Suicide attempters’ reaction to survival as a risk factor for eventual suicide.

OBJECTIVE: The authorsÕ goal was to evaluate whether suicide attemptersÕ reaction to surviving their attempt predicted eventual suicide. METHOD: Three hundred ninety-three suicide attempters were categorized on the basis of their reaction to having survived their attempt (i.e., glad to be alive, ambivalent, wished they were dead) and were followed for 5 to 10 years to determine whether they completed suicide. RESULTS: A survival analysis found that subjects who said that they wished they had died after a suicide attempt were 2.5 times more likely to commit suicide eventually than those who were glad they survived and those who were ambivalent about the attempt. CONCLUSIONS: Suicide attemptersÕ reaction to surviving is an important clinical variable that is easily assessed in evaluations that occur following a suicide attempt. The identification of patients who are most likely to kill themselves following a suicide attempt presents a serious challenge to clinicians (1). To examine risk factors for eventual suicide, a prospective study that involved 499 suicide attempters who were recruited from a large public hospital was conducted between 1970 and 1975 (2). Beck and Steer (3) examined 413 of these attempters, 20 (4.8%) of whom committed suicide during the follow-up period. Of several clinical and demographic variables considered (i.e., age, gender, race, marital status, employment status, presence of a depressive diagnosis, presence of a schizophrenia diagnosis, history of drug abuse, presence of an alcoholism diagnosis, previous suicide attempt, Beck Depression Inventory 4 score, Beck Hopelessness Scale 5 score, and Suicide Intent Scale 6 score), only a diagnosis of alcoholism, unemployment, and score on the precautions subscale of the Suicide Intent Scale accounted for significant variance in predicting eventual suicide. It was surprising that hopelessness did not predict eventual suicide because Beck et al. (7) found that hopelessness was one of the most robust predictors of suicide in hospitalized patients with suicidal ideation. Beck and Steer (3) noted that hopelessness was assessed after the attempt rather than before and that “its predictive validity may be obscured by the psychological aftermath of the attempt” (p. 208). This interpretation suggests that characteristics of the aftermath of a suicide attempt might have relevance in predicting ultimate suicide. Beautrais (1) found that reactions to the attempt (e.g., hoping to die before making the attempt, failing to be relieved by survival) contributed modestly in predicting eventual suicide in 302 suicide attempters. The purpose of the current study was to reanalyze the suicide attempters studied by Beck and Steer (3) to determine if their reaction to surviving the suicide attempt predicted eventual suicide. We hypothesized that individuals who wished they were dead following the suicide attempt would be at greater risk for killing themselves than those who were glad to be alive or ambivalent.

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