Suicide Attempts Early in Life Signal Long-Term Social, Health Problems, Study Finds

Young people who attempt suicide are not only more likely to have persistent psychiatric problems as they approach midlife than nonattempters, but they are also more likely to have physical health problems, engage in violence, and need more social supports as they age. These are key findings from a study by led by Sidra Goldman-Mellor, Ph.D., and colleagues at Duke University and several other institutions and reported in JAMA Psychiatry.

The researchers followed a birth cohort that comprised 91 young suicide attempters and 946 nonattempters, 95% of whom were followed to age 38. Study members were all individuals born from April 1972 to March 1973 in Dunedin, New Zealand, participants in a longitudinal study of health and behavior in a complete birth cohort. They were assessed at ages 18, 21, 26, 32, and 38 with structured interviews to determine incidents of self-harm and suicidal behavior, as well as physical health and social factors. Young attempters were classified as those who made an attempt prior to age 25.

Researchers found that young suicide attempters were twice as likely to have persistent episodes of major depression and substance dependence than nonattempters, and 20% made additional suicide attempts from ages 26 to 38. They were also significantly more likely to commit violence against others, including in intimate relationships. The young attempters were "in significantly worse physical health as they approached midlife." In particular, they were more likely to meet criteria for the metabolic syndrome, have higher levels of biomarkers of systemic inflammation, and to sustain more unintentional injuries. They did caution, however, that they "did not assume that suicide attempts are a cause of these outcomes" but rather are an "early warning signal for persistent vulnerability to poor outcomes." They point out that with suicidal behavior on the increase in the U.S. and other developed nations since the global recession began in 2007, their data highlight the need for "additional suicide prevention efforts and long-term monitoring and aftercare services."

To read about efforts to prevent suicides, see the Psychiatric News articles, "Kennedy Makes Suicide Concerns Focus of National Tour," and "Advocates, Federal Officials Vow Enhanced Suicide-Prevention Efforts."

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Young Suicide Attempters Said to Need Long-Term Care to Reduce Future Impairment

The outlook for young people who attempt suicide is unfavorable over the long run, a prospective study of more than 1,000 subjects who were followed from age 3 to age 38 has found. The study results are published in JAMA Psychiatry.

For example, while the young suicide attempters made up only 9% of the cohort, by the end of the follow-up study they accounted for 15% of those with metabolic syndrome, 22% of those with persistent psychiatric disorders, and 35% of those convicted of violent crimes. Moreover, they needed extensive unemployment or welfare benefits and tended to be lonely and dissatisfied with their lives, the researchers found.

"The surprising part of the study is the degree of impairment in multiple areas outside of purely mental health outcomes and their extent," Timothy Lineberry, M.D., an associate professor of psychiatry at the Mayo Clinic and a suicide expert who was not associated with the new study, told Psychiatric News. "For clinicians, the study results emphasize, even more than previous research has, that suicide attempts are a marker in young people of illness severity and potential future impairment."

Long-term monitoring and health services are needed for young suicide attempters, the researchers said. Yet when Psychiatric News asked lead researcher Sidra Goldman-Mellor, Ph.D., a postdoctoral fellow in psychiatry at Duke University, whether anyone was providing such monitoring and services, she said, "The few programs for which there is evidence of a reduction in subsequent suicidal behavior (and other negative outcomes) emphasize immediate post-attempt care, integrated mental and [general] health care provision systems, and continuity of care. The U.S. Air Force's Integrated Delivery System Program is one such example. Another is the suicide prevention program instituted by a municipality in Norway in the 1980s.... These programs show that it can be done, but it takes a great deal of dedication and resource commitment at all levels of an organization."

More information about the societal burden of suicide as well as suicide prevention can be found in the Psychiatric News article "Kennedy Makes Suicide Concerns Focus of National Media Tour."  Information about caring for suicidal patients can be found in The American Psychiatric Publishing Textbook of Suicide Assessment and Management, Second Edition.

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