Psychosocial and psychiatric factors associated with expected fatality during a suicide attempt in young males and females



Cite item

Abstract

Differential factors that influence intention during the non-fatal suicidal act in men and women are not studied enough. In a current study, 433 suicide attempters (age 24.89 + 0.98 years, male/female ratio = 1.29) were interviewed, mostly shortly after the attempt. Suicide attempters were stratified into three groups with growing expected fatality (EF) during suicidal act. It was found that the higher EF was associated with higher suicide intent scores, however, the medical severity of attempts, as well as violent/non-violent attempts distribution did not differ between groups. Men and women inside groups had similar suicide intent scores and medical severity, though men demonstrated a 2.4-3.5 times higher proportion of violent attempts (X70-X84), depending on the group. In men higher EF was associated with lower general well-being, higher depression and violence, hopelessness, and total life stress, in women – only with total life stress. Moreover, in men and women higher EF was associated with different negative life events under age 18. Prevalence of mental health disturbances was equal among men and women, however, in men prevailed addictions, while in women – neurotic and stress-related disorders; among those who expected more fatality the number of people with diagnoses and comorbidity was higher, especially in men. In conclusion, there exist distinct risk factors for EF and higher intent in young men and women attempting suicide, which may not necessarily result in higher medical outcomes but may serve important helping points during post-crisis counseling of young suicide attempters.

Full Text

Introduction

Suicide is a serious public health problem, involving different sex and age groups. In most cultures, men more often complete suicide, while women more often attempt suicide though having a higher depression rate and reporting higher suicidal ideation – a phenomenon known as “gender paradox in suicide”1,2. When discussing possible reasons for this, American epidemiologists Eve Moscicky pointed out that it may be due to 1) men tend to choose more lethal methods; 2) women are more likely to report psychological problems; 3) in men and women differentially curable psychiatric disorders are prevailing (addictions vs depression) and finally; 4) completed suicide is considered a male, while suicide attempt – a female act3. Sex/gender differences in suicidal behavior are discussed from the point of view of different risk factors, including biological (estrogens and androgens), psychosocial and cultural (life stress and gender roles), psychopathological (anxiety, depression, alcohol consumption), and psychiatric (mental health disorders)4-7. A recent meta-analysis of 67 studies has identified that female-specific risk factors for suicide attempts (SA) include eating disorder, posttraumatic stress disorder, bipolar disorder, being a victim of dating violence, depressive symptoms, interpersonal problems, and previous abortion, while male-specific risk factors are disruptive behavior/conduct problems, hopelessness, parental separation/divorce, friend's suicidal behavior, and access to means8. However, the overwhelming majority of studies included in this analysis belong to the USA, Canada, and western European countries, while 4 studies were from China and 1 from Brazil8. Given that cultural peculiarities influence suicidal behavior to a great extent, studies of gender-specific risk factors of a suicide attempt of more diverse populations could contribute to a better understanding of suicide.

Another factor that is also not described enough in the context of sex/gender differences in suicidal behavior is the intention to die and perceived fatality during a suicidal act. According to the most widely used definition, SA is understood as “A potentially self-injurious behavior, associated with at least some intent to die, as a result of the act”9. Thus, intent is considered a very important factor of suicidal behavior. However, intent remains elusive until the patient is evaluated by a skilled psychiatrist or a clinical psychologist, or at least all circumstances of such behavior become transparent. And even after that deep internal motives and wishes of the patient may remain hidden giving way to traditional and culturally acceptable explanations (i.e. women are more prone to manipulative attempts, etc.). The medical severity of the SA is often perceived as a possible predictor of the intention to die. On the other hand, many factors influence medical outcomes, including a personal understanding of the lethal potential of different methods and ambivalence of feelings and motives towards life and death. Moreover, cultural preferences and beliefs influencing the prevalence of methods of self-harm among males and females in the given population, as well as situational availability of means and organizational capacities of an urgent medical aid may have an impact10,11.

There exists uncertainty regarding the role of intent as a factor of suicide attempt. Some studies find a correlation between the intention to die and medical outcomes, while others do not12. For instance, Brown et al. (2004) have found a modest correlation between intent and lethality in 180 low-income middle-aged suicide attempters from an urban area10. However, the higher level of suicide intent was associated with more lethal attempts only for those individuals who had more accurate expectations about the likelihood of dying from their attempts10. In contrast, a Chinese study describes medically severe attempts in patients in rural areas with low intent to die that are associated with impulsivity13. Regarding factors that determine gender paradox in suicide, there are also contradictions – most of the studies confirm that men tend to choose more violent and potentially lethal methods of suicide, however, the role of gender differences in intent in this remains not clear due to mixed results3,12,13,14. While investigating factors that may influence intent authors often include life stress, however differences in specific early negative traumatizing events between men and women are rarely evaluated13. On the other hand, this may give knowledge about the psychological background and the role of early life factors in young men and women attempting suicide.

