Completed and attempted youth suicide in Victoria

Objective. To examine the biopsychosocial background of persons aged 15–24 years who had committed suicide in Victoria, compared with young people who presented to hospital after attempting suicide and who were either hospitalized or given outpatient treatment. From these data it was hoped to develop a screening instrument to delineate attempters at high risk to suicide. Design. A prospective study was undertaken using a standardized youth suicide interview schedule of all suicides in the 15–24-year age group in Victoria, compared with a sample of those presenting to public hospital emergency departments following attempted suicide. Data on completed suicides were collected by the staff of the Coroner's Office and Victoria Police, while psychiatric staff of Victorian hospitals assisted the collection of data on suicide attempters. Main outcome measures. Data comprised demographic features, method of suicide or attempt, reasons for the event, social and personal history, psychiatric background and life stressors. Results. One hundred and forty-eight completed suicides were compared with 105 hospitalized suicide attempters and 101 non-hospitalized suicide attempters. The majority of those completing suicide were male (86 percent), while those attempting suicide were predominantly female (64 percent in both groups). Those completing suicide typically used violent methods, while attempted suicides were mainly from overdose. The most common reported reasons for suicide were psychiatric problems and generalized feelings of worthlessness. Relationship problems and family conflict were the dominant reasons in both groups of suicide attempters. The data suggest that completed suicide was not related to specific events. Unemployment was cited as a reason for suicide in less than 5 percent of cases. Significantly, those who attempted suicide were more likely to have sought help prior to the attempt (hospitalized 64 percent and non-hospitalized 66 percent) compared with those who successfully suicided (12 percent). Conclusions. These data did not support common assumptions about suicide. Suicide threats or attempts do not discriminate between subsequent attempts and completed suicide. Approximately 88 percent of those who completed suicide displayed no discernible help-seeking behaviour. No specific events were related to completed suicide, indeed, those who completed suicide appeared to have experienced fewer stressful life events than those who attempted suicide. Over half the subjects lived at home. For attempters, there was a history of physical abuse, not reported for those who completed suicide. The majority of subjects were not heavy drug or alcohol users. These data suggest: (1) research needs to address the antecedents of suicidal behaviour, not the behaviour itself; (2) we need to explore the role of such causal factors as feelings of worthlessness and interpersonal skills, rather than homelessness and unemployment; and (3) suicide completers and attempters are heterogeneous groups, to be helped separately. © 1998 John Wiley & Sons, Ltd.