Suicide risk continues well past first attempt, doctors warn


A new study in Canada, which tracked over 130,000 people, has revealed that suicide risk remains well past the first suicide attempt and has recommended continued long-term monitoring of individuals who have survived the first attempt.

Suicide prevention efforts have traditionally focused on the time period immediately following the first suicide attempt, but researchers over at The Hospital for Sick Children (SickKids), the Institute for Clinical Evaluative Sciences (ICES) and Sunnybrook Health Sciences Centre have found through their new study that most suicide deaths occur well after the first attempt.

The study, which included more than 65,000 people who survived a self-poisoning episode – both children and adults – is the largest suicide-risk study to date. Researchers tracked every person who presented to an emergency department in Ontario for self-poisoning between April 2002 and December 2010.

The investigators found that the risk of suicide following non-fatal self-poisoning was 42 times higher than in the general population, and that the risk of death from accidents was 10 times higher following self-poisoning. This suggests that the first episode of deliberate self-poisoning is a strong predictor for subsequent suicide and premature death.

“The durable risk of suicide long after the first self-poisoning episode suggests that to save lives we may need ongoing sustained initiatives. Most individuals who eventually died by suicide used more violent methods on subsequent attempts, and only 7 per cent of them reached hospital alive. The hope is that our findings can be used to target this high-risk group and that it may influence suicide-prevention strategies to include long-term follow-up and efforts,” says Dr. Yaron Finkelstein, lead author of the study and Staff Physician in Paediatric Emergency Medicine, and Clinical Pharmacology and Toxicology, and Associate Scientist at SickKids.

In Canada, suicide is the second leading cause of death in individuals aged 15 to 35 years, yet prevention efforts have remained a challenge, because the long-term outcomes following suicide attempts have not been well characterized.

The present study also identified population-level suicide risk factors, which include being male, having engaged in multiple self-poisonings, higher socioeconomic status, a diagnosis of depression and psychiatric care in the year preceding the first self-poisoning episode.

“Previous research has largely focused on short-term studies of patients with known psychiatric conditions in individual health-care centres. However, no one has looked at the entire population including both patients with diagnosed mental health conditions as well as everyone else in the community.

Additionally, this is the first study to focus exclusively on individuals with a first presentation for self-poisoning. More research is required, and our multidisciplinary team is working hard to dig deeper, and is focusing on the vulnerable group of teenagers, as well as subsequent self-harm behaviours,” adds Finkelstein, who is also Associate Professor of Paediatrics, Pharmacology and Toxicology at the University of Toronto.

“It’s surprising how little we know about long-term outcomes after a first self-poisoning episode,” said Dr. David Juurlink, a Senior Scientist at ICES, Head, Division of Clinical Pharmacology and Toxicology, Sunnybrook Health Sciences Centre and the study’s senior author.

“By following a very large group of patients over a long period of time, this study demonstrates that the risk of suicide remains elevated long after a first attempt. The implication of this is that suicide prevention efforts in these patients must also be sustained.”

The study is published in online edition of JAMA Psychiatry.