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Correlates and antecedents of hospital admission for attempted suicide: a nationwide survey in Italy

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Abstract

The present study examined data on symptom patterns in the week prior to admission for suicide attempt, in a nationwide representative sample of patients. Socio-demographic, clinical, and treatment data was gathered for 1,547 patients admitted over a 12-day index period during the year 2004 to 130 public and 36 private psychiatric facilities in Italy. Patients were evaluated in terms of whether they had been admitted for having attempted suicide or not. A detailed checklist was used to assess symptom pattern at admission; diagnoses were based on ICD-10 categories. Two-hundred thirty patients (14.8%) in the sample had been admitted for suicide attempt. Patients with depression or with personality disorders were more frequently observed among suicide attempters. First-contact patients were significantly more likely to have been admitted after a suicide attempt, the only exception being individuals with bipolar disorder, manic phase. No diagnosis was statistically related to admission after suicide attempt, once symptoms pattern at admission had been accounted for. Disordered eating behavior, depressive symptoms, substance abuse, and non-prescribed medication abuse were positively related to attempted suicide, as were any traumatic events in the week prior to admission; symptoms of psychosis (hallucinations/delusions) and lack of self-care were negatively associated with suicide attempt admission. Greater attention to symptoms immediately preceding or concomitant with admission after a suicide attempt can be a key factor in establishing the best treatment plan and discharge strategy, the most effective community-service referral, and targeted intervention programmes for patients hospitalized for a suicide attempt.

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Acknowledgments

Dr. Giorgio Bignami provided continuous support over the entire course of the National Mental Health Project, during which this study was conceived. Melinda Tucker gave valuable suggestions and comments in the finalization of the manuscript.

Conflict of interest statement

The study was entirely funded by a grant from the Italian Ministry of Health. No other forms of financial support have been received for this study.

Author information

Authors and Affiliations

  1. Department of Psychology, University of Cagliari, Loc. Sa Duchessa, 09123, Cagliari, Italy

    Antonio Preti & Leonardo Tondo

  2. Institute of Biomathematics, Polo Scientifico, Loc. Crocicchia, University of Urbino, 61029, Urbino, PU, Italy

    Davide Sisti & Marco B. Rocchi

  3. IRCCS Centro S. Giovanni di Dio-Fatebenefratelli, Via Pilastroni 4, 20125, Brescia, Italy

    Giovanni de Girolamo

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  1. Antonio Preti
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  2. Leonardo Tondo
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for the PROGRES-Acute group

Corresponding author

Correspondence to Giovanni de Girolamo.

Additional information

This paper is dedicated to the memory of Pierluigi Morosini, M.D., who was the Scientific Director of the National Mental Health Project and enthusiastically supported and contributed to the development and conduct of this national research project.

Appendices

Appendix 1

The PROGRES-Acute group includes: National and Regional Coordinators, and scientific consultants: F. Amaddeo, A. Barbato, G. Borgherini, G. Borsetti, R. Bracco, R. Canosa, M. Casacchia, I. Casula, P. Ciliberti, A. Colotto, A. D’Aloise, G. de Girolamo, G. Dell’Acqua, M. De Palma, W. Di Munzio, A. Gaddini, G. Grassi, N. Longhin, M. Miceli, R. Miglio, P. Morosini, M. Nicotera, M. Percudani, B. Norcio, A. Picardi, R. Potzolu, E. Rossi, P. Rucci, G. Santone, S. Schiaffino, F. Scotti, R. Tomasi, G. Turrini, E. Zanalda. Researchers: G. Agostani, F. Basile, F. Basilico, N. Battino, L. Bavero, G. Bazzacco, L. Biscaglia, R. Borio, S. Buttacavoli, B. Caporali, F. Cappelletti, L. Caserta, L. Cifarelli, P. Congia, M. Dazzi, L. Elia, E. Fantini, A. Galli, R. Gangi, P. Ghirardo, L. Giordano, S. Goldoni, A. Guidoni, S. Marchegiani, G. Morelli, M. Nassisi, E. Paltrinieri, K. Pesaresi, A. Pettolino, L. Pinciaroli, G. Pitzalis¸ M. Severini, C. Sighinolfi, G. Spinetti, A. Trequattrini, U. Unterfrauner, K. Wolf, L. Zecca.

Appendix 2

Symptoms profile and precipitating factors in the week prior to admission

Agitation

Any exaggerated verbal, vocal or motor activity, with or without aggressive behavior, not justifiable on the basis of an urgent or important need

Confusion

Disorientation in time and space and/or attentive deficits preventing from acting in an appropriate way

Hallucinations/delusions

Hallucinations: perceptions without any confirmable real existence.

Delusions: erroneous perceptions or judgments about reality.

Disordered eating behavior

Any instance of irregular or erratic eating behavior with actual or probable consequences on health state

Severe anxiety

Any occurrence of anxiety at levels higher than habitually tolerated by the subject, with appreciable conduct abnormalities.

Depression

Low or bad mood or lack of interest in habitual activities and pleasure, longer than a week, irrespectively by the occurrence of associated symptoms (disordered sleep, disordered eating, guilt, suicidality)

Alcohol abuse

Use of alcohol out of control of the subject, despite the presence of physical, relational, occupational, or legal problems

Substance abuse

Use of illicit substances out of control of the subject, despite the presence of physical, relational, occupational, or legal problems

Abuse of non-prescribed medications

Use of non-prescribed therapeutic drugs out of control of the subject, despite the presence of physical, relational, occupational, or legal problems

Work/social functioning problems

Any occurrence of relevant work or social functioning impairment

Social withdrawal

Any instance of relevant withdrawal from social or interactions with others

Lack of self-care

Lack of care for hygiene or self-presentation (i.e., dress, hair, beard)

Conflict with family members

Any occurrence of conflict with family members causing difficulties to the subject or to his/her family members

Conflict with neighbors

Any occurrence of conflict with neighbors causing difficulties to the subject or to his/her counterparts

Violent behavior toward objects

Any instance of physical assault directed toward objects or things

Violent behavior toward people

Any instance of physical or verbal assault directed toward people, whether known or unknown

General medical condition

Any occurrence of physical/somatic disorder requiring treatment

Drug side effects

Any occurrence of side effects from treatment requiring changes of dosage, or drug withdrawal or the prescription of additional therapeutics

Traumatic events

Any event causing the potential of bodily or psychic harm, or with a foreseeable impact on public personal identity (image), causing stressful reactions

Victim of violence

Any occurrence of victimization, i.e., being the victim of assault, aggression or robbery

Crime committed

Any occurrence of law violation, causing or not referral to justice

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Preti, A., Tondo, L., Sisti, D. et al. Correlates and antecedents of hospital admission for attempted suicide: a nationwide survey in Italy. Eur Arch Psychiatry Clin Neurosci 260, 181–190 (2010). https://doi.org/10.1007/s00406-009-0037-x

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