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Predictive Factors of Suicide Attempt and Non-Suicidal Self-Harm in Emergency Department

Saad Salman, Jawaria Idrees, Fahad Hassan, Fariha Idrees, Mashaal Arifullah, Sareer Badshah



Introduction: Suicide is the third cause of mortality in America, second leading cause of death in developed countries, and one of the major health problems. Self-harm is self-inflicted damage to one’s self with or without suicidal intent. In the present study, the predictive factors of suicide attempt and non-suicidal self-harm were evaluated in patients referred to emergency department (ED) with these problem. Methods: The total number of 45 patients with suicide attempt or self-harm admitted to ED were included. Clinical symptoms, thoughts and behaviors of suicidal, and non-suicidal self-harm in these patients were evaluated at baseline. Suicidality, suicidal intent and ideation, non-suicidal self-injury, social withdrawal, disruptive behavior, and poor family functions were evaluated at admission time. Brief clinical visits were scheduled for the twelfth weeks. In the twelfth week, patients returned for their final visit to determine their maintenance treatment. Finally data were analyzed using chi-squared and multiple logistic regression. Results: Forty five patients were included in the study (56.1% female). The mean age of patients was 23.3±10.2 years (range: 15-75; 33.3% married). Significant association of suicide and self-injury was presented at the baseline and in the month before attempting (p=0.001). The most important predictive factors of suicide and self-harm based on univariate analysis were depression (suicidal and non-suicidal items of Hamilton depression rating scale), anxiety, hopelessness, younger age, history of non-suicidal self-harm and female gender (p<0.05). The participants’ quality of life analysis showed a significant higher quality in physical component summary (p=0.002), mental component summary (p=0.001), and general health (p=0.001) at follow up period. Conclusion: At the time of admission in ED, suicide attempt and non-suicidal self-harm are subsequent clinical markers for the patient attempting suicide again. The most independent predictive factors of suicide attempt and self-harm were poor family function, hopelessness, non-suicidality items of Hamilton depression rating scale, history of non-suicidal self-harm, and anxiety disorders.


Suicide, attempted; self-injurious behavior; emergency services, psychiatric; mental disorders; predictive value


Andover MS, Morris BW, Wren A, Bruzzese ME. The co-occurrence of non-suicidal self-injury and attempted suicide among adolescents: distinguishing risk factors and psychosocial correlates. Child Adolesc Ment Health. 2012;6:11.

Wasserman D, Cheng Q, Jiang G-X. Global suicide rates among young people aged 15-19. World Psychiatry. 2005;4(2):114-20.

Chen Y-Y, Wu KC-C, Yousuf S, Yip PS. Suicide in Asia: opportunities and challenges. Epidemiol Rev. 2011;34(1):129-44.

Amini A, Munesan MR, Dolatabadi AA, et al. Quality of Life in Emergency Medicine Specialists of Teaching Hospitals. Emergency. 2014;2(3):[In press].

Peltzer K, Pengpid S. Suicidal ideation and associated factors among school-going adolescents in Thailand. Int J Environ Res Public Health. 2012;9(2):462-73.

Amitai M, Apter A. Social aspects of suicidal behavior and prevention in early life: a review. Int J Environ Res Public Health. 2012;9(3):985-94.

Brent D, Emslie G, Clarke G, et al. Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial. JAMA. 2008;299(8):901-13.

Asarnow JR, Emslie G, Clarke G, et al. Treatment of selective serotonin reuptake inhibitor—Resistant depression in adolescents: Predictors and moderators of treatment response. J Am Acad Child Adolesc Psychiatry. 2009;48(3):330-9.

Washburn JJ, Richardt SL, Styer DM, et al. Psychotherapeutic approaches to non-suicidal self-injury in adolescents. Child Adolesc Ment Health. 2012;6(1):1-8.

Wilkinson P, Kelvin R, Roberts C, Dubicka B, Goodyer I. Clinical and psychosocial predictors of suicide attempts and nonsuicidal self-injury in the Adolescent Depression Antidepressants and Psychotherapy Trial (ADAPT). Am J Psychiatry. 2011;168(5):495-501.

Boxer P. Variations in risk and treatment factors among adolescents engaging in different types of deliberate self-harm in an inpatient sample. J Clin Child Adolesc Psychol. 2010;39(4):470-80.

Epstein NB, Baldwin LM, Bishop DS. The McMaster Family Assessment Device. J Marital Fam Ther. 1983;9(2):171-80.

Hamilton M. The Hamilton rating scale for depression. Assessment of depression: Springer; 1986. p. 143-52.

Haley SM, McHorney CA, Ware Jr JE. Evaluation of the MOS SF-36 physical functioning scale (PF-10): I. Unidimensionality and reproducibility of the Rasch item scale. J Clin Epidemiol. 1994;47(6):671-84.

Brazier J-, Harper R, Jones N, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992;305(6846):160-4.

Guan K, Fox KR, Prinstein MJ. Nonsuicidal self-injury as a time-invariant predictor of adolescent suicide ideation and attempts in a diverse community sample. J Consult Clin Psychol. 2012;80(5):842-9.

Brezo J, Paris J, Turecki G. Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review. Acta Psychiatr Scand. 2006;113(3):180-206.

Mork E, Walby FA, Harkavy-Friedman JM, et al. Clinical characteristics in schizophrenia patients with or without suicide attempts and non-suicidal self-harm-a cross-sectional study. BMC Psychiatry. 2013;13(1):1-8.

DOI: https://doi.org/10.22037/emergency.v2i4.5997


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