The present study evidences that the variables associated to suicide attempts are age, psychiatric comorbidity and previous suicide attempts. These findings are referred to in the previous literature; hence, this study, carried out on hospital patients, reflects the consistency of the results in the previously described variables [2
The association of psychiatric illness as a predictor of suicide attempts has been reported in the literature [9
]. More than 90% of patients who attempt suicide have a major psychiatric disorder [11
], and 95% of patients who committed a suicide attempt had a psychiatric diagnosis [13
]. A very recent project [40
] from the World Health Organisation (WHO) produced results on the association between the diagnosis of Mental Disorders and Suicidal Behaviours in several countries (including Spain), supported by worldwide data obtained from surveys in general populations (108,664 people from 21 countries on five continents answered the surveys). One of its conclusions is that the presence of a psychiatric diagnosis with DMS-IV Mental Disorder criteria is a strong predictor for the appearance of suicide ideations and behaviours, as well as for consummated suicide. This applies generally to both economically developed countries and to developing countries, except for one important difference: among the Mental Disorders associated with higher suicide risk, Affective Disorders stand out in developed countries, while the association is higher with diagnoses other than Affective Disorders, such as Impulse-Control Disorders, Substance Use Disorders and Post-Traumatic Stress Disorders, in developing countries.
In a large sample of patients in Sweden [10
], the authors concluded that the category of psychiatric diagnosis coexisting with a suicide attempt is a variable which influences the future risk of consummated suicide. Planned reduction of the risk of future suicide among those patients requires implementing care plans, mainly in the first two years following the current suicide attempt, in particular among those patients diagnosed with Unipolar and Bipolar Affective Disorder, and Schizophrenia.
Although the risk of suicide increases with age, it has been demonstrated that in young adults, suicide attempts are more frequent than in older adults [19
]. These findings, in relation with age, are consistent with those of the present study. In a study of 10,892 suicides and 57,439 attempted suicides among hospital-admitted individuals in 8 states, groups with high attempted suicide rates were teenagers, young adults, women, and people of Caucasian and Afro-American origin aged 25 to 44 years [19
]. Another study in Korea with 344 attempted suicides found that a significantly higher number of women than men were admitted to emergency rooms due to attempted suicide during the study period [21
]. In a random sample of 3021 adolescents aged 14-24 years, the females who attempted suicide showed suicidal thoughts and suicide attempts significantly more often, and suicide attempts at a far younger age than the males [23
A systematic review of studies on the epidemiology of suicide published from 1997 to 2007 showed that non-fatal suicidal behaviours are more prevalent among women and young, unemployed, unmarried individuals, with low levels of education and suffering from a psychiatric disorder [1
]. Our results are consistent in relation with age, gender and psychiatric disorders, but they do not coincide with the aforementioned study with regard to the variables of educational level and unemployment. In the univariate analysis we found a higher rate of suicide attempts among working populations, and with higher educational levels. The utilisation of health care services is probably related to socioeconomic status and educational level. Nonetheless, owing to the fact that we only have information on those patients who finally went to the hospital, we cannot make inferences regarding this point. In the multivariate generalised estimating equation logistic regression analysis, the association with educational level and employment disappears.
The variable most strongly associated with suicide attempts in the study is that of a prior history of attempted suicide. Ecological studies showed a positive correlation between rates of attempted suicide and suicide rates for both sexes among young people in Europe [41
]. Prospective monitoring studies of patients hospitalised as a result of a suicide attempt show that the risk of suicide and all causes of mortality were very high immediately after discharge [9
]. In a systematic review of data published on the following-up of patients subsequent to failed suicide attempts [42
], the authors found that, in a one-year follow-up period subsequent to the failed suicide attempt, the repeat attempt rate was15%. There is a strong correlation between suicide attempt and subsequent death by suicide. In a study of a group of patients who attended the General Hospital after a self-harm episode, the presence of previous self-harm episodes is a risk factor for the onset of future suicidal behaviours [6
]. This implies that outpatient care after attempted suicide is of paramount importance. Despite this fact, the identification of specific individuals who will go on to attempt and consummate suicide is currently unfeasible, owing to the scant sensitivity and specificity of the identification procedures available, and the low base rate of this behaviour [17
Similar findings with respect to age, sex and previous suicide attempts have been reported in other publications. Thus, a study on a European level shows how the person-based suicide attempt rates were higher among women than among men and the highest person-based rates were found in the younger age groups [37
]. Moreover, more than 50% of the individuals attempting suicide made more than one attempt [37
]. Another study shows connection between suicide attempts and the individuals in the youngest age group, who reported suicidal ideation at baseline and psychiatric disorders, especially depression and drug abuse [38
]. A systematic sample of 114 patients from consecutive cases of attempted suicide referred to a general hospital in Helsinki shows that a high proportion of individuals attempting suicide (82%) suffered from comorbid mental disorders [39
In turn, in a population-based study conducted in Spain [2
] among young women, mental disorders and psychiatric comorbidity and recent ideation of suicide were identified as high risk factors for an attempted suicide. Episodes of severe depression are the diagnosis representing the greatest risk in relation to the presence of the ideation of suicide and attempted suicide.
In relation with the differences found between men and women, the literature shows that a history of suicide attempt is significantly associated with any anxiety, personality, or substance use disorder among both men and women. However, in men, suicide attempts had a strong association with dependent personality disorder (adjusted odds ratio = 3.81; 95% CI = 1.14 to 12.73), whereas in women, suicide attempts had a strong association with antisocial personality disorder (adjusted odds ratio = 2.71; 95% CI = 1.72 to 4.25) [43