Non-presentation at hospital following a suicide attempt: a national survey

Abstract Background A few previous studies suggest that a large number of individuals do not present at hospital following a suicide attempt, complicating recurrence prevention and prevalence estimation. Methods Data were extracted from a regular phone survey in representative samples of the French population aged 18–75 years old. Five surveys between 2000 and 2017 collected data about the occurrence of a previous suicide attempt and subsequent care contacts. A total of 102,729 individuals were surveyed. Among them, 6,500 (6.4%) reported a lifetime history of suicide attempt. Results Following their last suicide attempt, 39.3% reported they did not present to hospital (53.4% in 18–24 year-olds), with limited changes in rates with time. Risk factors for non-presentation were being male [adjusted odds ratio = 1.3, 95% confidence interval (1.1–1.5)], living with someone [1.2 (1.0–1.4)], being a non-smoker [1.4 (1.2–1.6)], and being younger at time of attempt [0.97 (0.96–0.98) per year]. Of those who did not present to hospital, only 37.7% reported visiting a doctor or a psychiatrist/psychologist after their act v. 67.1% in those who presented to hospital (as a second health contact). In both cases, half disclosed their act to someone else. Prevalence rates of suicide attempts reported in community were 4.6 times higher than those in hospital administrative databases. Conclusions This survey at a national level confirmed that a large proportion of individuals does not go to the hospital and does not meet any health care professionals following a suicidal act. Assessment of unmet needs is necessary.

[1]  F. Jollant,et al.  Recurrence and mortality 1 year after hospital admission for non-fatal self-harm: a nationwide population-based study , 2019, Epidemiology and Psychiatric Sciences.

[2]  A. Reneflot,et al.  Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017 , 2019, Scandinavian journal of public health.

[3]  H. Christensen,et al.  Experience of Health Care Services After a Suicide Attempt: Results from an Online Survey , 2018, Suicide & life-threatening behavior.

[4]  Sofian Berrouiguet,et al.  Combining brief contact interventions (BCI) into a decision-making algorithm to reduce suicide reattempt: the VigilanS study protocol , 2018, BMJ Open.

[5]  C. Clements,et al.  Incidence of suicide, hospital-presenting non-fatal self-harm, and community-occurring non-fatal self-harm in adolescents in England (the iceberg model of self-harm): a retrospective study. , 2017, The lancet. Psychiatry.

[6]  M. Olfson,et al.  National Trends in Suicide Attempts Among Adults in the United States , 2017, JAMA psychiatry.

[7]  C. C. Chee,et al.  Le Recueil d’information médicalisé en psychiatrie (RIM-P) : un outil nécessaire pour la surveillance des hospitalisations suite à une tentative de suicide , 2017 .

[8]  Louis-Marie Paget,et al.  [The psychiatric hospital discharge database (RIM-P): An essential tool for the surveillance of hospitalization after a suicide attempt]. , 2017, Revue d'épidémiologie et de santé publique.

[9]  J. Bostwick,et al.  Suicide Attempt as a Risk Factor for Completed Suicide: Even More Lethal Than We Knew. , 2016, The American journal of psychiatry.

[10]  M. Husky,et al.  Risk factors for suicide attempts and hospitalizations in a sample of 39,542 French adolescents. , 2016, Journal of affective disorders.

[11]  P. Corcoran,et al.  The iceberg of suicide and self-harm in Irish adolescents: a population-based study , 2014, Social Psychiatry and Psychiatric Epidemiology.

[12]  D. Gunnell,et al.  Hospital Presenting Self-Harm and Risk of Fatal and Non-Fatal Repetition: Systematic Review and Meta-Analysis , 2014, PloS one.

[13]  A. House,et al.  Are hospital services for self-harm getting better? An observational study examining management, service provision and temporal trends in England , 2013, BMJ Open.

[14]  K. Saunders,et al.  Attitudes and knowledge of clinical staff regarding people who self-harm: a systematic review. , 2012, Journal of affective disorders.

[15]  Kate E A Saunders,et al.  Self-harm and suicide in adolescents , 2012, The Lancet.

[16]  L. Appleby,et al.  Implementation of mental health service recommendations in England and Wales and suicide rates, 1997–2006: a cross-sectional and before-and-after observational study , 2012, The Lancet.

[17]  E. Christiansen,et al.  Risk of Repetition of Suicide Attempt, Suicide or all Deaths after an Episode of Attempted Suicide: A Register-Based Survival Analysis , 2007, The Australian and New Zealand journal of psychiatry.

[18]  M. Ngwenya,et al.  Self-Harm and Suicide , 2008 .

[19]  Keith Hawton,et al.  Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. , 2003, The British journal of psychiatry : the journal of mental science.

[20]  M. Sharpe,et al.  Psychological autopsy studies of suicide: a systematic review , 2003, Psychological Medicine.

[21]  Karen Rodham,et al.  Deliberate self harm in adolescents: self report survey in schools in England , 2002, BMJ : British Medical Journal.

[22]  T. Joiner,et al.  The course of post-crisis suicidal symptoms: how and for whom is suicide "cathartic"? , 2001, Suicide & life-threatening behavior.

[23]  S. Gilbody Deliberate self harm. , 1996, Journal of accident & emergency medicine.

[24]  J. Pacheco,et al.  Suicide , 1968, Royal Institute of Philosophy Lectures.

[25]  B. Kable Mental health. , 2005, Australian family physician.