In a current study, we have planned to assess risk factors of SA in individuals with such differing component of intent as expected fatality (EF) in the hope to understand better what factors may influence intent in young men and women during the suicidal act. We were aiming to evaluate whether higher EF is associated with the higher intention to die and may lead to more severe medical outcomes. We have also hypothesized that risk factors for higher EF may include general life stress and some specific negative life events that happened in the period of personality development, as well as depressive symptoms, hopelessness, anger, and propensity for violence. One of the supposed factors was the psychiatric status of the attempter that was also under study.

Methods and sample characteristics

The current study was generated from the database of the genetics project of suicide attempts known as GISS (https://ki.se/en/nasp/genetic-investigation-of-suicide-attempt-and-suicide-giss). Within this project, Slavonic trio families (a proband, who has attempted suicide and both parents) were recruited in different cities of Ukraine. The study was approved by the Ethical Committee of Karolinska Institute, Stockholm, Sweden, and confirmed by the Ministry of Public Health of Ukraine. Inclusion criteria were 16 years and over, a fact of SA with medical severity according to Medical Damage Scale – 2 scores or over, signing informed consent form by all members of the family.

The study protocol included information regarding last (index) and previous suicide attempt(s), family suicide history, physical health, negative life events, as well as several psychometric tests15. Interviews were performed by a group of trained interviewers, clinical psychologists, and psychiatrists (one of the authors of this paper) either in inpatient wards and resuscitation units before releasing from the hospital or shortly after release, at homes or in a psychologists’ offices. For evaluation of lethality of the attempt, the Medical Damage Scale (MDS) with a rating from 0 (no damage) to 8 (lethal) adjusted to each different method of self-harm was used16,17. For evaluation of the intention to die Beck's Suicide Intention Scale (BSIS) was applied16. All respondents were asked to fill the Negative Life Events (NLE) protocol that consisted of 69 questions selected from the Composite International Diagnostic Interview (CIDI), core version 2.1, section K (post-traumatic stress disorder), and from the European Parasuicide Study Interview Schedule used in the WHO/EURO Multicentre Study on Parasuicide18. The total score of accumulated NLEs (SUMLE) was calculated as a sum of positive answers for each event (what happened, how many times, at what age), corrected by a quotient from 1 to 3 depending on the relevance of the given event as a trigger event for suicide attempt15. The protocol included 20 special questions that assessed personal network NLEs under age 18 (presented in Table 3).

Psychometric tests included WHO-5 Well-Being Index (WHO), Beck Depression Inventory (BDI)19 and 4 questions from Beck Hopelessness Scale20 previously found to be critical for dichotomy evaluation of a person as having hopelessness or not21. Proneness to violence was assessed using the Plutchik Feelings and Acts of Violence Scale (PFAV)22, anger (trait and state) was evaluated by Spielberger State/Trait Anger Scale (STAS)23. Psychiatric diagnoses were evaluated by WHO composite CIDI 2.1 inventory24. All instruments were either used as already existing Russian versions or were translated into Russian by a team of psychologists and psychiatrists proficient in English.

The central instrument of the study was BSIS, which has a long story of application in many clinical studies25. This instrument consists of two parts, which are addressing two broad domains: 1) preparatory measures and 2) subjective feelings and intentions16. First evaluates measures taken by an individual including isolation, timing, precautions against discovery, or inversely, acting in favor of discovery, like communicating before the attempt with a possible rescue and leaving pathways to rescue open, etc. The second part is dedicated to the aims, goals, perceptions, and anticipations during self-harm, which are subjectively proclaimed by respondents, including the alleged purpose of attempt, expectations of fatality and attitudes towards living or dying, etc. Among the BSIS items the question formulated as “What did you think were the chances that you would die as a result of your act?” with answer options: “1 = thought that death was unlikely or did not think about it”; “2 = thought that death was possible but not probable”; and “3 = thought that death was probable or certain”; “4 = other, specify” warrants special attention. This question is directly aimed at evaluating expected fatality (expectation of death) during the suicidal act.

Fig. 1

In a current study 446 probands (age 24.89 + 0.98 years) from consecutively recruited family trios were included, 251 of them were males (56.27%, age 24.80 + 0.76 years) and 195 – females (43.72%, age 25.01 + 1.18 years). From the whole sample, only 6 respondents have chosen an answer “4 = other reason” and have claimed that they were driven by voices that urged them to self-harm; their psychotic state was confirmed by CIDI. Moreover, in 7 respondents’ protocols, this part of the questionnaire was not filled. Therefore, 13 subjects were excluded from the analysis, making the final number 433. Based on the response to the BSIS question “What did you think were the chances that you would die as a result of your act?” group has split into 3 subgroups: those, who responded that “death was unlikely or did not think about it” – 159 people; those, who responded that “death was possible but not probable” – 92 people; and those, who responded that “death was probable or certain” – 182 people. Thus, the distribution between groups was 36.7% : 21.3% : 42.0%. The general male/female ratio in the studied sample was 1.29 while in the subgroups it fluctuated from 1.15 to 1.33, in group 3 higher than in groups 1 and 2 (fig. 1).

