Assessment of Suicide Risk: Some Limitations in the Prediction of Infrequent Events

Efforts to predict suicide and attempted suicide generally have yielded equivocal results. Neither single signs, standard psychological tests, specially devised tests, clinical judgments nor scales are found to be able to predict suicide at useful levels. Prediction of suicide is hampered by the relative rarity of this behavior together with the inadequate specificity of clinical characteristics and antecedent events. No highly unique descriptive attributes of suicide committers have been discovered. Within these existing limitations, a set of potential predictor variables are presented that may result in improved prediction of suicidal risk.

Prediction of suicide in psychiatric patients. Report of a prospective study

A prospective research study attempted to identify persons who would subsequently commit or attempt suicide. The sample consisted of 4,800 patients who were consecutively admitted to the inpatient psychiatric service of a Veterans Administration hospital. They were examined and rated on a wide range of instruments and measures, including most of those previously reported as predictive of suicide. Many items were found to have positive and substantial correlations with subsequent suicides and/or suicide attempts. However, all attempts to identify specific subjects were unsuccessful, including use of individual items, factor scores, and a series of discriminant functions. Each trial missed many cases and identified far too many false positive cases to be workable. Identification of particular persons who will commit suicide is not currently feasible, because of the low sensitivity and specificity of available identification procedures and the low base rate of this behavior.

Suicide and attempted suicide among children and adolescents. A transcultural study

Official statistics on suicides among children and adolescents in West Germany and Japan were used to compare transcultural social and psychiatric data on 108 German and 103 Japanese suicides and attempted suicides. This analysis revealed characteristic differences with respect to the following variables: ratio of attempted and accomplished suicide, age, method, integrating problems at school, alcohol and drug dependence, relationships with the opposite sex, broken homes, and number of friends. Based on these findings, the suicidal tendencies and social backgrounds of patients from both of these highly industrialized countries are discussed.

[Dexamethasone suppression test and suicide]

Suicidal behavior may be related to perturbations of the hypothalamo-pituitary axis. We administered the DST to 51 patients admitted for suicide attempt on admission day. No correlation is found between DST result and type of suicide attempt. The DST's diagnostic predictive value was absent for our population. Neither alcoholism, nor repeat of suicide attempt, nor suicidal behavior rating scales were correlated with DST results. Drug interference effects and the "stress" factor may explain our DST results on a population of suicide attemptors.

Psychiatric disorders in the families of borderline patients

The prevalence of psychiatric disorders was studied among the families of hospitalized borderline patients, defined by Gunderson and Singer's criteria, and compared with the families of schizophrenic and depressed control patients. Among borderline probands, 38.3% have a first-degree relative with depression, 25.5% had one with pathological mood swings, and 23.4% had one with "eccentric or peculiar behavior." There was no significant increase in the prevalence of schizophrenia among the relatives of borderline patients. Depression was more prevalent in the families of schizotypal borderlines compared with unstable or mixed-pattern patients. There were no schizophrenic diagnoses among the impaired relatives of schizotypal borderlines. A relationship is suggested between affective disorder and criteria-defined borderline disorders.

Suicide attempts in children and adolescents

In a review of pediatric hospital emergency room admissions over 7 years, the authors found 505 children and adolescents who had attempted suicide. There were three times as many girls as boys, and the boys were significantly younger. Features that distinguished them from matched controls were religion, living situation, substance abuse, current psychiatric illness, prior psychotherapy, and current medical illness. Their families had more psychiatric illness (primarily drug or alcohol abuse), suicide, paternal unemployment, and paternal and maternal absence than the controls' families. The suicide attempts usually occurred in the winter, after school or in the evening, at home with someone nearby, and by drug overdose.