Suicide Attempts Better Predictor of Completed Suicide Than Previously Known

A history of suicide attempts has long been known to be one of the strongest predictors of a successful suicide, but Mayo Clinic researchers say it’s more lethal than previously known.

They found that suicide risk was nearly 60 percent higher than previously reported when based on individuals making a first attempt at suicide, including those whose first attempts were fatal. This risk was dramatically higher for attempts using firearms.

“We hoped to address the shortcomings of earlier studies by including two groups previously overlooked by other studies,” says J. Michael Bostwick, M.D., a psychiatrist at Mayo Clinic and the lead author of the study published in the American Journal of Psychiatry.

The study enrolled people whose first attempts to commit suicide received medical attention. “Not only did we include those who survived this initial attempt, but we also included those who died on their first attempt and ended up on the coroner’s slab rather than in the emergency room,” he said. “These are large groups that have been routinely ignored in calculation of risk.”

Suicide is one of the 10 most common causes of death in the U.S., and is a major public health concern. The study found that nearly 60 percent of people who attempted suicide died on their first attempt.

“Almost no other study in the literature includes individuals who die on that first attempt,” Dr. Bostwick added. “A large part of the reason that such a high proportion of the total suicides occurred on first attempt can be attributed to firearm usage.

“The results show that it is 140 times more likely for firearms to cause suicide, compared to all other methods. That means nearly three-fourths of all deaths at first suicide attempt were caused by using firearms. This shows that guns are, unfortunately, but not surprisingly, remarkably effective.”

The study also found that the male-female ratio was higher (1.7-to-1) among those making their attempts than what other studies previously purported. Older age in men also is associated with higher suicide risk.

While the study confirmed previous findings that the risk decreased in survivors given a follow-up psychiatry appointment, the vast majority of survivors, irrespective of gender, killed themselves within a year after the index attempt.

The findings underscore how important it is that survivors have psychiatric follow-up scheduled after the first attempt, and how the first year following a suicide attempt is a critical window for a repeat fatal attempt.