History of multiple suicide attempts as a behavioral marker of severe psychopathology

Am J Psychiatry. 2004 Mar;161(3):437-43. doi: 10.1176/appi.ajp.161.3.437.


Objective: Individuals with a differing number of past suicide attempts are generally considered a homogeneous group, despite emerging evidence to the contrary. The current study aimed to test the hypothesis that multiple suicide attempters would exhibit a more severe clinical profile than single suicide attempters.

Method: A series of self-report batteries and clinical interviews was administered to 39 single attempters and 114 multiple attempters who came to an urban hospital emergency room after a suicide attempt. The participants were predominantly poor and nonwhite.

Results: Multiple suicide attempters versus single attempters exhibited a greater degree of deleterious background characteristics (e.g., a history of childhood emotional abuse, a history of family suicide), increased psychopathology (e.g., depression, substance abuse), higher levels of suicidality (e.g., ideation), and poorer interpersonal functioning. Profile differences existed even after control for borderline personality disorder.

Conclusions: Results indicate that multiple attempters display more severe psychopathology, suicidality, and interpersonal difficulties and are more likely to have histories of deleterious background characteristics than single attempters. Moreover, these differences cannot be explained by the diagnosis of borderline personality disorder. Results suggest that the identification of attempt status is a simple, yet powerful, means of gauging levels of risk and psychopathology.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • African Continental Ancestry Group / psychology*
  • African Continental Ancestry Group / statistics & numerical data
  • Borderline Personality Disorder / epidemiology
  • Borderline Personality Disorder / psychology
  • Borderline Personality Disorder / therapy
  • Child
  • Child Abuse / psychology
  • Child Abuse / statistics & numerical data
  • Child Abuse / therapy
  • Child of Impaired Parents / psychology
  • Cognitive Behavioral Therapy
  • Comorbidity
  • Depressive Disorder / epidemiology
  • Depressive Disorder / psychology
  • Depressive Disorder / therapy
  • Emergency Service, Hospital
  • European Continental Ancestry Group / psychology
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Humans
  • Interpersonal Relations
  • Male
  • Mental Disorders / diagnosis
  • Mental Disorders / epidemiology*
  • Mental Disorders / psychology
  • Middle Aged
  • Personality Assessment
  • Personality Inventory
  • Poverty / psychology
  • Poverty / statistics & numerical data
  • Psychopathology
  • Recurrence
  • Risk Factors
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / psychology
  • Suicide, Attempted / prevention & control
  • Suicide, Attempted / psychology*
  • Suicide, Attempted / statistics & numerical data
  • Treatment Outcome