A comparison of medically serious suicide attempters admitted to intensive care units versus other medically serious suicide attempters

(2022) 22:805 Quesada‑Franco et al. BMC Psychiatry https://doi.org/10.1186/s12888-022-04427-8 Open Access RESEARCH A comparison of medically serious suicide attempters admitted to intensive care units versus other medically serious suicide attempters Marta Quesada‑Franco1,2*, Mª Dolores Braquehais3,4,5,6, Sergi Valero7,8, Anna Beneria1,2,3, J. A. Ramos‑Quiroga1,2,3,5, Enrique Baca‑García9,10,11,12,13,14,15,16 and Luis Pintor‑Pérez17 Abstract Background: Medically serious suicide attempts (MSSA) represent a subgroup of clinically heterogeneous suicidal behaviours very close to deaths by suicide. A simple definition of an MSSA is a suicide attempt with life-threatening consequences, regardless of the severity of the attempter’s mental disorder. Few studies have specifically analysed the heterogeneity of MSSA. Therefore, the aim of this study is to describe the profile of individuals who made a highly severe MSSA and to compare those admitted to Intensive Care Units (ICU) – including Burn Units– with other MSSA admitted to other medical and surgical units. Methods: The study sample consisted of 168 patients consecutively admitted to non-psychiatric wards from two public hospitals in Barcelona after an MSSA during a 3-year period. In order to select more severe MSSA, the minimum hospital stay was expanded from Beautrais’ definition of ≥ 24 h to ≥ 48 h. Mean hospital stay was 23.68 (SD = 41.14) days. Patients needing ICU treatment (n = 99) were compared to other MSSArs (n = 69) that were admitted to other medical and surgical units, not requiring intensive care treatment, with an initial bivariant analysis followed by a logis‑ tic regression analysis using conditional entrance. Results: Medically serious suicide attempters (MSSArs) spent more time hospitalized, more frequently reported recent stressful life events, were more likely to have at least one prior suicide attempt (SA) and their current attempt was more frequently non-planned, compared to the profile of MSSArs reported in previous studies. The most frequent method was medication overdose (67.3%) and jumping from heights (23.2%). Among those who chose more than one method (37.6%), the most frequent combination was medication overdose and drug use. Affective disorders and personality disorders were the most frequent diagnoses. Higher educational level, history of previous mental disorders and prior lifetime suicide attempts were significantly more frequent among those admitted to ICU compared to other MSSArs. Patients needing admission to ICU less frequently used self-poisoning and cuts. *Correspondence: 1 Department of Psychiatry, Hospital Universitari, Vall d’Hebron, Barcelona, Spain Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Quesada‑Franco et al. BMC Psychiatry (2022) 22:805 Page 2 of 10 Conclusions: MSSA needing ICU admission can be regarded clinically as similar to attempts resulting in suicide. More research on this type of highly severe suicide behaviour is needed due to its serious implications both from a clinical and public health perspective. Keywords: Medically serious suicide attempts, Nearly lethal suicide attempts, Intensive care unit Background More than 700,000 people die by suicide every year, which is one person every 40 s and accounted for 1.3% of all deaths worldwide in 2019 [1]. Suicide occurs at all stages of life, being the fourth cause of death in people between 15 and 29 years [1]. Individuals who made an MSSA in the past are at higher risk of dying by suicide than those who make less serious lethal suicide attempts [2, 3]. Studies have shown that survivors of MSSA are epidemiologically very similar to those who die by suicide [4, 5]. Consequently, recent research has focused on subjects with MSSA, as the study of this subgroup can best shed light on deaths by suicide [3]. Moreover, from the methodological perspective, the study of MSSA overcomes some problems related to the study of suicidal behaviour. In contrast to the psychological autopsy conducted in suicides, in MSSA the main source of information is the survivor. However, criteria to define an MSSA are heterogeneous. Broadly, a simple definition is suicide attempts with life-threatening consequences, regardless of the severity of the attempter’s mental disorder. Beautrais and collaborators provide a specific clinical definition of MSSA: patients who require hospital admission for more than 24 h after the attempt and met one of the following treatment criteria: a) treatment in a specialized clinical unit (i.e.: intensive care, hyperbaric or burn units), c) need of surgery under general anaesthesia, c) need of medical treatment beyond gastric lavage, activated charcoal, and/ or routine neurological observations; and, d) patients who require hospital admission for more than 24 h not because of the aforementioned criteria but because of the highly lethal suicidal methods (e.g.: hanging or gunshot) [4, 6–11]. Other studies define MSSA with psychometric scales such as: the Self-inflicted Injury Severity (SIISF) [12–14]; the Lethality Scale [15]; the Lethality of Suicide Attempt Scales II (LSARS-II) [16, 17]; the Lethality Rating Scale (LRS) [3, 18–21] or the Risk Rescue Rating Scales (RRRS) [22–24]. Other researchers refer to the time spent in non-psychiatric wards after the MSSA. For instance, in certain studies the mean hospital length of stay was 19 days [3, 20, 21] and 22.7 days in other studies [25]. Aside from the medical consequences of the MSSA, from a psychosocial analysis they can be conceptualized as a heterogenous group [26]. A cluster analysis study based on social-demographic and clinical factors conducted with 124 MSSA found that three major groups of patients could be identified: 1) “impulsive-ambivalent”, predominantly females, with a less severe suicide attempt, generally after a personal crisis and with low scores (...truncated)