Masahito Fushimi, M.D., Ph.D.

A history of previous suicide attempts serves as a significant risk factor associated with suicide victims. In other words, suicide attempters have a high probability of completing suicide in the future (i.e., high-risk group for future suicide victims). In fact, one of the important suicide prevention measures is to provide care to suicide attempters and prevent them from contemplating suicide again. A comparison of the two groups—completed suicide and attempted suicide—has revealed clear differences.

For example, according to our previous reports, in the completed suicide group, the number of male completers exceeded that of female completers; the number of middle-aged or elderly completers was high; and the majority of completed suicide cases involved hanging, which was the most common method of suicide. The converse was true for the attempted suicide group (drug overdose and cutting were common methods of suicide in this group). Additionally, in the completed suicide group of our study, only 16.2% of the completers had a history of suicide attempts; the remaining 83.8% had no such history (excluding the cases where information regarding suicide history was not available). Therefore, we can say that providing care only to those subjects who have attempted suicide is not sufficient for reducing the number of completed suicides, as findings indicate clear differences between the characteristics of suicide completes and attempters. Although preventive measures for suicide attempters (i.e., high-risk approach) are important, we can say that it is equally important to implement such measures for the general population as well (i.e., population approach).

Another point to be considered is that there is a substantial difference in the number of people belonging to the completed suicide and attempted suicide group. While the exact extent of the difference cannot be determined, the number of suicide attempters is estimated to be significantly larger than that of suicide completers. Only a small percentage of suicide attempters actually complete suicide. Therefore, the characteristics of suicide attempters, who outnumber the suicide completers, should be understood and studied in detail. This will help ascertain the consequences of suicide attempters. Although the attempted suicide group can in itself be called a high-risk group, it is necessary that the group be classified by the levels of risk of future completion, with the higher-risk group being extracted from the total number of suicide attempters.

The question of whether suicide completers and attempters have essentially different natures (i.e., only a different final result for the same nature of planning behavior for suicide) remains to be resolved. To address this problem, the following two points can be said to be important.

• It is not enough to implement only high-risk strategies; population strategies are equally important and essential for suicide prevention.
• From the attempted suicide group, which is significantly larger than the completed group, those subjects that have a higher probability of future suicide completion (i.e. “the higher risk group” of “the high-risk group”) should be appropriately extracted.

Related articles

1. Fushimi M, Sugawara J, Shimizu T. Suicide patterns and characteristics in Akita, Japan. Psychiatry and Clinical Neurosciences 2005; 59: 296-302.
2. Fushimi M, Sugawara J, Saito S. Comparison of completed and attempted suicide in Akita, Japan. Psychiatry and Clinical Neurosciences 2006; 60: 289-295.
3. Fushimi M, Sugawara J, Shimizu T. Suicide in Akita Prefecture, Japan. International Psychiatry 2006; 3: 3.
4. Fushimi M: Suicide Trends and Prevention in Akita Prefecture, Japan. Quarterly Journal of Mental Health 2007; 1:51-55.