Skip to main content
Top
Published in: BMC Psychiatry 1/2010

Open Access 01-12-2010 | Research article

Study of the outcome of suicide attempts: characteristics of hospitalization in a psychiatric ward group, critical care center group, and non-hospitalized group

Authors: Kaoru Kudo, Kotaro Otsuka, Jin Endo, Tomoyuki Yoshida, Hisayasu Isono, Takehito Yambe, Hikaru Nakamura, Sachiyo Kawamura, Atsuhiko Koeda, Junko Yagi, Nobuo Kemuyama, Hisako Harada, Fuminori Chida, Shigeatsu Endo, Akio Sakai

Published in: BMC Psychiatry | Issue 1/2010

Login to get access

Abstract

Background

The allocation of outcome of suicide attempters is extremely important in emergency situations. Following categorization of suicidal attempters who visited the emergency room by outcome, we aimed to identify the characteristics and potential needs of each group.

Methods

The outcomes of 1348 individuals who attempted suicide and visited the critical care center or the psychiatry emergency department of the hospital were categorized into 3 groups, "hospitalization in the critical care center (HICCC)", "hospitalization in the psychiatry ward (HIPW)", or "non-hospitalization (NH)", and the physical, mental, and social characteristics of these groups were compared. In addition, multiple logistic analysis was used to extract factors related to outcome.

Results

The male-to-female ratio was 1:2. The hospitalized groups, particularly the HICCC group, were found to have biopsychosocially serious findings with regard to disturbance of consciousness (JCS), general health performance (GAS), psychiatric symptoms (BPRS), and life events (LCU), while most subjects in the NH group were women who tended to repeat suicide-related behaviors induced by relatively light stress. The HIPW group had the highest number of cases, and their symptoms were psychologically serious but physically mild. On multiple logistic analysis, outcome was found to be closely correlated with physical severity, risk factor of suicide, assessment of emergent medical intervention, and overall care.