The analysis was performed in two steps: 1) focusing on age differences, general BSIS score and sub-scores, medical severity, and violent vs non-violent methods of attempts ratio; and 2) focusing on associations between perceived fatality and psycho-social variables, as well as NLEs experienced by the attempters. This part also included an analysis of the psychiatric status in relation to EF.

Statistical methods included descriptive statistics and post hoc Tukey multiple comparisons analysis. For associations with interval variables, Kendall’s tau-b (τb) coefficient and its p-value were calculated, for alternative variables, the Somers’ D coefficient with asymptotic standard error (ASE) was used, its p-value was calculated using T-test. In necessary situations, the chi-squared test was used. The Statistical Package for the Social Sciences (SPSS) for Windows, version 17.0 was utilized.

.

 Results

Table 1

          As can be seen from Table 1, there was a slight difference between groups in terms of age – those who were imagining that death was probable or certain, tended to be older than those that thought death was unlikely (males – 12.4% older, p < 0.05, females – 4.8% older, insignificant), age of patients in group 2 was in the middle. Another clear tendency is that general, objective, and subjective BSIS scores are growing from Group 1 to Group 3, the difference in most cases is significant between Groups 1-2, 1-3, and 2-3. However, there were no significant differences in BSIS scores between men and women in all three groups. The medical severity of the SA in all three groups did not differ either. To evaluate the proportion of violent vs non-violent methods of self-harm in men and women we have summed all cases of self-intoxication (X60-X69), referred to as non-violent, and all other cases where hanging, strangulation, self-cutting, submersion, falling from high places and under moving transport, as well as using firearms, etc. (X70-X84) referred as violent. As can be seen, the proportion between violent and non-violent differed significantly between males and females: in males, violent methods constituted 60-62%, while in females – 18-25%. However, the distribution of methods was the same in all three groups (Table 1).

Table 2

Further analysis was focused on the psychosocial characteristics of patients in all three groups (Table 2). As can be seen, in males there was a negative association with the subjective well-being (τb = -0.107; p = 0.037), positive association with depression (τb = 0.123; p = 0.015), hopelessness (D = 0.169; p = 0.014) and with violence index (τb = 0.113; p = 0.031). In females, a progression of expected fatality also tended to be associated with hopelessness, but insignificant. On the other hand, there was a strong and significant positive association with total life stress score (SUMLE) both in males and females (table 2). It should be noted that there was no association with the previous SA neither in males nor in females.

Table 3

In men and women, a higher intention to die and higher expected fatality was associated with different NLEs under age 18 (Table 3). In men, there was only one strong and significant association (D = 0.297; p = 0.001) with “being neglected or left alone by caring adult”. In women there were associations with “sexual harassment” (weak, on the edge of significance, D = 0.160; p = 0,065) and “physical attack and assault” (significant, D = 0.183; p = 0.05). Notably, in females there were found two other significant associations – with “hatred to one of the parents” (D = 0.169; p = 0.038) and “failure to achieve an important goal in life” (D = 0.187; p = 0.017).

                    Psychiatric diagnoses in the general sample were registered in 51.8% of cases, in 52.2% among men, and 51.3% among women. At the same time, clear differences in diagnoses distribution between genders were observed. Among men, the most prevalent (33.3% of all cases) were substances abuse disorders (F10-F19). They were followed by almost equal representation (26-27% each) of affective (F30-F39) disorders and neurotic/stress-related/somatoform disorders (F40-F49). Schizophrenia, schizotypal and delusional disorders (F20-F29) in the male sample comprised 12%, while eating disorders (F50) were detected in 1% of cases. In women most prevalent (45.8%) were neurotic and stress-related disorders, followed by affective disorders (34.3%) and addictions (17.9%), while schizophrenia and eating disorders were represented by 1% each.

            In the group of those who believed that “death was unlikely, or did not think about it”, 53.2% of men and 51.1% of women had any diagnosis with comorbidity of 1.81 and 1.68 diagnoses per person, respectively. In the group of those, who “believed that death was probable but unlikely” 46.0% of men and 47.5% of women were diagnosed with any disorder. Comorbidity in this group was 1.69 among men and 2.21 among women. In those who believed that “death was probable or certain” the proportion of diagnoses was higher (65.3% among men and 57.9% among women), with comorbidity of 2.03 in men and 2.20 in women. The differences between groups were studied by chi-squared test. The differences between groups 1 and 2, 1 and 3 were insignificant (p > 0.05); but when comparing groups 2 and 3, the differences were significant in males (p < 0.05).

