Life after near death: What interventions work for a suicide survivor?
Motives and methods of self-harm may suggest an individual's risk for future attempts
An important confounding factor in these findings is that effective lithium treatment requires long-term adherence, which implies a long-term doctor-patient relationship. As Cipriani et al32 noted, patients who can maintain an ongoing therapeutic relationship may be “less disturbed” than those who cannot, making them less likely to kill themselves regardless of pharmacologic treatment. Furthermore, patient interviews reveal that the therapeutic alliance created by a continuous relationship can be a protective support against further SA.33
Clinical implications
Suicide survivors often continue to struggle with suicidality well beyond the index attempt. This suicidality is a maladaptive problem-solving method that functions as a chronic morbid illness. As such, it is not enough to analyze the phenomenon of surviving an SA; one must examine the ongoing process of surviving suicidality.
Consider 3 factors. Consider all 3 factors— motive, method, and management—when addressing suicide survivorship.
Method lethality significantly influences survival likelihood. In clinical practice, we have observed that the index attempt is a learning experience for some patients that will inform their choice of method on the next attempt. When interacting with a suicide survivor, carefully assess the reasoning behind their initial choice of method and whether it has evolved toward higher lethality since the index attempt.
Management recommendations after SA continue to evolve. Risk factor management—such as treating underlying mood disorders, home visits to reduce social isolation, and prioritized “green card” contact with psychiatrists—has been shown to decrease reattempt rates, but many other interventions have not shown the expected benefit. Increased intervention rates have not yielded proportional decreases in suicidal ideation, attempts, or completion.
Suicide survivors often continue to struggle with suicidality well beyond the index attempt
Consider the SA motive and method when planning how to manage the survivor
Method lethality significantly influences survival likelihood (firearms are the most common and deadly method in the United States)
In many clinical trials, the incidence of suicidal thoughts, plans, gestures, or attempts has not significantly decreased when SA survivors received extra treatment
Management recommendations after SA continue to evolve; effective techniques appear to be keeping lines of communication open and providing individualized treatment
Individualize pharmacologic treatments and psychotherapy to help guide the patient away from maximum suicide risk
SA: suicide attempt
- American Association of Suicidology. www.suicidology.org.
- American Foundation for Suicide Prevention. www.afsp.org.
- Mayo Clinic Patient/Family Education. Suicide: What to do when someone is suicidal. www.mayoclinic.com/health/suicide/MH00058.
- Carbamazepine • Carbatrol
- Lithium • Eskalith, Lithobid
- Valproic acid • Depakene, Depakote
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