Conclusion

There are different potential needs for each group. The HICCC group needs psychiatrists on a full-time basis and also social workers and clinical psychotherapists to immediately initiate comprehensive care by a medical team composed of multiple professionals. The HIPW group needs psychological education to prevent repetition of suicide attempts, and high-quality physical treatment and management skill of the staff in the psychiatric ward. The NH group subjects need a support system to convince them of the risks of attempting suicide and to take a problem-solving approach to specific issues.
Appendix
Available only for authorised users
Literature
1.
go back to reference Chiles JA, Strosahl KD: 7. Managing suicidal emergencies: More on crisis and case management. Clinical manual for assessment and treatment of suicidal patients. 2005, American psychiatric Publishing, Inc., Washington, DC/London/England Chiles JA, Strosahl KD: 7. Managing suicidal emergencies: More on crisis and case management. Clinical manual for assessment and treatment of suicidal patients. 2005, American psychiatric Publishing, Inc., Washington, DC/London/England
2.
go back to reference Baca-García E, Diaz-Sastre C, Resa EG, Blasco Hilario, Conesa DB, Saiz-Ruiz J, de Leon Jose: Variables associated with hospitalization decision by emergency psychiatrists after a patient's suicide attempt. Psychiatric Services. 2004, 55 (7): 792-7. 10.1176/appi.ps.55.7.792.CrossRefPubMed Baca-García E, Diaz-Sastre C, Resa EG, Blasco Hilario, Conesa DB, Saiz-Ruiz J, de Leon Jose: Variables associated with hospitalization decision by emergency psychiatrists after a patient's suicide attempt. Psychiatric Services. 2004, 55 (7): 792-7. 10.1176/appi.ps.55.7.792.CrossRefPubMed
3.
go back to reference The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. 1992, World health organization. Geneva The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. 1992, World health organization. Geneva
4.
go back to reference Kitamura T, Machizawa S, Maruyama S, Nakagawa Y, Morita M, Sato T, Suga R, Nankai M, Uchiyama M, Fujiwara S, Yuzuriha T, Ito J, Kodama K, Koseki K, Takazawa N, Morihira J: Reliability of re-test of Brief Psychiatric Rating Scale (BPRS). Journal of mental health. 1985, 32: 1-15. Kitamura T, Machizawa S, Maruyama S, Nakagawa Y, Morita M, Sato T, Suga R, Nankai M, Uchiyama M, Fujiwara S, Yuzuriha T, Ito J, Kodama K, Koseki K, Takazawa N, Morihira J: Reliability of re-test of Brief Psychiatric Rating Scale (BPRS). Journal of mental health. 1985, 32: 1-15.
5.
go back to reference Endicott J, Spitzer RL, Fleiss JL, Cohen J: The Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbances. Arch Gen Psychiatry. 1976, 33: 766-771.CrossRefPubMed Endicott J, Spitzer RL, Fleiss JL, Cohen J: The Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbances. Arch Gen Psychiatry. 1976, 33: 766-771.CrossRefPubMed
7.
go back to reference Asukai N: Suicide and mental disorders. Psychiatry Clin Neurosci. 1995, 49: 91-97. 10.1111/j.1440-1819.1995.tb01926.x.CrossRef Asukai N: Suicide and mental disorders. Psychiatry Clin Neurosci. 1995, 49: 91-97. 10.1111/j.1440-1819.1995.tb01926.x.CrossRef
8.
go back to reference Baca-García E, Perez-Rodriquez M, Basurete-Villamor I, Saiz-Ruiz J, Leiva-Murillo J, de Prado-Complido M, Santiago-Mozos R, Atrés-Rodríquez , de Leon J: Using Data Mining to Explore Complex Clinical Decisions: A Study of Hospitalization after a Suicide Attempt. J Clin Psych. 2006, 67 (7): 1124-1133. 10.4088/JCP.v67n0716.CrossRef Baca-García E, Perez-Rodriquez M, Basurete-Villamor I, Saiz-Ruiz J, Leiva-Murillo J, de Prado-Complido M, Santiago-Mozos R, Atrés-Rodríquez , de Leon J: Using Data Mining to Explore Complex Clinical Decisions: A Study of Hospitalization after a Suicide Attempt. J Clin Psych. 2006, 67 (7): 1124-1133. 10.4088/JCP.v67n0716.CrossRef
9.
