Suicide Risk Persists Decades Later

History of Attempts Is a Potent Risk Factor

From the WebMD Archives

Nov. 15, 2002 -- When it comes to the risk of suicide, apparently time doesn't heal all wounds.

British researchers report that the risk of suicide remained nearly constant over 22 years for a group of patients with a history of attempts. In fact, their rate of suicide or subsequent attempts slightly increased since their initial episode.

"I think that patients who have a history of self-harm very often have a very entrenched relationship with death that may not often be immediately apparent," says psychiatrist and lead researcher Gary Jenkins, MD, of East Ham Memorial Hospital in London.

"However, my experience with this group of patients is that if you ask them about their feelings about death, you will usually find that there very often are quite persistent underlying morbid thoughts about death ... even when the patient is not in a state of crisis or breakdown."

Jenkins tracked 140 patients who were brought to his hospital after attempting suicide between 1977 and 1980. Most were women and average age 32 at their initial attempt. Applying the collected information to a larger group, he concludes in the Nov. 16 issue of the British Medical Journal that their rate of suicide and probable suicide was slightly increased over the 22 years of follow-up.

A previous study in the British Medical Journal suggests that the rate of suicide is 100 times higher in the year following an initial attempt. Other studies, tracking patients over a shorter period, suggest a similar repeat-attempt risk as Jenkins' finding.

But based on this study -- among the longest to examine suicide risk patterns -- doctors need to take measures to provide long-term care for these people, he says.

"In assessing a patient who has a history of self-harm, the risk of completed suicide is very high and remains high," Jenkins tells WebMD. "This should alert physicians to the importance of psychiatric referral. Psychiatrists should be reminded that patients with a history of self-harm might benefit from long-term engagement with psychiatric services so that their mental state may be monitored and appropriate action can be taken."


And what can family and friends of a potential victim do?

"Often, people feel that 'now it's over' once the attempter has gotten through whatever crisis they experienced. But if you know for a fact that someone has attempted suicide in the past, you need to be mindful of the things that happen to them now," says John McIntosh, PhD, chairman of the department of psychology at Indiana University and past president of the American Association of Suicidology.

"When they start to show distress, don't assume everything will just blow over. You need to take action more quickly to try to mobilize support for them. This study implies that people who attempt suicide are essentially at that same risk of repeating that behavior for the rest of their lives."

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SOURCES: British Medical Journal, Nov. 16, 2002 • Gary Jenkins, MD, consultant psychiatrist, department of psychiatry, East Ham Memorial Hospital, London • John McIntosh, PhD, chairman, department of psychology, Indiana University
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