Childhood Abuse and Lethality of Suicide
Oct 14, 2012
Following on from my last post, about understanding the "epigenetic" basis of suicide attempts, a recent paper by Spokas and colleagues at La Salle University [LINK], continues to build evidence which those in Psychiatric Services must take into account in evaluating the risk of successful suicide.
Spokas and her colleagues explored whether those who impulsively attempt suicide are at lesser or equal risk than those who premeditate suicide. Individuals who made an impulsive attempt expected that their attempts would be less lethal; yet the actual lethality of both groups' attempts was similar. Those who made an impulsive attempt were less depressed and hopeless than those who made a premeditated attempt. Participants who made an impulsive attempt were less likely to report a history of childhood sexual abuse and more likely to be diagnosed with an alcohol use disorder than those who made a premeditated attempt.
These researchers argue that clinicians should not minimize the significance of impulsive attempts, as they are associated with a similar level of lethality as premeditated attempts. Focusing mainly on depression and hopelessness as indicators of suicide risk has the potential to under-identify those who are at risk for making impulsive attempts. Of equal importance, in my view, is that, following such existing research as that of Dore et al [LINK] clinicians should be especially careful to (a) ask specific questions of patients about history of childhood abuse (b) rate as higher than usual the risk of successful, pre-meditated, suicide in those wiith such histories. In my view, her research is also significant in that it highlights something I've noticed amongst those who "successfully" complete suicide -- noted in my discussion with fellow colleagues, in the course of clinical practice, and in those friends of mine who have killed themselves -- having an active alcohol (or drug) use disorder is no guarantee that someone's risk of suicide is not high -- many of those with histories of childhood abuse may successfully bring their substance use problems "under control" and then go on to kill themselves. In some ways they seem to accept the lesser world resulting from the damage of their abuse, but their value system does not permit them to accept the life remaining -- an argument for inspiring hope, enabling recovery, and where possible intervening EARLY in the lives of those abused.
Whilst I have written to Professor Spokas requesting a copy of her paper (probably still in a "pre-publication" version), her email autoresponse says she is away -- I'll post her paper if she responds to my request.