Leo Sher, M.D.

Our research paper, “Depressed multiple-suicide attempters – A high-risk phenotype” has recently been published in Crisis – The Journal of Crisis Intervention and Suicide Prevention (1).

We compared the demographic and clinical characteristics of three patient groups: depressed patients without a history of suicide attempts (non-attempters), depressed patients with a history of one to three suicide attempts (attempters), and depressed patients with a history of four or more suicide attempts (multiple attempters). A lifetime history of all suicide attempts, including number of attempts and the method of the attempt, was recorded on the Columbia Suicide History Form.

We observed that attempters and multiple attempters had higher levels of depression, hopelessness, aggression, hostility, and impulsivity and were more likely to have borderline personality disorder and family history of major depression or alcohol use disorder compared with non-attempters, but did not differ between each other on these measures. Multiple attempters had greater suicidal ideation at study entry and were more likely to have family history of suicide attempt compared with attempters. We have also found that multiple attempters had greater suicide intent at the time of the most medically serious suicide attempt and more serious medical consequences during their most medically serious suicide attempt in comparison with attempters.

Our study indicates that depressed patients with a history of four or more suicide attempts display features that suggest a higher risk of completing suicide compared with depressed patients with a history of three or fewer suicide attempts or with nonattempters. The fact that that most attempters do not later die by suicide should not distract psychiatrists and other medical professionals from a considerable increase in risk associated with a suicide attempt, and, especially, with multiple suicide attempts. Mental and non-mental health professionals should not be misled by the adage, “those who try rarely die.”

Reference

1. Sher L., Grunebaum M.F., Burke A.K., Chaudhury S., Mann J.J., Oquendo M.A. Depressed multiple suicide attempters: a high risk phenotype. Crisis – The Journal of Crisis Intervention and Suicide Prevention, 2017, Vol. 38, No. 6, pp. 367-375.