go back to reference Malone KM, Szanto K, Corbitt EM, Mann JJ: Clinical assessment versus research methods in the assessment of suicidal behavior. Am J Psychiatry. 1995, 152 (11): 1601-7.CrossRefPubMed Malone KM, Szanto K, Corbitt EM, Mann JJ: Clinical assessment versus research methods in the assessment of suicidal behavior. Am J Psychiatry. 1995, 152 (11): 1601-7.CrossRefPubMed
10.
go back to reference Miret M, Nuevo R, Ayuso-Mateos JL: Documentation of suicide risk assessment in clinical records. Psychiatr Serv. 2009, 60 (7): 994-10.1176/appi.ps.60.7.994.CrossRefPubMed Miret M, Nuevo R, Ayuso-Mateos JL: Documentation of suicide risk assessment in clinical records. Psychiatr Serv. 2009, 60 (7): 994-10.1176/appi.ps.60.7.994.CrossRefPubMed
11.
go back to reference Skogman K, Alsen M, Öjehagen A: Sex differences in risk factors for suicide after attempted suicide--a follow-up study of 1052 suicide attempters. Soc Psychiatry Psychiatr Epidemiol. 2004, 39: 113-20. 10.1007/s00127-004-0709-9.CrossRefPubMed Skogman K, Alsen M, Öjehagen A: Sex differences in risk factors for suicide after attempted suicide--a follow-up study of 1052 suicide attempters. Soc Psychiatry Psychiatr Epidemiol. 2004, 39: 113-20. 10.1007/s00127-004-0709-9.CrossRefPubMed
12.
go back to reference Oda S, Higashi T: Current status of research on suicide and suicide prevention in foreign countries. J Nahl Inst Public Health. 2003, 52- Oda S, Higashi T: Current status of research on suicide and suicide prevention in foreign countries. J Nahl Inst Public Health. 2003, 52-
13.
go back to reference Suzuki H: The realities of attempted suicides at the emergency service of a university hospital. Journal of clinical and experimental medicine. 2003, 55-58. Suzuki H: The realities of attempted suicides at the emergency service of a university hospital. Journal of clinical and experimental medicine. 2003, 55-58.
14.
go back to reference Okamoto K, Sakata Y, Shimokawa K, Takahashi H, Shigena S, Endo K, Monou H: On sexual difference of help-seeking behavior. Proceedings of the Japanese society of psychosomatic medicine. 2002, 42 (10): Okamoto K, Sakata Y, Shimokawa K, Takahashi H, Shigena S, Endo K, Monou H: On sexual difference of help-seeking behavior. Proceedings of the Japanese society of psychosomatic medicine. 2002, 42 (10):
15.
go back to reference Matsuishi K: Self-harm & suicide attempts in emergency & critical care center. Japanese journal of molecular psychiatry. 2007, 293-294. Matsuishi K: Self-harm & suicide attempts in emergency & critical care center. Japanese journal of molecular psychiatry. 2007, 293-294.
16.
go back to reference Iwato S, Otsuka K, Nakamura H, Fujiwara E, Sasaki C, Nakamura H: Depression in working people in suicide-prone districts: Study of current conditions and risk factors. The journal of the iwate medical association. 2009, 1-15. Iwato S, Otsuka K, Nakamura H, Fujiwara E, Sasaki C, Nakamura H: Depression in working people in suicide-prone districts: Study of current conditions and risk factors. The journal of the iwate medical association. 2009, 1-15.
17.
go back to reference Schnaideman ES: Suicide as psychache a clinical approach to self-destructive behavior. 1993, London: Rowan & Littelefield publishers Schnaideman ES: Suicide as psychache a clinical approach to self-destructive behavior. 1993, London: Rowan & Littelefield publishers
18.
go back to reference Takahashi Y: Senile depression & suicide. Geriatric Medicine. 2002, 40 (4): 477-479. Takahashi Y: Senile depression & suicide. Geriatric Medicine. 2002, 40 (4): 477-479.
19.
go back to reference Asukai N: Actual situation of suicide caused by mental disorders. Journal of Japanese association of psychiatric hospitals. 2001, 20: 13-16. Asukai N: Actual situation of suicide caused by mental disorders. Journal of Japanese association of psychiatric hospitals. 2001, 20: 13-16.
20.
go back to reference Hawton K, Sutton L, Haw C, Sinclair J, Deeks JJ: Schizophrenia and suicide: systematic review of risk factors. Br J Psychiatry. 2005, 187: 9-20. 10.1192/bjp.187.1.9.CrossRefPubMed Hawton K, Sutton L, Haw C, Sinclair J, Deeks JJ: Schizophrenia and suicide: systematic review of risk factors. Br J Psychiatry. 2005, 187: 9-20. 10.1192/bjp.187.1.9.CrossRefPubMed
