Epidemiology of suicide attempts in a psychiatric setting in Northern Italy

Objectives An observational study was carried out to investigate suicide attempts in the period from January 1, 2006 to December 31, 2010 in the population of legal age from the territory of Rovigo in Northern Italy. Methods All intentional self-poisoning or self-injury events, irrespective of motivation, that came to the attention of Mental Health Services was recorded. Personal data (age, sex, marital status, occupation, educational level and family composition), clinical data (main diagnostic group, method used in the attempt, previous contact with the Service, previous suicide attempts, site of first psychiatric consultation) were recorded for every person encountered by the psychiatrist involved in the first evaluation. All the people recruited were also asked to fill in a self-administered interview composed of three questionnaires: QD - questionnaire of depression by CBA - cognitive behavioral assessment; BSI borderline syndrome index and RFL - reason for living inventory. Results Two-hundred and sixty-five suicide attempts with a psychiatric evaluation were considered in a population of 149,300 people over a period of 5 years. A higher distribution in females and younger people was found. There is a high percentage of unemployed people (23.1%), especially among males (29.3%) (chi(2) test:4.02; p <.05). In the majority of cases the means of the suicidal attempt is drug poisoning (59%) and violent methods (hanging, gas poisoning, jumping, fire arms and drowning) represent the 25.2% of all the sample, with a higher percentage for male subjects (35.9%; OR: 2.66 [95% CI: 1.34-5.29]). The great majority of people were assessed in Emergency Rooms (64.1%) and after the psychiatric evaluation, 69.2% of the people were hospitalized in psychiatric wards. The main diagnostic group is personality disorders (33.3%) followed by mood disorders (24.4%): there is a significant sex difference with more females with mood disorders (chi(2) test: 6.88; p <.01) and more males with alcohol/substance disorders (chi(2) test: 19.4; p <.01). In 40.6% of cases had at least one contact with Mental Health Services before while a relevant percentage of people (43.2%) had a positive history for previous attempts. People with a positive history of suicidal attempts were at major risk of borderline personality (OR: 2.01 [95% CI: 1.02-3.95]) while it was less evident in people with a higher presence of reason for living by the RFL questionnaire (p < 0.05; adjusted OR: 0.39 [95% CI: 0.16-0.94]). Conclusions The findings confirm data in the literature on suicide attempts in Western populations and provide the state of the art at the local and national level. The investigation stresses the established evidence that a large proportion of suicide attempters do not pertain to the population usually served by Mental Health facilities. It also suggests a possible discrimination of different profiles among those attempting suicide. Some indications for future prevention planning emerge: it is possible to differentiate two levels of prevention with a "selected prevention" on males, unemployed individuals and those who do not come to the attention of mental health professionals, and an "indicated prevention" for patients with a positive history of suicidal attempts.