            Discussion

            We have built the whole study around the question “What did you think were the chances that you would die as a result of your act?”, which is a component of the suicide intent. Intent refers to the desire to end one’s life and includes the person’s knowledge of the risk and the means to achieve the desired outcome26. We have hypothesized that the question that focuses on the probability to die may have a special meaning to a young person. Despite many years of utilization of BSIS, as well as other instruments measuring suicide intent, the possible special role of EF was not addressed. Moreover, studies suggest discrepancies between circumstantial and subjective measures of BSIS and between different questions of the subjective part, for instance, the purpose of the attempt, an expectation of death, desire to live or die, etc25.

          Our study supports the view that all components of BSIS are quite well coordinated. In our sample, we have found rather even distribution of individuals, both males and females, between three groups with growing EF, with a slight predominance in the lowest and highest EF groups. We have observed significant progression in general intent in all three groups, including both preparatory and subjective components. Thus, we have found a high coincidence between expected fatality measured by one question and the whole scale scores. It gives us the possibility to discuss EF and intent as parallel items.

In the group of patients who reported that “death was probable or certain” patients were older, which is consistent with other authors’ findings27. However, despite a growing intention to die, the medical severity of the SA in all three groups did not differ. Thus, our results support studies that find no or very mild correlation between suicide intent measured by BSIS and medical severity of the suicide attempt13,27,28. Inside the groups, we did not find any differences between men and women neither in intent nor in the medical severity of attempts. Therefore, our study is consistent with those that do not find a gender gap in intent during a suicidal act13,14,29. It means that women may have the same intent to die like men, which implies that the choice of the method may be the main factor that affects lethality.

Studies suggest that females survive suicide attempts more often than males because they use less lethal means, and their outcomes are less lethal compared to males even when using the same method30,31. In our sample, the proportion of more violent and potentially lethal methods (all methods except poisonings, including self-cutting, hanging and suffocation, using firearms, smoke vapors and gases, etc., coded X70-X84 according to ICD 10) in men was 1.5-1.7 times higher, than in women. In women, in contrast, non-violent (i.e. self-poisonings with different medicines and other toxic substances) occurred 2.9-4.6 times more often. Interestingly, in men, this distribution was the same in all three groups, while in women the proportion of less violent methods was growing progressively from group 1 to 3 (from 2.93 to 4.62 times). It gives an impression that the more intention is driving women and the higher EF they claim, the more strongly they stick to traditional “female” type of suicide methods.

Notably, when the intent is evaluated not with the psychometric instrument but is classified by a clinical staff based on the nature of the suicide attempt and using the Feuerlein Scale, the relation to gender appears completely different32. The Feuerlein Scale was developed in the 70s last century, it is based on the circumstances and traditional clinical understanding of the suicidal act. As an outcome it describes several categories, in particular: 1) (non-habitual) Deliberate Self-Harm; 2) Parasuicidal Pause (refers to suicidal behavior carried out mainly to escape from an unbearable situation/from problems); 3) Parasuicidal Gesture (refers to an appellative or manipulative suicidal act excluding ideas or threats without any action performed); and 4) Serious Suicide Attempt (refers to suicidal behavior carried out with a clear intent to die). A study has recently demonstrated a significant association of more serious attempts with males, even inside such the most widely used method as poisoning32. Thus, a different understanding of intent (psychometric or based on clinical judgment) leads to conflicting results.

When looking at selected psychosocial variables that may influence intent and EF we identified several differences between men and women. Men appeared to be more influenced by depressive emotions, low general well-being and pessimism (hopelessness). We have previously described the role of hopelessness as a mediating factor between life stress and severe suicide attempt in males33. Here we can see one more confirmation of it. Moreover, the fact that in men we find associations with more factors than in women may partly explain their higher suicide risk, they seem to be influenced by a more diverse set of determinants. Other studies provide evidence that poor well-being is generally associated with higher suicidal intent, depression and hopelessness34 and life stress35. In our sample life stress was strongly associated with intent and EF both in men and women, but associations with other variables men are worth attention. Notably, studies suggest that a greater tendency to not recognize or respond to their own negative emotions or distress in men may result in more chronic and severe emotional responses to adverse life events, which may contribute to higher suicide risk in them36.

In this respect analysis of gender-specific life events that happened to a person until the age of 18 looks particularly important. In our study higher EF in men was strongly associated with separation from parents for a year or more (strong but insignificant) and being neglected or left alone by a caring adult (strong and highly significant). All this makes an impression that parent-child interrelations and lack of parental warmth in childhood are transformed in young males into higher intent during a suicidal crisis, possibly due to emotional problems. In women, the strongest associations were found with quite a different set of events: failure to achieve an important goal, serious physical attack or assault, and hatred to one of the parents (all of the same strength and significant). Sexual harassment was also on the list but suggestive, not reaching significance. The strong association with physical attack or assault and hatred to one of the parents may be collateral to serious problems and conflicts in the family and emotional abuse, which are often found in young suicide attempters37. On the other hand, association with the failure to achieve an important goal points to frustration as a serious risk factor of the higher intent during a suicidal crisis.

