First Suicide Attempts More Lethal Than Prior Estimates

First suicide attempts are more deadly than hitherto appreciated, so prevention efforts should focus on people at risk of making that initial attempt, according to a study from the Department of Health Sciences Research at the Mayo Clinic in Rochester, Minnesota, published today online in the American Journal of Psychiatry.

Using data from the Rochester Epidemiology Project, Mayo’s J. Michael Bostwick, M.D., and colleagues found that 1,490 residents of Olmsted County, Minnesota, made a first suicide attempt between 1986 and 2007, with follow-up through the end of 2010. Of those, 81 died—48 on that first attempt and 33 on a later attempt, most within the following year.

Men were more likely to use guns to kill themselves. Both men and women who used firearms were 140 times more likely to die than those using other methods. Overall, 57 percent of the attempts involved medication overdoses.

Encouragingly, however, scheduling a follow-up psychiatry appointment for survivors sharply lowered the chances of a second suicide attempt that was successful (odds ratio=0.212).

The researchers noted that this is the first study to show odds for dying by suicide in a representative community sample of first lifetime suicide attempters who came to medical attention—a group previously ignored in calculations of risk.

“We contend that counting both index and subsequent attempt deaths more accurately reflects prevalence,” concluded Bostwick. “Our findings support suicide attempt as an even more lethal risk factor for completed suicide than previously thought.”

For more in Psychiatric News about suicide prevention, see “Gun Policy and Suicide Prevention."

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