|
Abstract
|
Suicide attempt is an outcome of a personal crisis and deep distress. Many individuals with a suicide attempt may have mental health disorders, but this is not a contributing factor for all cases. Although related, suicide attempts differ from self-harm by being acts conducted with suicidal intent (1). Also, a larger proportion of self-harm incidents are seemingly due to cutting, while poisonings account for a larger share of suicide attempts.
The World Health Organization recommends monitoring of suicide attempts as an integral part of national strategies for suicide prevention (2). Having national figures on suicide attempt enables researchers to keep track of trends. However, being able to quantify the burden related to suicide attempts may also motivate policy makers to address this emerging public health problem.
In this issue of the Journal, Bommersbach et al. contribute with an important study on recent trends of suicide attempt and self-harm in the United States (3). A major strength of the study was the data sample, which was representative of national hospital contacts. The National Center for Health Statistics runs a yearly survey where a select subsample of emergency departments are asked to record information from medical records on all patient presentations during a randomly defined 4-week period. Approximately 77% of those emergency departments that were invited to participate in the survey consented. In other words, numbers of suicide attempts were derived from a subsample of all emergency department presentations, implying that the total number of suicide attempts occurring in the United States was estimated from this subsample. In all, data on 197,510 visits to emergency departments, including 2,422 suicide attempts, were collected during the period 2011-2020. By applying probability-based weights, the total number of contacts on a national level was estimated to be 1,225,223,605 emergency department visits, including 16,975,653 suicide attempts. In effect, the extrapolation applied a 1:6200 ratio, that is, the final figures were approximately 6,200-fold higher than the originally collected data. This implies a risk of estimation bias. However, when assessing changes over time, the main criterion is that the data collection is conducted in the same manner each time (i.e., applying the same set of assumptions). This seems to be the case in this study. Given that relatively few countries have national data collections on suicide attempt--for example, facilitated through administrative electronic hospital registries (4)--a stable and consistently applied sampling approach is a valuable alternative and likely to reveal fluctuations over time. In this U.S.-based study, the inclusion of data from different types of health insurance coverages, such as self-paying individuals, is a strength, although some individuals might be hesitant to seek help due to lack of coverage. Information on important sociodemographic factors, such as ethnicity, and on diagnosed mental disorders adds to the study's relevance. Insights regarding characteristics of those who present with suicide attempts opens possibilities of providing better support for this group.
Language: en |