As to the psychiatric disorders, our main findings are that more diagnoses and higher comorbidity are inherent to patients from a group with the highest EF and intent. This is consistent with other studies that point out that a higher rate of psychopathologies and diagnosed disorders predicts higher suicide intent27,28,38. It is remarkable that in our sample proportion of patients with diagnoses was the same in men and women, however, only in men with higher EF proportion of those diagnosed with a disorder was significantly higher. Though CIDI 2.1 is assessing a limited number of disorders, however, it helped to reveal major differences between men and women in this respect, pointing out that addictions were more prevalent among men while neurotic and stress-related disorders – in women. This finding also contributes to understanding differential risk factors for higher intent and EF in men and women.

The recent development in understanding the suicidal process (especially of turning from suicidal ideation to actions resulting in a suicide attempt and death by suicide) is associated with interpersonal-psychological theory developed by T. Joiner39. This model proposes that sex differences in suicide are the result of differences in acquired capability for suicide, which is supposed to consist of two components: fearlessness about death and physical pain insensitivity39,40. Higher acquired capability for suicide among men than women makes it more likely that men will kill themselves when suicide is being considered. Thwarted belongingness and perceived burdensomeness are also factors contributing to Joiner’s theory and suicide risk factors for men, while stoicism and sensation-seeking that are inherent to men may be mediating factors40. Our findings open interesting perspectives of further studies in which suicide intent and expected fatality could be included in the set of variables in men and women together with thwarted belongingness and fearlessness about death.

Summing up, we should like to stress that studies of suicide intent concerning the severity of attempts with emphasis on differences between men and women often produce conflicting results. Much depends on how intent is conceptualized and assessed, for instance, psychometric evaluation and clinical assessment by psychiatric staff may not coincide28,32,41. Relations between measured intent, attempts severity and choice of the method in men and women are either fully denied42 or admitted and acknowledged8,10. On the other hand, the intent is an important factor – in longitudinal studies, in a longer perspective, high BSIS scores predict higher overall mortality, suicide attempts, and death by suicide43. All this determines the importance of further research in this field, especially considering novel models of suicide that emerged recently. The gender suicide paradox is also far from resolution and still evokes vivid discussions regarding underlying factors and determinants. One of the perspectives is the evaluation of gender-specific risk factors for suicide attempts and completed suicide. Investigation of suicide intent and risk factors for high intent and expected fatality in men and women in this sense may be helpful, including life stress and specific life events in the early life. This has not only theoretical value but also practical importance so far as such knowledge may provide valuable insights for a consultant or a therapist dealing with a suicidal person.

In conclusion, one question “What did you think were the chances that you would die as a result of your act?” with suggested answers “thought that death was unlikely or did not think about it”; “thought that death was possible but not probable”; and “thought that death was probable or certain” differentiates young suicide attempters into three distinct groups that differ significantly in psychosocial, clinical and psychological characteristics. Evaluation of the objective correlates of the motives and perceptions during a suicide attempt in young men and women may serve a better understanding of the nature of intrapsychic conflict and ambivalent thoughts on the peak of the suicidal crisis. It may also help to provide more efficient psychosocial aid to suicide attempters in clinical settings. Young suicide attempters constitute a substantial part of the patients in emergency rooms, toxicological departments and resuscitation units of the hospitals, some of them being admitted in a medically severe condition while others need a brief medical treatment. However, all they require psychological and social aid before discharge and remain at higher risk of repetition of suicide attempts and further completed suicide. On the other hand, medical personnel may be reluctant to use complicated questionnaires and may be limited in time. In the clinical settings answer to one question “What did you think were the chances that you would die as a result of your actions?” may be helpful in the evaluation of intent, especially if the answer points to a high expected probability of fatal outcome and coincides in men with a psychiatric diagnosis, stress, depression, and hopelessness and in young women with physical assault. It may be also of certain help to ambulance staff, paramedics and police officers, who are first contacts to this contingent, often with a limited understanding of suicidal behavior.

Limitations. Our study evaluates everything retrospectively, after an attempt, and though soon after it, still there may be recall bias, especially taking into consideration the stress of the respondents. The sample may be skewed due to the fact only those suicide attempters were recruited in the study whose parents were available. Therefore, the findings might not be generalizable to all suicide attempters admitted to emergency departments. Second, although we provided periodic training for the interviewers, the evaluations were performed by different residents from several universities and hospitals, which could have affected reliability.

