Risk factors of suicide mortality among multiple attempters: A national registry study in Taiwan

I-Ming Chen; Shih-Cheng Liao; Ming-Been Lee; Chia-Yi Wu; Po-Hsien Lin; Wei J Chen

doi:10.1016/j.jfma.2015.07.009

Risk factors of suicide mortality among multiple attempters: A national registry study in Taiwan

J Formos Med Assoc. 2016 May;115(5):364-71. doi: 10.1016/j.jfma.2015.07.009. Epub 2015 Aug 13.

Authors

I-Ming Chen¹, Shih-Cheng Liao², Ming-Been Lee³, Chia-Yi Wu⁴, Po-Hsien Lin⁵, Wei J Chen⁶

Affiliations

¹ Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
² Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
³ Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Department of Psychiatry, National Taiwan University College of Medicine, Taipei, Taiwan; National Suicide Prevention Centre, Taipei, Taiwan. Electronic address: mingbeen@ntu.edu.tw.
⁴ School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan.
⁵ Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
⁶ Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.

PMID: 26279174
DOI: 10.1016/j.jfma.2015.07.009

Abstract

Background/purpose: Little is known about the risk factors of suicide mortality among multiple attempters. This study aims to investigate the predictors of suicidal mortality in a prospective cohort of attempters in Taiwan, focusing on the time interval and suicide method change between the last two nonfatal attempts.

Methods: The representative data retrieved from the National Suicide Surveillance System (NSSS) was linked with National Mortality Database to identify the causes of death in multiple attempters during 2006-2008. Cox-proportional hazard models were applied to calculate the hazard ratios for the predictors of suicide.

Results: Among the 55,560 attempters, 6485 (11.7%) had survived attempts ranging from one to 11 times; 861 (1.5%) eventually died by suicide. Multiple attempters were characterized by female (OR = 1.56, p < 0.0001), nonrecipient of national aftercare service (OR = 1.62, p < 0.0001), and current contact with mental health services (OR = 3.17, p < 0.0001). Most multiple attempters who survived from hanging (68.1%) and gas poisoning (61.9%) chose the same method in the following fatal episode. Predictors of suicidal death were identified as male, older age (≥ 45 years), shorter interval and not maintaining methods of low lethality in the last two nonfatal attempts. Receipt of nationwide aftercare was associated with lower risk of suicide but the effect was insignificant.

Conclusion: The time interval of the last two nonfatal attempts and alteration in the lethality of suicide method were significant factors for completed suicide. Risk assessment involving these two factors may be necessary for multiple attempters in different clinical settings. Effective strategies for suicide prevention emphasizing this high risk population should be developed in the future.

Keywords: case registry; multiple attempters; population-based study; risk factor; suicide method.

MeSH terms

Adult
Aged
Cause of Death
Female
Humans
Male
Mental Disorders / epidemiology*
Middle Aged
Mortality*
Proportional Hazards Models
Prospective Studies
Registries
Risk Assessment
Risk Factors
Suicide / statistics & numerical data*
Suicide, Attempted / statistics & numerical data*
Taiwan