Vol. 142 No. 2930 (2012)
Cost of attempted suicide: a retrospective study of extent and associated factors
- Stephanie Czernin
- Marc Vogel
- Matthias Flückiger
- Flavio Muheim
- Jean-Claude Bourgnon
- Miko Reichelt
- Martin Eichhorn
- Anita Riecher-Rössler
- Gabriela Stoppe
QUESTIONS UNDER STUDY: Suicidal behaviour is a major source of burden of disease. While most studies focus on cost associated with completed suicides, data on costs of, non-lethal, suicide attempts are lacking. The aim of this study was to assess direct annual cost of suicide attempts in Basel in 2003 from a health services perspective.
METHODS: Retrospective cost-of-illness-study of the Basel cohort of the 2003 WHO/EURO-Multicentre Study on Parasuicide. We extracted cost information from the two major hospitals involved in treatment of these patients. We determined overall cost, compared cost medians and identified variables associated with higher cost by means of logistic regression.
RESULTS: For 2003, treatment of suicide attempters in Basel’s main hospitals amounted to 3,373,025 Swiss Francs (CHF), mainly attributable to psychiatric care. Mean and median cost per case were 19,165 CHF and 6,108 CHF, respectively. Based on these findings, the extrapolated direct medical costs for medical treatment of suicide attempts in Switzerland per year amount to 191 million CHF. Parameters associated with high costs were age above 65 (p<0.01), using a hard method (p<0.05), receiving intensive care (p<.05), and lethal intention (p<0.05). The ICD-10 diagnostic category F3 was associated with significantly higher costs than F1 (p<0.05) and F4 (p<0.05).
CONCLUSIONS: Attempted suicide produces substantial direct medical costs, which are only a part of the financial burden. Prevention targeting mood disorders, the elderly and the use of hard methods may be most cost-effective. Further research should aim at identifying additional indirect costs and the cost-effectiveness of prevention measures.
- Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL (eds). Global burden of disease and risk factors. New York, NY: Oxford University Press; Washington, DC: World Bank; 2006.
- World Health Organization. SUPRE Prevention of suicidal behaviours: a task for all. 2012 [cited 2012 June 22nd]; Available from: http://www.who.int/mental_health/prevention/suicide/information/en/index.html.
- Knox KL, Caine ED. Establishing priorities for reducing suicide and its antecedents in the United States. Am J Public Health. 2005;95:1898–903.
- Schopper D, Pereira J, Torres A, Cuende N, Alonso M, Baylin A, et al. Estimating the burden of disease in one Swiss canton: what do disability adjusted life years (DALY) tell us? Int J Epidemiol. 2000;29:871–77.
- Beautrais A, Mishara B. World Suicide Prevention Day--September 10, 2007: "suicide prevention across the life span". Crisis. 2007;28:57–60.
- Bertolote JM, Fleischmann A, De Leo D, Bolhari J, Botega N, De Silva D, et al. Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey. Psychol Med. 2005;35:1457–65.
- Kuo WH, Gallo JJ. Completed suicide after a suicide attempt. Am J Psychiatry. 2005;162:633.
- Kessler RC, Berglund P, Borges G, Nock M, Wang PS. Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990-1992 to 2001-2003. JAMA. 2005;293:2487–95.
- Angst J, Degonda M, Ernst C. The Zurich Study: XV. Suicide attempts in a cohort from age 20 to 30. Eur Arch Psychiatry Clin Neurosci. 1992;242:135–41.
- Rey Gex C, Narring F, Ferron C, Michaud PA. Suicide attempts among adolescents in Switzerland: prevalence, associated factors and comorbidity. Acta Psychiatr Scand. 1998;98:28–33.
- Michel K, Knecht C, Kohler I, Sturzenegger M. Suizidversuche in der Agglomeration Bern [Attempted suicide in the Bern region]. Schweiz Med Wochenschr. 1991;121:1133–39.
- Swiss Federal Office of Public Health. Suizid und Suizidprävention in der Schweiz: Bericht in Erfüllung des Postulates Widmer (02.3251) [Suicide and suicide prevention in Switzerland: report in answer to the Widmer postulate (02.3251)]. 2005. Swiss Federal Office of Public Health. Accessed 5 November 2010. Available from: http://www.bag.admin.ch/themen/medizin/00683/01915/index.html.
- Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Joyce PR, et al. Prevalence of suicide ideation and suicide attempts in nine countries. Psychol Med. 1999;29:9–17.