21.
go back to reference Hawton K, Sutton L, Haw C, Sinclair J, Harriss L: Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors. J Clin Psychiatry. 2005, 66: 693-704. 10.4088/JCP.v66n0604.CrossRefPubMed Hawton K, Sutton L, Haw C, Sinclair J, Harriss L: Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors. J Clin Psychiatry. 2005, 66: 693-704. 10.4088/JCP.v66n0604.CrossRefPubMed
22.
go back to reference Hawgood J, De Leo D: Anxiety disorders and suicidal behaviour: an update. Curr Opin Psychiatry. 2008, 21: 51-64. 10.1097/YCO.0b013e3282f2309d.CrossRefPubMed Hawgood J, De Leo D: Anxiety disorders and suicidal behaviour: an update. Curr Opin Psychiatry. 2008, 21: 51-64. 10.1097/YCO.0b013e3282f2309d.CrossRefPubMed
23.
go back to reference Sareen J, Cox BJ, Afifi TO, de Graaf R, Asmundson GJ, Ten Have M, Stein MB: Anxiety disorders and Risk for Suicidal Ideation and Suicide Attempts. Arc Gen Psychiatry. 2005, 62: 1249-1257. 10.1001/archpsyc.62.11.1249.CrossRef Sareen J, Cox BJ, Afifi TO, de Graaf R, Asmundson GJ, Ten Have M, Stein MB: Anxiety disorders and Risk for Suicidal Ideation and Suicide Attempts. Arc Gen Psychiatry. 2005, 62: 1249-1257. 10.1001/archpsyc.62.11.1249.CrossRef
24.
go back to reference McIntyre RS, Muzina DJ, Kemp DE, Blank D, Woldeyohannes HO, Lofchy J, Soczynska JK, Banik S, Konarski JZ: Bipolar disorder and suicide: research synthesis and clinical translation. Curr Psychiatry Rep. 2008, 10: 66-72. 10.1007/s11920-008-0012-7.CrossRefPubMed McIntyre RS, Muzina DJ, Kemp DE, Blank D, Woldeyohannes HO, Lofchy J, Soczynska JK, Banik S, Konarski JZ: Bipolar disorder and suicide: research synthesis and clinical translation. Curr Psychiatry Rep. 2008, 10: 66-72. 10.1007/s11920-008-0012-7.CrossRefPubMed
25.
go back to reference Isono H, Otsuka K, Hoshi K, Yambe T, Endo J, Nakamura H, Endo S: A comparative study between Patients with mood disorder and with neurotic disorder who exhibited suicide-related behaviors. The journal of the iwate medical association. 2008, 151-162. Isono H, Otsuka K, Hoshi K, Yambe T, Endo J, Nakamura H, Endo S: A comparative study between Patients with mood disorder and with neurotic disorder who exhibited suicide-related behaviors. The journal of the iwate medical association. 2008, 151-162.
26.
go back to reference De Leo D, Klieve H: Communication of suicide intent by schizophrenic subjects: data from the Queensland Suicide Register. Int J Ment Health Syst. 2007, 1: 6-10.1186/1752-4458-1-6.CrossRefPubMedPubMedCentral De Leo D, Klieve H: Communication of suicide intent by schizophrenic subjects: data from the Queensland Suicide Register. Int J Ment Health Syst. 2007, 1: 6-10.1186/1752-4458-1-6.CrossRefPubMedPubMedCentral
27.
go back to reference Vassilas C, Morgan H: Elderly suicides' contact with their general practitioner before death. Int J Geriatr Psychiatry. 1994, 9: 1008-1009. Vassilas C, Morgan H: Elderly suicides' contact with their general practitioner before death. Int J Geriatr Psychiatry. 1994, 9: 1008-1009.
28.
go back to reference Cho K: Psychological characteristics of suicide in workers. Occupational mental health. 2002, 10 (2): 137- Cho K: Psychological characteristics of suicide in workers. Occupational mental health. 2002, 10 (2): 137-
29.
go back to reference Endo J, Otsuka K, Yoshida T, Nakamura H, Yambe T, Isono H, Chida F: On factors related to risk to life in attempted suicides: comparison between absolutely and relatively dangerous suicides in emergency & critical care center. The Journal of the Japanese Association for Emergency Psychiatry. 2009, 12: 60-73. Endo J, Otsuka K, Yoshida T, Nakamura H, Yambe T, Isono H, Chida F: On factors related to risk to life in attempted suicides: comparison between absolutely and relatively dangerous suicides in emergency & critical care center. The Journal of the Japanese Association for Emergency Psychiatry. 2009, 12: 60-73.
30.
