However, a better understanding of the different types of suicide attempts may help us as clinicians and may facilitate research into their management.
The most important thing for clinicians to remember is that nearly half of suicide attempts are preceded by a previous suicide attempt. Therefore, suicide prevention efforts focused on persons who have attempted suicide are of crucial importance.
However, it has been very hard to predict suicidal behavior, even in persons who have attempted suicide.
One of the reasons for this is probably that, as every clinician knows, not all suicide attempts are the same. Previous research has focused on the severity of the suicide attempts and on the personality of the person attempting suicide. However, there has been little research using statistical methods to classify suicide attempts based on characteristics of the attempts.
1,009 hospitalized suicide attempters were included in the study. Data on 11 clinically relevant items about the suicidal behavior were assessed. These 11 items were statistically analyzed to identify subgroups (“clusters”) of suicidal behavior.
Three clusters were identified:
1. “Impulse-ambivalent” subgroup: This was the most common cluster. The means used were less lethal and there was less planning.
2. The “Frequent” subgroup: This cluster had the fewest number of persons. It included persons who reported a greater number of previous suicide attempts, who more often had serious or violent attempts, and who had an earlier age at the first suicide attempt. These persons were also less likely to have used alcohol or drugs prior to the suicide attempt. Many persons in the this cluster had experienced high levels of childhood abuse. The authors noted that, clinically, frequent attempters would be easily differentiated from the other clusters by the early onset, higher number of attempts, accompanying psychiatric morbidity, family history of suicidal behavior, and high levels of harm avoidance and childhood maltreatment. Thus, frequent attempters had many of the clinical characteristics of borderline personality disorder.
3. The “Well-planned” subgroup: Persons in this cluster had more carefully planned and prepared attempts, with more alcohol or drug use before the attempt, and more precautions to avoid interruptions or be rescued. High scores on severe emotional abuse in childhood were much more likely to be associated with the “Well-planned” group than with the “Impulsive-ambivalent” group.
The term harm avoidance refers to the tendency to inhibit behavior to avoid negative consequences. It has been associated with aggression against oneself and with the severity of suicide attempts. The “Well-planned” suicide attempts were associated with one of the following two combinations:
a) High harm avoidance plus childhood emotional neglect
b) Low harm avoidance plus high hopelessness.
Cluster analysis showed three distinct clusters of persons who had attempted suicide. The specific clinical features of these persons and their suicidal behaviors may help us to plan suicide prevention strategies aimed at each subgroup.
Every suicide attempt must be taken seriously. Categorizing suicide attempts into these three categories can help during clinical evaluation.
In addition to the characteristics of the suicide attempt itself, childhood emotional abuse or neglect, hopelessness, and harm avoidance should be evaluated.