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Suicide intent, risk patterns among Singaporeans

Tristan Manalac
09 Jul 2019
In December 2016, three students, aged 14, 16 and 19 respectively, took their lives in just four days.

Habitual poor coping, serious financial problems and expressed regret are strong predictors of suicide intent, according to a recent Singapore study. On the other hand, prior planning and hiding attempts are significant predictors of suicide risk.

“[T]he findings have implications for informing best practice in suicide assessment and primary prevention for suicides in Singapore,” said researchers. “By using brief risk assessments that are substantiated by empirical findings from current research in the local population, the clinician would be taking a step forward in utilizing the scientist-practitioner model in their evidence-based practice.”

Accessing records of 460 suicide attempters (mean age, 29.08±12.86 years; 70.4 percent female), researchers identified 20 independent variables for the prediction of self-reported suicide intent. This included lack of confidence, mental illness, religion, emotional support, prior planning and having a place for the act, among others. [PLoS One 2019;14:e0217613]

Logistic regression analysis revealed that only three of these variables were uniquely and significantly important. Habitual poor coping (odds ratio [OR], 8.11, 95 percent CI, 1.38–47.58) emerged as the strongest predictor, such that patients with this trait were at least eight times more likely to have suicidal intent that their counterparts without this trait.

Having serious financial problems (OR, 4.39, 1.07–18.07) was also a significant predictor of suicide intent, yielding a more than fourfold increase in risk. Expressed regret, in comparison, had an OR of 1.04 (0.26–4.22).

“The concept of regret was a variable collected in the interview, but it is not well established in previous literature,” said researchers. “The finding that those who expressed regret were less likely to report suicide intent, might imply that the suicide attempt could be a ‘cry for help’ but not reflective of a desire to die, suggesting that likely interventions include those that promote better decision making and regret regulation.”

The overall model, containing all 20 independent variables, achieved statistical significance (p<0.001), indicating that it was able to reliably distinguish between patients with high and low suicide risk. Specifically, the model was able to explain between 15.1 percent and 50.1 percent of the variance, and correctly classified patients 96.1 percent of the time.

In terms of suicide risk, logistic regression identified just two statistically important factors. Attempting to hide the act was the strongest predictor, such that those who demonstrated this behaviour were 13 times more likely to be assessed as having high suicide risk (OR, 13.13, 3.28–52.5). Prior suicide planning also significantly increased the risk of the act (OR, 8.32, 2.38–29.06).

“The results of this study provided evidence to support best practice for suicide assessment and management for medical doctors in the emergency department,” said researchers. “When a brief and accurate suicide risk assessment and effective suicide management is needed in a busy clinical environment following a suicide attempt, evidence from this study supports the assessment of prior suicide planning and attempt to hide to be incorporated into the risk assessment protocol.”

“Such information could be integrated to inform risk assessment and to formulate a suicide management plan, together with incorporation of contribution of habitual poor coping, serious financial problems and expressed regret into suicide management,” they added.

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