Importance of Identifying Characteristics of High-Intent Suicide Attempters Admitted to Emergency Departments.

The number of suicide attempters in Korea increases every year, and according to the National Emergency Department Information System, the number of hospital visits due to self-injury and suicide attempts was reported to have increased by about 26% from 21,237 cases in 2011 to 26,750 cases in 2015.1 In addition, according to a suicide survey, the death rate of suicide attempters was 700 persons per 100,000 population, which was about 25 times higher than the 28.1 persons out of 100,000 of the general population.2 For this reason, many other countries are conducting emergency department-based management programs for suicide attempters as a part of their suicide prevention policy, and in case of Korea, the program has been reported to reduce the death rate of participants' suicide attempts to about one-third.3

Accordingly, management of suicide attempters to prevent suicide is considered to be a very important factor, and the findings of Woo et al.,4 which presented specific characteristics of high-intent suicide attempters who visited the emergency department from a clinical perspective, appear to be very important. Their findings are consistent with those of previous studies in that high suicidal intent was positively correlated with age, Hamilton Depression Rating Scale (HAM-D) scores, existence of a suicide plan, and persistence of suicidal ideation. In particular, because the results of multiple logistic regression analysis showed that depression, existence of a suicide plan, and HAM-D scores significantly contribute to high suicidal intent, these findings are expected to be useful for future national suicide prevention policies and management programs for suicide attempters.

However, caution should be exercised in interpreting the findings because the study was focused on a specific area and the sample size was small. First, in the logistic regression analysis, age was not a significant risk factor of high-intent suicide attempters. It is well known that the lower the age, the higher the impulsiveness.5 Therefore, in the association between suicidal intent and age, the confounding variables of impulsivity should be taken into account. Since cutting and overdosing have been reported to be highly associated with non-lethal self-injury in terms of the relationship between the method of suicide and suicidal intent,6 further investigation appears to be necessary. Furthermore, the finding of non-significant effect of income level among demographic characteristics on suicidal intent should be interpreted with care because a previous study reported the influence of income level on suicide risk.7 In particular, future research on the effect of the strength of suicidal intent on actual suicide risk appears to be crucial since suicide attempts do not necessarily lead to suicide.8 Lastly, further spread of emergency department-based suicide prevention program across country should be made to reflect intervention systems that consider the evaluation results of suicidal intent and the characteristics of high-intent suicide attempters.