Fig.1 Studied groups – gender distribution. (M : F ratio is multiplied by 100 to adjust scaling)

Differences between studied groups in demography, suicide intent, medical severity (M+SD) and the distribution of violent/non-violent attempts (%%)*

 

 

Group 1

Group 2

Group 3

 

Males/Females (N)

M1 (85)

F1 (74)

M2 (50)

F2 (42)

М3 (104)

F3 (78)

Significance between groups*

Age

22.96+5.77

24.20+7.55

23.88+6.75

25.28+10.07

25.75+6.87

25.34+8.68

M1<M3

BSIS total score

18.08+3.28

17.72+2.87

19.74+3.11

20.08+3.34

23.58+3.14

23.74+3.07

M1<M2<M3; F1<F2<F3

BSIS preparatory

11.22+2.53

11.27+2.35

12.34+2.56

12.53+2.76

13.72+2.66

13.78+2.51

M1<M2<M3; F1<F2<F3

BSIS subjective

6.89+1.83

6.42+1.50

7.40+1.47

7.55+1.50

9.86+1.21

9.95+1.48

M1<M3; F<-F2<F3

MDS

3.21+1.20

3.11+1.03

3.06+1.19

3.41+0.83

3.22+1.22

3.25+1.07

 

Violent/ Non-violent

62.0/38.0

25.4/74.6

60.0/40.0

24.4/75.6

62.4/37.6

17.8/82.2

 

 

*Group 1 - “death was unlikely or did not think about it”; Group 2 - “death was possible but not probable”; Group 3 - “death was probable or certain”. Significant (p <0.05) differences between the means were confirmed by Tukey pairwise comparisons.

Table 2

Associations between the subjective expectations of the fatality of the suicide attempt and psychosocial characteristics of the patients in relation to gender

(Kendal’s τb and Somers’ D coefficients)

 

Males

Females

τb

p

τb

p

WHO general well-being

-0.107*

0.037

-0.078

0.175

Beck Depression Scale

0.123*

0.015

0.091

0.109

Violence (PFAV)

0.113*

0.031

0.062

0.297

Angry temperament

0.007

0.901

0.013

0.825

Angry reactivity

0.003

0.957

-0.005

0.937

Total anger

0.001

0.984

0.014

0.812

Total stress (SUMLE)

0.119*

0.018

0.192*

0.001

 

D

p

D

p

Previous suicide attempt

0.066

0.402

-0.048

0.550

Hopelessness (yes/no)

0.169*

0.014

0.142

0.072

* significant associations (p < 0.05

Тable 3

Negative life events until 18 y.o. associated with the expectation of the fatality during suicide attempt in young men and women

 

Males

Females

Life events until 18 y.o.

D

p

D

p

Being raped

0.143

0.467

0.097

0.354

Sexual harassment

-0.058

0.743

0.160

0.065

Serious physical attack or assault

0.065

0.416

0.183*

0.050

Separation from parents for a year or more

0.215

0.065

-0.043

0.731

Being brought up by others than parents

0.108

0.428

-0.049

0.727

Divorce of the parents

-0.038

0.721

-0.107

0.340

Parents being away from home for a long time

0.225

0.101

0.127

0.242

Taking care for brothers and sisters for a long time

-0.057

0.622

0.191

0.060

Feeling that parents do not love him/her

0.073

0.352

0.138

0.081

Parents having serious financial problems

0.005

0.939

0.008

0.919

Being neglected or left alone by caring adult

0.297*

0.001

0.146

0.111

Parents having serious relationship problems

0.029

0.688

0.087

0.277

Hatred to one of the parents

0.011

0.883

0.169*

0.038

Suffering from physical illness leading to incapacity

-0.018

0.850

-0.142

0.250

Staying at home or in the hospital for a long time

-0.037

0.693

0.093

0.389

Staying in the psychiatric hospital for 3 months or more

-0.095

0.523

0.179

0.278

Failure to achieve an important goal

-0.067

0.349

0.187*

0.017

Being convicted for a criminal offence

0.134

0.213

-0.295

0.210

Been sentenced to jail or other correctional institution

0.120

0.388

-0.347

0.277

Being a victim of a crime

-0.153

0.167

0.139

0.187

* significant associations, Somers’ D coefficient

 

×

About the authors

Всеволод Анатольевич Розанов

Saint-Petersburg State University;
V.M.Bekhterev National Research Center for Psychiatry and Neurology

Author for correspondence.
Email: vsevolod.rozanov.53@gmail.com
ORCID iD: 0000-0002-9641-7120
Russian Federation

