Apples to oranges?: A direct comparison between suicide attempters and suicide completers

doi:10.1016/j.jad.2009.10.020

Journal of Affective Disorders

Volume 124, Issues 1–2, July 2010, Pages 90-97

https://doi.org/10.1016/j.jad.2009.10.020 Get rights and content

Abstract

Background

Suicide attempters and completers may represent different but overlapping groups of distressed individuals. Although depression is related to an increased risk of suicide, the presence of depression may not discriminate suicide attempters from completers. The present study compared suicide attempters and suicide completers on symptoms of depression, the presence of suicide-related variables and stressful life events.

Aims

The present study sought to identify the key differences between 50 suicide attempters and 50 completers, all diagnosed with a Major Depressive Disorder at the time of their suicidal act.

Methods

Suicide attempters and family member informants of suicide completers participated in a thorough psychosocial evaluation. To maximize comparisons with completers, suicide attempters were subclassifed based on the lethality of their attempt.

Results

Suicide attempters and completers were similar on most measures of depressive symptoms. However, suicide completers were significantly more likely to use alcohol or drugs prior to their suicidal act and they were more likely to leave a suicide note. Suicide completers were significantly more likely to have encountered significant job stress and financial problems.

Conclusions

The present findings have documented several similarities and differences between suicide attempters and suicide completers. Future research may help to clarify the key warning signs that reflect the risk of completed suicide in adults who have been diagnosed with a Major Depressive Disorder.

Section snippets

Procedures

The research protocol was approved by the University Institutional Review Board. Written informed consent was obtained from all participants. Data was collected using simple random sampling with post-stratification (Zhang, 2000), whereby participants needed to meet three core criteria: (1) adult age, (2) presence of depression, and (3) one of two types of suicidal actions, either a recent suicide attempt or death by suicide. Within these parameters, eligible adults were randomly solicited to

Results

Initial analyses compared 50 suicide attempters to 50 suicide completers on a variety of dependent measures. In order to focus on suicide risk that develops in the context of depression and despair, all attempters and all completers met diagnostic criteria for a Major Depressive Disorder at the time of their suicidal act. However, a significant difference between groups was observed on the lethality of the suicidal act (χ² = 51.39, p < 0.01). Not surprisingly, suicide completers were more likely

Discussion

The present study evaluated 50 depressed adult psychiatric inpatients who had attempted suicide as compared to 50 depressed adults who had died by suicide. Similar to prior research (Michel, 1987), most depressive symptoms did not discriminate between suicide completers and highly lethal attempters. However, the presence and severity of depression can be very relevant to suicidal behavior. Depression usually sets the stage for a possible suicidal crisis. It is quite uncommon for patients to

Limitations of research on suicide completers

It is often assumed that attempters and completers represent the same group of individuals who were assessed at different points along the pathway towards suicide. However, few studies have been able to compare suicide completers with suicide attempters, because few investigators have access to both populations. Research that directly compares completers with attempters becomes complicated by the reliance on different assessment procedures. Completers are not available to answer interview

Role of funding source

Funding for this study was provided by grants from the National Institute of Mental Health (MH67996) and grant P20 RR017701 from the IDeA Program of the National Center for Research Resources. These agencies had no further role in the study design, data collection, data analysis, or writing of the paper.

Conflict of interest

All authors declare that they have no conflict of interest.

Acknowledgements

The present study was supported in part through grant P20 RR017701 from the IDeA Program of the National Center for Research Resources. The authors greatly appreciate the assistance of Lesa Dieter, George Jurjus, and Nicole Peak for assistance with data collection. We are extremely thankful to Matthew Fuller, PharmD of the Cleveland VA Medical Center for his ratings of toxicity of overdoses. The authors also thank the staff at the Cuyahoga County Coroner's Office for their help and cooperation,

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¹: Dr. DeJong is currently affiliated with the VAMC, Battle Creek Michigan.

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Research reportApples to oranges?: A direct comparison between suicide attempters and suicide completers

Abstract

Background

Aims

Methods

Results

Conclusions

Section snippets

Procedures

Results

Discussion

Limitations of research on suicide completers

Role of funding source

Conflict of interest

Acknowledgements

Biol. Psychiatry

J. Affect. Disord.

J. Affect. Disord.

Biol. Psychiatry

Diagnostic and Statistical Manual of Mental Disorders

Suicides and serious suicide attempts: two populations or one?

Psychol. Med.

A case control study of suicide and attempted suicide in older adults

Suicide Life Threat. Behav.

Further suicidal behavior among medically serious suicide attempters

Suicide Life Threat. Behav.

Prevalence and comorbidity of mental disorders in persons making serious suicide attempts: a case-controlled study

Am. J. Psychiatry

Affective disorders and suicide risk: a reexamination

Am. J. Psychiatry

Risk factors for suicide in psychiatric outpatients: a 20-year prospective study

J. Consult. Clin. Psychol.

Clinical correlates of inpatient suicide

J. Clin. Psychiatry

Psychological autopsy studies of suicide: a systematic review

Psychol. Med.

Validity of proxy-based data in suicide research: a study of patients 50 years of age and older who attempted suicide. II. Life events, social support, and suicidal behavior

Acta Psychiatr. Scand.

Validity of proxy-based data in suicide research: a study of patients 50 years of age and older who attempted suicide. I. Psychiatric diagnosis

Acta Psychiatr. Scand.

The prospectively observed course of illness among depressed patients who commit suicide

Acta Psychiatr. Scand.

Clinical predictors of suicide in primary major depressive disorder

J. Clin. Psychiatry

Assessment of depression and suicidal actions: agreement between suicide attempters and informant reports

Suicide Life Threat. Behav.

Risk factors for suicide completion in major depression: a case control study of impulsive–aggressive men

Am. J. Psychiatry

Guide to conducting a psychological autopsy

Professional Psychology: Research and Practice

Time-related predictors of suicide in major affective disorder

Am. J. Psychiatry

Research report
Apples to oranges?: A direct comparison between suicide attempters and suicide completers