died later by suicide.
Runeson B et al. Method of attempted suicide as predictor of subsequent successful suicide: National long term cohort study. BMJ 2010 Jul 13; 341:c3222. (http://dx.doi.org/10.1136/bmj.c3222)
Comment
Findings from this study, the largest and most representative study on this topic, strongly suggest that certain suicide-attempt methods confer a great risk for future suicide. Study limitations include imprecise psychiatric diagnostic information, the absence of information on other risk factors, and the exclusion of suicide attempters who were not psychiatrically hospitalized. Nonetheless, individuals, especially those with psychosis, who attempt to kill themselves by hanging, drowning, shooting, or jumping are at extremely high risk for completed suicide.