Categories of attempted suicide: a longitudinal study.

A series of 151 index suicide attempts was categorized on the basis of situation and motivation: (a) 56 per cent occurred in a state of heightened emotionality due to a relatively limited stress;(b) 9 per cent were characterized by a life crisis which seriously challenged the patient' emotional homeostasis; and (c) 35 per cent attempted suicide in relation to the symptomatology of a pre-existing serious psychiatric disorder. At the time of first contact, usually in the general hospital emergency room, 69 per cent were sent home, the remainder being admitted for medical care (18 per cent) or transferred to a psychiatric hospital (13 per cent). In follow-up ambulatory care, successful referral correlated with the intensity of staff efforts during the early post-attempt contacts. The findings suggest that a brief hospitalization, perhaps two to three days, might be regularly utilized as a bridgehead for further ambulatory care, particularly for stress category patients with a high appointment failure rate. In a two-year follow-up, 16 of the 151 index cases re-attempted and two committed suicide. At the time of the index attempt, 24 (16 per cent) were in ongoing treatment. Among these 24 patients were many substance abusers and prior attempters as well as the two committed suicides of the follow-up period. Ongoing treatment should be weighed as a high risk factor suggesting particular caution in arranging the disposition for such patients.