References

  1. Canetto SS, Sakinofsky I. The gender paradox in suicide. Suicide and Life Threatening Behavior. 1998;28:1-23.
  2. Murphy GE. Why women are less likely than men to commit suicide. Compr Psychiatry. 1998; 39 (4): 165-175. https://doi.org/10.1016/S0010-440X(98)90057-8
  3. Moscicki EK. Gender differences in completed and attempted suicides. Annals of Epidemiology. 1994; 4: 152-158. https://doi.org/10.1016/1047-2797(94)90062-0
  4. Beautrais AL. Gender issues in youth suicidal behaviour. Emergency Medicine (Fremantle). 2002; 14: 35-42.
  5. Kaess M, Parzer P, Haffner J, et al. Explaining gender differences in non-fatal suicidal behaviour among adolescents: a population-based study. BMC Public Health. 2011;11:597. https://doi. org/10.1186/1471-2458-11-597
  6. Mergl R, Koburger N, Heinrichs K, et al. What are reasons for the large gender differences in the lethality of suicidal acts? An epidemiological analysis in four European countries. PLoS One. 2015; 10(7): e0129062. https://doi.org/10.1371/journal.pone.0129062
  7. Rozanov VA. On the gender paradox in suicidology – a contemporary context. Suicidology. 2021; 12 (1): 80-108. https://doi.org/10.32878/suiciderus.20-12-01(42)-80-108 (In Russ/Engl)
  8. Miranda-Mendizabal A, Castellví P, Parés-Badell O, et al. Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies. Int J Public Health. 2019; 64: 265–283. https://doi.org/10.1007/s00038-018-1196-1
  9. Posner K, Oquendo MA, Gould M, Stanley B, Davies M. Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants. Am J Psychiatry. 2007;164(7):1035-1043. https://doi.org/10.1176/ajp.2007.164.7.1035
  10. Brown GK, Henriques GR, Sosdjan D, Beck A. Suicide intent and accurate expectations of lethality: Predictors of medical lethality of suicide attempts. Journal of Consulting and Clinical Psychology. 2004; 72: 1170–1174. https://doi.org/10.1037/0022-006X.72.6.1170
  11. Sapyta J, Goldston DB, Erkanli A, et al. Evaluating the predictive validity of suicidal intent and medical lethality in youth. Journal of Consulting and Clinical Psychology. 2012; 80: 222-231. https://doi.org/10.1037/a0026870.
  12. Levi-Belz Y, Beautrais A. Serious suicide attempts. Crisis. 2016; 37: 299-309. https://doi.org/10.1027/0227-5910/a000386
  13. Sun L, Zhang J, Lamis DA. Features for medically serious suicide attempters who do not have a strong intent to die: a cross-sectional study in rural China. BMJ Open. 2018; 8:e023991. 10.1136/bmjopen-2018-023991' target='_blank'>https://doi.org/doi: 10.1136/bmjopen-2018-023991
  14. Strosahl K, Chiles JA, Linehan M. Prediction of suicide intent in hospitalized parasuicides: Reasons for living, hopelessness, and depression. Compr Psychiatry. 1992;33:366–373. https://doi.org/10.1016/0010-440x(92)90057-w
  15. Wasserman D, Geijer T, Rozanov V, Wasserman J. Suicide attempt and basic mechanisms in neural conduction: Relationships to the SCN8A and VAMP4 genes. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics. 2005; 133B: 116-119. https://doi.org/10.1002/ajmg.b.30128
  16. Beck AT, Beck R, Kovacs M. Classification of suicidal behaviors: I. Quantifying intent and medical lethality. American Journal of Psychiatry. 1975; 132: 285-287.
  17. Smith K, Conroy RW, Ehler BD. Lethality of suicide attempt rating scale. Suicide and Life Threatening Behavior. 1984; 14: 215-242.
  18. Bille-Brahe U, Kerkhof A, De Leo D, Schmidtke A, Crepet P, Lönnqvist J, A repetition-prediction study of European parasuicide populations: a summary of the first report from Part II of the WHO/EURO Multicentre Study on Parasuicide in co-operation with the EC Concerted Action on Attempted Suicide. Acta Psychiatrica Scandinavica. 1997; 95: 81–86. https://doi.org/10.1111/j.1600-0447.1997.tb00378.x
  19. Storch EA, Roberti JW, Roth DA. Factor structure, concurrent validity, and internal consistency of the Beck Depression Inventory-Second Edition in a sample of college students. Depression and anxiety. 2004; 19: 187–189.
  20. Beck AT, Weisman A, Lester D, Trexler L. The measurements of pessimism. The Hopelessness Scale. Journal of Consulting and Clinical Psychology. 1974; 41: 861-865.
  21. Aish A-M, Wasserman D. Does Beck’s Hopelessness Scale really measure several components? Psychological Medicine. 2001; 31: 367-372.
  22. Plutchik R, van Praag HM. A self-report measure of violence risk, II. Comprehensive Psychiatry. 1990; 31: 450-456.
