Repeated self-poisoning: increasing severity of self-harm as a predictor of subsequent suicide

Gregory Leigh Carter · David Martin Reith · Ian M. Whyte · Michelle McPherson

94 citations0/0 files storedThe British Journal of Psychiatry

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Suicide and Self-Harm Studies Poisoning and overdose treatments Homicide, Infanticide, and Child Abuse

Abstract

BACKGROUND: Prediction of suicide risk is difficult in clinical practice. AIMS: To identify changes in clinical presentation predictive of suicide in patients treated for repeated episodes of self-poisoning. METHOD: A nested case-control study used the Hunter Area Toxicology Service database to identify exposure variables and the National Death Index to identify suicide. Cases were patients who had hospital treatment on more than one occasion between 15 January 1987 and 31 December 2000. RESULTS: There were 31 cases, for which 93 controls were selected. Study variables associated with an increased risk of subsequent suicide were an increase in the number of drugs ingested (odds ratio 2.59, 95% CI 1.48-4.51), an increase in the dose ingested (OR 1.33, 95% CI 1.01-1.76), an increase in coma score (OR 1.71, 95% CI 1.11-2.66), a decrease in Glasgow Coma Score (OR 1.21, 95% CI 1.03-1.43) and an increase in drug or alcohol misuse (OR 2.33, 95% CI 1.06-5.10). CONCLUSIONS: Patients who have escalating severity of self-poisoning episodes are at high risk of completed suicide.

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References

2013Diagnostic and Statistical Manual of Mental Disorders 1991Cognitive-Behavioral Treatment of Chronically Parasuicidal Borderline Patients 1985Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation 1999Effectiveness of Partial Hospitalization in the Treatment of Borderline Personality Disorder: A Randomized Controlled Trial 2002Fatal and non-fatal repetition of self-harm 1990Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients 2003Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital 2001A Randomized Controlled Trial of Postcrisis Suicide Prevention

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