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Long-term risk factors for suicide in suicide attempters examined at a medical emergency in patient unit: results from a 32-year follow-up study
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  • Published on:
    RE: Long term risk factors for suicide in suicide attempters examined at a medical emergency in patient unit: results from a 32 year follow up study

    Anischka Devilas, Nursing Student at the University of The Bahamas
    Dear Editor,
    It is quite insightful that Probert-Lindstrom et al. (2020) conducted this 21-32-year follow-up study despite the uncertainty whether the manipulation of such variables would alter the overall course of the research. The purpose which was meant to evaluate the differences in risk factors for suicide attempts less than 5 years compared to more than 5 years was evident throughout. However, it is unclear if this purpose is the original aim that prompted the commencement of the original research in 1987- 1998. The article was both informative and brought awareness in correlation to mental illness and suicide. This is something the authors depicted well without bias considering the implication of other variables. Brown et al. (2000) leading risk factors were also linked to mental disorders despite not comparing time.
    Moreover, the authors stressed that the risk factors of suicide beyond the suicide index such as 20 years are not typically assessed in other prospective studies. This insinuates that perhaps extensive research must be conducted so the evaluation of long-term risk can be better understood to provide substantial data required for diagnosing purposes. Although risk factors less than five years and more than five years pose corresponding risk for possible suicide, what is the distinct correlation of risk factors beyond 20 plus years that is problematic?


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    Conflict of Interest:
    None declared.
  • Published on:

    Dear Professor Kawada,

    Thank you for your response and interest in our study!

    You refer to the studies by Tidemalm et al (1) and Beckman et al (2), both very interesting and important studies who comment on risk factors for suicide in the long term.

    Tidemalm et al. (1) investigate suicide risk in suicide attempters with a specific focus on psychiatric disorders. We refer repeatedly to this study and make similar findings in regard to diagnoses, though our scope of investigated risk factors was wider. Further, the diagnoses in Tidemalm et al:s study was assessed in psychiatric in-patient care, while in ours at a medical emergency unit. Their finding that health care efforts are of high importance in the first two years following the suicide attempt is in line with our finding that a large portion (53%) of individuals died within the first five years, though we did not analyse risk factors after two years specifically.

    Beckman et al. (2) make important conclusions of the long-term risk of suicide, though they investigate a somewhat different type of sample; self-harming young people (i.e. not specifically suicide attempters) admitted to in-patient care. We did not investigate self-harm defined more broadly and it is beyond the scope of our study to comment on the risk factors for suicide associated with this.

    Thank you once again for your comments!

    Kind regards,

    Sara Probert-Lindström, Jonas Berge, Åsa Westrin, Agneta Öjeha...

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    Conflict of Interest:
    None declared.
  • Published on:
    Risk factors for suicide in suicide attempters and follow-up period

    Probert-Lindström et al. conducted a long-term prospective study to investigate the clinical risk factors of suicide among suicide attempters with special reference to follow-up period (1). Suicide and all-cause mortality were used as dependent variables. A diagnosis of psychosis at baseline represented the risk factor with the highest hazard ratio at >5 years of follow-up, followed by major depression and a history of suicide attempt. In addition, the severity of a suicide attempt showed a non-proportional association with the risk for suicide, and it was a relevant risk factor for suicide only within the first 5 years after an attempted suicide. The authors clarified that risk factors of suicide among suicide attempters differed according to the follow-up period, and I have two concerns about their study.

    Tidemalm et al. conducted a follow-up study for 21-31 years to investigate the effect of coexistent psychiatric morbidity on risk of suicide after a suicide attempt (2). The adjusted HRs (95% CIs) of schizophrenia for completed suicide were 4.1 (3.5-4.8) in men and 3.5 (2.8-4.4) in women. In addition, the adjusted HRs (95% CIs) of bipolar/unipolar disorder for completed suicide were 3.5 (3.0-4.2) in men and 2.5 (2.1-3.0) in women. The increased risks for completed suicide were also found for other depressive disorder, anxiety disorder, alcohol misuse, drug misuse, and personality disorder. They pointed out that healthcare in the first two years after attempted...

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    Conflict of Interest:
    None declared.