  23. Spielberger CD, Jacobs G, Russel S, Crane RS. (1983). Assessment of Anger: The State-Trait Anger Scale. In: Butcher JN, Spielberger CD, Eds. Advances in Personality Assessment. Lawrence Erlbaum Associates Inc; 1983: 159-187.
  24. Kessler RC, Üstun TB. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research. 2004; 13: 93-121. https://doi.org/10.1002/mpr.168
  25. Freedenthal S. Assessing the wish to die: A 30-year review of the suicide intent scale. Archives of Suicide Research. 2008; 12: 277–298. https://doi.org/10.1080/13811110802324698
  26. Silverman MM, Berman AL, Sandal ND, O’Carroll PW, Joiner TE. Rebuilding the Tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors Part I: Background, rationale. Suicide and Life-Threatening Behavior, 2007; 37: 245–247. https://doi.org/10.1521/suli.2007.37.3.264
  27. Woo S, Lee SW, Lee K, et al. Characteristics of high-intent suicide attempters admitted to emergency departments. J Korean Med Sci. 2018; 33(41):e259. https://doi.org/10.3346/jkms.2018.33.e259
  28. Hausmann-Stabile, Kuhlberg CJA Zayas LH, Nolle AP, Cintron SL. Means, intent, lethality, behaviors, and psychiatric diagnosis in Latina adolescent suicide attempters. Professional Psychology: Research and Practice. 2012; 43.3: 241–248.
  29. Denning D, King D, Cox C. Method choice, intent, and gender in completed suicide. Suicide Life-Threat Behav. 2000;30:282–288.
  30. Cibis A, Mergl R, Bramesfeld A, Althaus D, Niklewski G, Schmidtke A, et al. Preference of lethal methods is not the only cause for higher suicide rates in males. J Affect Disord. 2012;136:9–6.
  31. Värnik A, Kõlves K, Feltz-Cornelis CM, Marusic A, Oskarsson H, Palmer A, et al. Suicide methods in Europe: a gender-specific analysis of countries participating in the “European Alliance Against Depression”. J Epidemiol Community Health. 2008;62:545–51.
  32. Freeman A, Mergl R, Kohls E, Székely A, Gusmao G, Arensman E, et al. A cross-national study on gender differences in suicide intent. BMC Psychiatry, 2017; 17: 234. https://doi.org/10.1186/s12888-017-1398-8.
  33. Mid’ko AА, Biron BV, Rozanov VA. [Suicidal behavior in males: clarification of the role of hopelessness and depression using structural modeling. Part I. Influence of hopelessness on the risk of medically severe suicide attempts]. Suicidology. 2013; 4: 17-26 [Article in Russian].
  34. Sisask M, Värnik A, Kõlves K, Konstabel K, Wasserman D. Subjective psychological well-being (WHO-5) in assessment of the severity of suicide attempt. Nordic Journal of Psychiatry. 2008; 62: 431-5. https://doi.org/10.1080/08039480801959273
  35. Liu TL, Miller I. Life events and suicidal ideation and behavior: A systematic review. Clinical Psychology Review, 2014; 34: 181–192. http://dx.doi.org/10.1016/j.cpr.2014.01.006
  36. Beaton S, Forster P. Insights into men’s suicide. InPsych. The bulletin of The Australian Psychological Society Limited. 2012: 16-19.
  37. Miller AB, Esposito-Smythers C, Weismoore JT, Renshaw KD. The relation between child maltreatment and adolescent suicidal behavior: A systematic review and critical examination of the literature. Clinical Child and Family Psychology Review. 2013; 16: 146–172. https://doi.org/10.1007/s10567-013-0131-5
  38. Kumar CT, Mohan R, Ranjith G, Chandrasekaran R. Characteristics of high intent suicide attempters admitted to a general hospital. Journal of Affective Disorders. 2006; 91: 77-81. https://doi.org/10.1016/j.jad.2005.12.028
  39. Joiner T: Why people die by suicide. Cambridge, Harvard University Press, 2005.
  40. Witte T, Gordon K, Smith P, Orden K. Stoicism and Sensation Seeking: Male Vulnerabilities for the Acquired Capability for Suicide. Journal of Research in Personality. 2012. 46. 384-392. https://doi.org/10.1016/j.jrp.2012.03.004.
  41. Choo CC, Harris KM, Chew PKH, Ho RC Clinical assessment of suicide risk and suicide attempters’ self-reported suicide intent: A cross sectional study. PLoS ONE. 2019; 14(7): e0217613. https://doi.org/10.1371/journal.pone.0217613
  42. Nordentoft M, Branner J. Gender differences in suicidal intent and choice of method among suicide attempters. Crisis. 2008; 29(4): 209–212. https://doi.org/10.1027/0227-5910.29.4.209
  43. Suominen K, Isometsä E, Ostamo A, Lönnqvist J. Level of suicidal intent predicts overall mortality and suicide after attempted suicide: a 12-year follow-up study. BMC Psychiatry. 2004; 4:11. https://doi.org/10.1186/1471-244X-4-11

Supplementary files

There are no supplementary files to display.


Copyright (c) Розанов В.А., Kanevskyi V.I., Biron B.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies