HIGH MORTALITY BY NATURAL AND UNNATURAL CAUSES - A 10-YEAR FOLLOW-UP-STUDY OF PATIENTS ADMITTED TO A POISONING TREATMENT CENTER AFTER SUICIDE ATTEMPTS

Objective-To describe mortality by suicide and other causes of death i n a group of patients who attempted suicide, and to identify predictiv e factors. Design-10 year follow up study based on records of suicide attempters in 1980.Setting-Poisoning treatment centre at a general hos pital. Subjects-974 patients aged 15 and over referred to the poisonin g treatment centre after deliberate self poisoning. Main outcome measu res-Death by different causes registered in the Danish death cause reg ister. Results-In 10 years of follow up 306 patients died: 103 by suic ide, 131 from natural causes, and 31 by accidents; five were murdered, and in 36 cases the cause of death was uncertain. The standard mortal ity ratio was 550. Cause specific standardised mortality rates were 29 60 for suicide, 236 for natural causes, 1256 for accidents, and 5459 f or uncertain causes. In a Cox regression analysis, high risk factors f or subsequent suicide were: more than one previous suicide attempt (re lative risk 2.25), living alone (2.28), and age (1.03 per year). Predi ctors of death by natural causes were receiving a pension (1.69), drug misuse (2.72), more than one previous suicide attempt (2.25), age (1. 06 per year), and male sex (2.49). The group of patients fulfilling at least one high risk criterion for later suicide differed significantl y from the rest of the patient group in incidence of suicide, but both sensitivity and specificity were low. Conclusions-Most patients who a ttempted suicide were at high risk of succeeding because the risk fact ors, though significant, are not very specific. A strategy to prevent suicide must be directed toward the majority of those who attempt suic ide.