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Paradox at Heart of Suicide Attempts
The most lethal suicide attempts tend to be most premeditated, Spanish researchers have confirmed in the first such clinical investigation. The discovery poses the question of how these two aspects of suicide are related biologically and how they relate to impulsiveness as a personality trait, the team writes in The Journal of Clinical Psychiatry. Almost 480 people who attempted suicide between 1996 and 1998 and were admitted to a general hospital in Madrid were included in the study. The severity of each attempt was scored from 1 to 4 based on the treatment chosen by the clinician treating the patient. Thus, 1 represented discharge from the emergency room without psychiatric treatment, 2 indicated psychiatric treatment recommended after discharge from the emergency room, 3 correlated to psychiatric admission, and 4 indicated medical admission, including to the intensive care unit.
The impulsiveness of the suicide attempt was assessed by combining two items from the Suicidal Intent Scale, namely 'active preparation for attempt' and 'degree of premeditation'. This allowed attempts to be classified as impulsive, intermediate, or nonimpulsive.
In all, 55% of attempts were rated as impulsive, 28% as intermediate, and the remainder nonimpulsive. The severity of attempts were more evenly spread, with 20% scored as 1, 35% rated 2, 39% classified as 3, and 6% rated 4.
Analysis of the data revealed that there was an inverse relationship between impulsive nature of the suicide attempt and its lethality, with the most impulsive attempts likely to result in less morbidity, and vice versa.
The authors, led by Enrique Baca-Garcia, from the University of Alcala, Madrid, conclude: 'New biological studies during the acute phase following suicide attempts will need to focus on the complex interactions between the clinical dimensions (lethality, impulsivity as a state, and impulsivity as a personality trait) and the biological correlates (particularly serotonergic function) of suicide behaviour.
'New clinical studies trying to resolve the paradox will need to examine the complex relationship between impulsivity as a trait and impulsivity as a state and learn how each is impacted by psychopathology, substance intoxication, and other environmental influences.'
They add: 'The difference between impulsivity as a trait and impulsivity as a state may prove to be at the heart of the perceived paradox.'
J Clin Psychiatry 2001; 61: 560-564
http://www.psychiatrymatters.md/
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