Largest-Ever Suicide-risk Study Identifies New Prevention Opportunity
Photo by Ben Harvey.
Researchers at the University of Toronto, The Hospital for Sick Children (SickKids), the Institute for Clinical Evaluative Sciences (ICES) and Sunnybrook Health Sciences Centre have conducted the largest suicide-risk study to date based on more than 65,000 people who survived a self-poisoning episode, including both adults and children.
The study is published in the April 1 online edition of JAMA Psychiatry.
Researchers tracked every person who presented to an emergency department in Ontario for self-poisoning between April 2002 and December 2010. They found that the risk of suicide following non-fatal self-poisoning was 42 times higher than in the general population, and that the risk of death from accidents was 10 times higher following self-poisoning. This suggests that the first episode of deliberate self-poisoning is a strong predictor for subsequent suicide and premature death.
“The durable risk of suicide long after the first self-poisoning episode suggests that to save lives we may need ongoing sustained initiatives. Most individuals who eventually died by suicide used more violent methods on subsequent attempts, and only 7 per cent of them reached hospital alive. The hope is that our findings can be used to target this high-risk group and that it may influence suicide-prevention strategies to include long-term follow-up and efforts,” says Dr. Yaron Finkelstein, lead author of the study. He is an Associate Professor of Paediatrics, Pharmacology and Toxicology at U of T and Staff Physician in Paediatric Emergency Medicine, and Clinical Pharmacology and Toxicology, and Associate Scientist at SickKids.
In Canada, suicide is the second leading cause of death in individuals aged 15 to 35 years, yet prevention efforts have remained a challenge, because the long-term outcomes following suicide attempts have not been well characterized. The present study also identified population-level suicide risk factors, which include being male, having engaged in multiple self-poisonings, higher socioeconomic status, a diagnosis of depression and psychiatric care in the year preceding the first self-poisoning episode.
“Previous research has largely focused on short-term studies of patients with known psychiatric conditions in individual health-care centres. However, no one has looked at the entire population including both patients with diagnosed mental health conditions as well as everyone else in the community. Additionally, this is the first study to focus exclusively on individuals with a first presentation for self-poisoning. More research is required, and our multidisciplinary team is working hard to dig deeper, and is focusing on the vulnerable group of teenagers, as well as subsequent self-harm behaviours,” adds Finkelstein.
“It’s surprising how little we know about long-term outcomes after a first self-poisoning episode,” said Dr. David Juurlink, a Professor of Medicine, Pediatrics, and Health Policy, Management, and Evaluation at U of T, Senior Scientist at ICES, and Head, Division of Clinical Pharmacology and Toxicology, Sunnybrook Health Sciences Centre. “By following a very large group of patients over a long period of time, this study demonstrates that the risk of suicide remains elevated long after a first attempt. The implication of this is that suicide prevention efforts in these patients must also be sustained.” Juurlink was the study’s senior author.
