Suicide Attempters - Drug Overdose Patterns and Ratings of Suicidality

Abstract: A decline of suicide rate can be accomplished by different psychiatric interventions. Early identification of individuals at risk for future suicide is especially important. Results from rating scales could add detailed information, which in turn might strengthen a psychiatric suicid risk assessment. This thesis deals with emergency evaluations and psychiatric inpatient evaluations after a suicide attempt. Intoxications with non-fatal or fatal outcome were examined. Two drugs, the analgesic dextropropoxyphene and the antidepressant amitriptyline were measured in suicides more often than expected from prescription-surveys. The Suicidal Intent Scale (SIS) assesses preparations and aims and thus severity of the suicide attempt. A high SIS score combined with age above 55 years could be regarded as useful risk factors in the clinical evaluation of future suicide risk. Suicide attempters referred to psychiatric hospitalization were rated according to the Beck Hopelessness Scale (BHS) and the Suicide Assessment Scale (SUAS), which both measure different aspects of suicidality. Eventual suicides were recorded at least 12 months later. The validity of the BHS turned out not to be as good as in other studies, and our findings showed that high BHS scores are rather related to depression than to suicide risk. The SUAS has a broad set of items, which evaluate different aspects of the suicidal process. Its ability to predict suicide within one year after a suicide attempt was good. High SUAS-scores were also well associated with a combination of a biological marker of stress - postdexamethasone non-suppression of cortisol, and CSF-5-hydroxyindoleacetic acid - an often discussed marker of suicide risk. The first conclusion is that the prescription pattern in Sweden regarding dextropropoxyphene must be changed. The second is that the SIS and the SUAS are useful tools for suicide risk assessment, and especially together with already known risk factors such as high age and a diagnosis of depression.