go back to reference Matsuishi K, Kitamura N, Sato M, Nagai K, Huh SY, Ariyoshi K, Sato S, Mita T: Change of suicidal ideation induced by suicide attempt. Psychiatry Clin Neurosci. 2005, 59: 599-604. 10.1111/j.1440-1819.2005.01421.x.CrossRefPubMed Matsuishi K, Kitamura N, Sato M, Nagai K, Huh SY, Ariyoshi K, Sato S, Mita T: Change of suicidal ideation induced by suicide attempt. Psychiatry Clin Neurosci. 2005, 59: 599-604. 10.1111/j.1440-1819.2005.01421.x.CrossRefPubMed
31.
go back to reference Jenkins GR, Hale R, Papanastassiou M, Crawford MJ, Tyrer P: Suicide rate 22 years after parasuicide: cohort study. BMJ. 2002, 325: 1155-10.1136/bmj.325.7373.1155.CrossRefPubMedPubMedCentral Jenkins GR, Hale R, Papanastassiou M, Crawford MJ, Tyrer P: Suicide rate 22 years after parasuicide: cohort study. BMJ. 2002, 325: 1155-10.1136/bmj.325.7373.1155.CrossRefPubMedPubMedCentral
32.
go back to reference Suokas J, Suominen K, Isometsä E, Ostamo A, Lönnqvist J: Long-term risk factors for suicide mortality after attempted suicide--findings of a 14-year follow-up study. Acta Psychiatr Scand. 2001, 104: 117-21. 10.1034/j.1600-0447.2001.00243.x.CrossRefPubMed Suokas J, Suominen K, Isometsä E, Ostamo A, Lönnqvist J: Long-term risk factors for suicide mortality after attempted suicide--findings of a 14-year follow-up study. Acta Psychiatr Scand. 2001, 104: 117-21. 10.1034/j.1600-0447.2001.00243.x.CrossRefPubMed
33.
go back to reference Suominen K, Isometsä E, Suokas J, Haukka J, Achte K, Lönnqvist J: Completed suicide after a suicide attempt: a 37-year follow-up study. Am J Psychiatry. 2004, 161: 562-3. 10.1176/appi.ajp.161.3.562.CrossRefPubMed Suominen K, Isometsä E, Suokas J, Haukka J, Achte K, Lönnqvist J: Completed suicide after a suicide attempt: a 37-year follow-up study. Am J Psychiatry. 2004, 161: 562-3. 10.1176/appi.ajp.161.3.562.CrossRefPubMed
34.
go back to reference Kishi Y, Kurosawa N: Cases of suicide attempt admitted in emergency & critical care center and methology of suicide prevention. Journal of Japanese association of psychiatric hospitals. 2001, 20: 17-21. Kishi Y, Kurosawa N: Cases of suicide attempt admitted in emergency & critical care center and methology of suicide prevention. Journal of Japanese association of psychiatric hospitals. 2001, 20: 17-21.
35.
go back to reference Nakata S, Hasegawa A: Suicidal patients in Chiba psychiatric medical center. Journal of clinical and experimental medicine. 2003, 59-63. Nakata S, Hasegawa A: Suicidal patients in Chiba psychiatric medical center. Journal of clinical and experimental medicine. 2003, 59-63.
36.
go back to reference Nishi D, Matsuoka Y: Appropriate assessment of suicide intent. Journal of clinical and experimental medicine. 2007, 221-224. Nishi D, Matsuoka Y: Appropriate assessment of suicide intent. Journal of clinical and experimental medicine. 2007, 221-224.
37.
go back to reference American sychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders: American Psychiatric Association. 2004 American sychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders: American Psychiatric Association. 2004
38.
go back to reference Tidemalm Dag: Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swrdish cohort study with long term follow-up. BMJ. 2008, 337: a2205-10.1136/bmj.a2205.CrossRefPubMedPubMedCentral Tidemalm Dag: Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swrdish cohort study with long term follow-up. BMJ. 2008, 337: a2205-10.1136/bmj.a2205.CrossRefPubMedPubMedCentral
Metadata
Title
Study of the outcome of suicide attempts: characteristics of hospitalization in a psychiatric ward group, critical care center group, and non-hospitalized group
Authors
Kaoru Kudo
Kotaro Otsuka
Jin Endo
Tomoyuki Yoshida
Hisayasu Isono
Takehito Yambe
Hikaru Nakamura
Sachiyo Kawamura
Atsuhiko Koeda
Junko Yagi
Nobuo Kemuyama
Hisako Harada
Fuminori Chida
Shigeatsu Endo
Akio Sakai
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2010
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-10-4

Other articles of this Issue 1/2010

BMC Psychiatry 1/2010 Go to the issue