Suicidio

Attempted Suicide
Do We Understand the Patients’ Reasons?
Ulrich Schnyder, M.D., Ladislav Valach, Ph.D., Kathrin Bichsel, M.D., and
Konrad Michel, M.D.
Abstract: This explorative study compared the patients’, doctors’, and nurses’ views regarding their attribution of reasons
for attempting suicide and the patients’ emotional state immediately preceding their suicide attempts. A sample of 30out of
94 consecutive patients seen in the emergency room of University Hospital were examined shortly after they had attempted
suicide. Immediately after the routine clinical interview, conducted by a psychiatric resident and a nurse, patients filled in
a questionnaire giving 14 possible reasons for attempting suicide as well as 8 feelings characterizing the emotional state
preceding thesuicide attempt. In the meantime, and without
prior discussion of the case, the resident and the nurse independently completed the same questionnaire. In addition, sociodemographic and clinical data were obtained. Intrapersonal
reasons such as to get relief from a terrible state of mind or from
an unbearable situation were most frequently chosen by patients, nurses, and doctors alike. The moststriking difference
was found for “loss of control”: this item was chosen significantly more often by patients than by nurses and doctors.
Accordingly, patients reported significantly more often feelings
of anxiety/panic and emptiness (mental vacuum), whereas feelings of despair and powerlessness/hopelessness were mentioned
most frequently by nurses and doctors. Mental health professionals shouldbear in mind that many suicide attempters
experience feelings of anxiety/panic prior to their suicidal act,
and that a majority report having lost control over themselves,
thus indicating a state of emotional crisis. © 1999 Elsevier
Science Inc.

Introduction
Assessment of the risk for suicide is known to be a
difficult task involving many uncertainties [1–3],
and the reliability ofpsychiatrists’ predictions of a

Psychiatric Outpatient Department, University Hospital, Zurich, Switzerland.
Address reprint requests to: Dr. Ulrich Schnyder, M.D., Psychiatric Outpatient Department, University Hospital, Culmannstrasse 8, 8091 Zurich, Switzerland.

62
ISSN 0163-8343/99/$–see front matter
PII S0163-8343(98)00064-4

patient’s potential for suicide has been questioned
[4].Emergency rooms can be stressful workplaces
and thus may not always provide ideal circumstances for a proper assessment. It has been shown
that work stress has negative effects on the attitudes
of emergency personnel towards suicide attempters
[5]. Patients who are seen repeatedly after deliberate self-poisoning are often met by an indifferent or
negative attitude [6,7]. Among relatives andpartners of suicide attempters, ambivalence about helping the patient and aggressive feelings towards
them are common [8,9]. Knowledge about suicide is
associated with a more understanding attitude towards suicide attempters [10,11]. However, therapeutic interventions of emergency personnel are
experienced as helpful when suicide attempters are
listened to and met with an empathic attitude: inthis respect, nurses and social workers appear to be
more helpful than doctors [12–15].
Not all suicide attempters consider dying as their
primary goal: other reasons such as the wish to
escape from an unbearable situation or to get relief
from a terrible state of mind may be more prevalent
[16 –18]. Among professionals there is a tendency to
consider suicidal behavior as “manipulative.”Bancroft et al. [19] distinguished between suicidal and
nonsuicidal (expressive, instrumental, communicative, and excuse) reasons for taking overdoses.
Overall, they found little relationship between patients’ and psychiatrists’ choice of reasons. The
most striking disagreement was found for the two
reasons chosen most commonly by the psychiatrists, i.e., communicating hostility and aiming at...