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Long-term risk factors for suicide in suicide attempters examined at a medical emergency in patient unit : results from a 32-year follow-up study

Probert-Lindström, Sara LU orcid ; Berge, Jonas LU ; Westrin, Åsa LU ; Öjehagen, Agneta LU and Skogman Pavulans, Katarina LU (2020) In BMJ Open 10(10).
Abstract

OBJECTIVES: The overall aim of this study is to gain greater knowledge about the risk of suicide among suicide attempters in a very long-term perspective. Specifically, to investigate possible differences in clinical risk factors at short (≤5 years) versus long term (>5 years), with the hypothesis that risk factors differ in the shorter and longer perspective. DESIGN: Prospective study with register-based follow-up for 21-32 years. SETTING: Medical emergency inpatient unit in the south of Sweden. PARTICIPANTS: 1044 individuals assessed by psychiatric consultation when admitted to medical inpatient care for attempted suicide during 1987-1998. OUTCOME MEASURES: Suicide and all-cause mortality. RESULTS: At follow-up, 37.6% of the... (More)

OBJECTIVES: The overall aim of this study is to gain greater knowledge about the risk of suicide among suicide attempters in a very long-term perspective. Specifically, to investigate possible differences in clinical risk factors at short (≤5 years) versus long term (>5 years), with the hypothesis that risk factors differ in the shorter and longer perspective. DESIGN: Prospective study with register-based follow-up for 21-32 years. SETTING: Medical emergency inpatient unit in the south of Sweden. PARTICIPANTS: 1044 individuals assessed by psychiatric consultation when admitted to medical inpatient care for attempted suicide during 1987-1998. OUTCOME MEASURES: Suicide and all-cause mortality. RESULTS: At follow-up, 37.6% of the participants had died, 7.2% by suicide and 53% of these within 5 years of the suicide attempt. A diagnosis of psychosis at baseline represented the risk factor with the highest HR at long-term follow-up, that is, >5 years, followed by major depression and a history of attempted suicide before the index attempt. The severity of a suicide attempt as measured by SIS (Suicide Intent Scale) showed a non-proportional association with the hazard for suicide over time and was a relevant risk factor for suicide only within the first 5 years after an attempted suicide. CONCLUSIONS: The risk of suicide after a suicide attempt persists for up to 32 years after the index attempt. A baseline diagnosis of psychosis or major depression or earlier suicide attempts continued to be relevant risk factors in the very long term. The SIS score is a better predictor of suicide risk at short term, that is, within 5 years than at long term. This should be considered in the assessment of suicide risk and the implementation of care for these individuals.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
depression & mood disorders, psychiatry, schizophrenia & psychotic disorders, suicide & self-harm
in
BMJ Open
volume
10
issue
10
article number
e038794
publisher
BMJ Publishing Group
external identifiers
  • pmid:33130567
  • scopus:85095391935
ISSN
2044-6055
DOI
10.1136/bmjopen-2020-038794
language
English
LU publication?
yes
id
77ec2f6c-1407-43f7-8300-6c78214fa1d2
date added to LUP
2020-11-16 10:29:42
date last changed
2025-10-31 23:47:15
@article{77ec2f6c-1407-43f7-8300-6c78214fa1d2,
  abstract     = {{<p>OBJECTIVES: The overall aim of this study is to gain greater knowledge about the risk of suicide among suicide attempters in a very long-term perspective. Specifically, to investigate possible differences in clinical risk factors at short (≤5 years) versus long term (&gt;5 years), with the hypothesis that risk factors differ in the shorter and longer perspective. DESIGN: Prospective study with register-based follow-up for 21-32 years. SETTING: Medical emergency inpatient unit in the south of Sweden. PARTICIPANTS: 1044 individuals assessed by psychiatric consultation when admitted to medical inpatient care for attempted suicide during 1987-1998. OUTCOME MEASURES: Suicide and all-cause mortality. RESULTS: At follow-up, 37.6% of the participants had died, 7.2% by suicide and 53% of these within 5 years of the suicide attempt. A diagnosis of psychosis at baseline represented the risk factor with the highest HR at long-term follow-up, that is, &gt;5 years, followed by major depression and a history of attempted suicide before the index attempt. The severity of a suicide attempt as measured by SIS (Suicide Intent Scale) showed a non-proportional association with the hazard for suicide over time and was a relevant risk factor for suicide only within the first 5 years after an attempted suicide. CONCLUSIONS: The risk of suicide after a suicide attempt persists for up to 32 years after the index attempt. A baseline diagnosis of psychosis or major depression or earlier suicide attempts continued to be relevant risk factors in the very long term. The SIS score is a better predictor of suicide risk at short term, that is, within 5 years than at long term. This should be considered in the assessment of suicide risk and the implementation of care for these individuals.</p>}},
  author       = {{Probert-Lindström, Sara and Berge, Jonas and Westrin, Åsa and Öjehagen, Agneta and Skogman Pavulans, Katarina}},
  issn         = {{2044-6055}},
  keywords     = {{depression & mood disorders; psychiatry; schizophrenia & psychotic disorders; suicide & self-harm}},
  language     = {{eng}},
  number       = {{10}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{BMJ Open}},
  title        = {{Long-term risk factors for suicide in suicide attempters examined at a medical emergency in patient unit : results from a 32-year follow-up study}},
  url          = {{http://dx.doi.org/10.1136/bmjopen-2020-038794}},
  doi          = {{10.1136/bmjopen-2020-038794}},
  volume       = {{10}},
  year         = {{2020}},
}