Longitudinale and international epidemiologic comparasion of risk factors for parasuicide within a clinical hig risk group

Parasuicidal acts do not constitute a homogeneous group; the term "suicide attempt" might be misleading due to the fact that different patterns of motives, degrees of planning and repetition rates were found for distinguishable groups of parasuicides. The WHO/EURO study on parasuicde (acts of deliberate self-harm and suicide attempts) is conducted in 25 centres all over Europe. The specific aim of the study is to explore the reasons, conditions, and circumstances that lead to intentional self-harm behaviour, comprising acts within the broad range from low to high suicide intention. A standardized and obligatory interview was administered to patients admitted to two Tyrolean psychiatric clinics because of an act of deliberate self-harm. Interviews were conducted for the period of one year, follow-up interviews were carried out 12 months after the index parasuicide in order to elicit information concerning possible repeated self-harm episodes and changes of the present living conditions of the person since the first interview. The selected study population is known to be a high-risk group for suicide, particularly the suicide risk is considerably elevated during the first three years after the first episode of deliberate self-harm. In comparison to other study centres the most important findings revealed an elevated rate of repeated self-harm episodes within 12 months, the use of more lethal methods, and a considerably higher proportion of male parasuicides in the Tyrolean study centre. The most common psychiatric diagnoses assessed among the study participants were alcohol abuse/dependence and affective disorders. Further analysis revealed that the study sample should be regarded as heterogeneous in terms of plans, motives, and repeated self-harm behaviour. In consequence it appears to be more appropriate to distinguish between types of deliberate self-harm acts. Classes or types of patients could be discriminated by the degree of preparation and planning of the parasuicide. Some types were characterized by the lack of planning and preparation, including impulsive acts of deliberate self-harm. Other types exhibited moderate to strong activities of preparation and planning. Accordingly, motives and rates of repeated self-harm episodes differed considerably between the types. Motives might be interpreted with reference to the dimension of life- and death-orientation. Life-oriented motivational types were characterized by interpersonal conflict motives, whereas death-oriented motivational types showed the well-known pattern of suicidal preoccupation. Therefore, results concerning motivational types indicate that life-oriented motivational patterns should be interpreted as maladaptive efforts to communicate the present crisis. The impact of the WHO/Study results led to the development of a clinical interview that intents to monitor the acute suicidality of inpatients. The clinical interview is currently in an experimental state of application. Further implications of the findings of the Tyrolean centre point to the need of changes in treatment. Due to the fact that interpersonal conflict motives play a crucial role in triggering self-harm behaviour, it seems to be of importance to include the patient`s significant others in the treatment process. With regard to international activities and cooperation the WHO/Euro study stimulated the establishment of an "European network on suicde prevention". The principal investigator Univ.-Doz. Dr. Haring and Dr. Fartacek (Salzburg) are the representatives for Austria in the network; both also develop and coordinate a national plan on suicide prevention