- Clayton D, Barcelo A. The cost of suicide mortality in New Brunswick, 1996. Chronic Dis Can. 1999;20:89–95.
- Goldsmith SK, Committee on Pathophysiology and Prevention of Adolescent and Adult Suicide, Institute of Medicine (U.S.). Reducing suicide: a national imperative. Washington, DC: National Academies Press; 2002.
- Runeson B, Wasserman D. Management of suicide attempters: what are the routines and the costs? Acta Psychiatr Scand. 1994;90:222–28.
- Kennelly B, Ennis J, O'Shea E. Economic cost of suicide and deliberate self harm. Reach out. National strategy for action on suicide prevention 2005–2014. 2005, Dublin. Department of Health and Children.
- O'Dea D, Tucker S. The Cost of Suicide to Society. 2005, Wellington. Ministry of Health.
- Swiss Federal Statistical Office: Structure of the resident permanent population by cantons 1999–2009. Accessed March 5, 2012. Available from: http://www.bfs.admin.ch/bfs/portal/de/index/themen/01/22/lexi.Document.20567.xls.
- Schmidtke A, Bille-Brahe U, DeLeo D, Kerkhof A, Bjerke T, Crepet P, et al. Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989-1992. Results of the WHO/EURO Multicentre Study on Parasuicide. Acta Psychiatr Scand. 1996;93:327–38.
- World Health Organization. The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. Geneva: World Health Organization; 1993.
- Hulten A, Jiang GX, Wasserman D, Hawton K, Hjelmeland H, De Leo D, et al. Repetition of attempted suicide among teenagers in Europe: frequency, timing and risk factors. Eur Child Adolesc Psychiatry. 2001;10:161–69.
- Steffen T, Maillart A, Michel K, Reisch T. Final report on monitoring of suicidal behavior in the Bern agglomeration of the years 2004 to 2010 in the context of the WHO/MONSUE Multicentre Study on Suicidal Behaviour and the Bernese Alliance against Depression [Abschlussbericht Monitoring des suizidalen Verhaltens in der Agglomeration Bern der Jahre 2004 bis 2010 im Rahmen der WHO/MONSUE Multicentre Study on Suicidal Behaviour und des Berner Bündnisses gegen Depressionen]. 2011, Bern. Swiss Federal Office of Public Health. Accessed March 5, 2012. Available from: http://www.bag.admin.ch/themen/medizin/00683/03923/index.html.
- Gini C. Variabilità e mutabilità [Variability and Mutability]. 1912
- Royston P, Altman DG, Sauerbrei W. Dichotomizing continuous predictors in multiple regression: a bad idea. Stat Med. 2006;25:127–41.
- Beck K, Trottmann M, Käser U, Keller B, Zweifel P. Nachhaltige Gestaltung des Risikoausgleichs in der Schweizer Krankenversicherung [Sustainable Risk Adjustment in Swiss Mandatory Health Insurance]. Bern: h.e.p. Verlag; 2006.
- Sinclair JM, Gray A, Rivero-Arias O, Saunders KE, Hawton K. Healthcare and social services resource use and costs of self-harm patients. Soc Psychiatry Psychiatr Epidemiol. 2011;46:263–71.
- Conwell Y, Duberstein PR, Caine ED. Risk factors for suicide in later life. Biol Psychiatry. 2002;52:193-204.
- Dennis MS, Wakefield P, Molloy C, Andrews H, Friedman T. A study of self-harm in older people: mental disorder, social factors and motives. Aging Ment Health. 2007;11:520–25.
- Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry. 2002;159:909–16.
- Baltes PB, Mayer KU. The Berlin aging study: aging from 70 to 100. Cambridge: Cambridge University Press; 1999.
- Juurlink DN, Herrmann N, Szalai JP, Kopp A, Redelmeier DA. Medical illness and the risk of suicide in the elderly. Arch Intern Med. 2004;164:1179–84.
- Stoppe G, Sandholzer H, Huppertz C, Duwe H, Staedt J. Family physicians and the risk of suicide in the depressed elderly. J Affect Disord. 1999;54:193–98.
- Hegerl U, Althaus D, Schmidtke A, Niklewski G. The alliance against depression: 2-year evaluation of a community-based intervention to reduce suicidality. Psychol Med. 2006;36:1225–33.
- Shaffer D, Gould MS, Fisher P, Trautman P, Moreau D, Kleinman M, et al. Psychiatric diagnosis in child and adolescent suicide. Arch Gen Psychiatry. 1996;53:339–48.
- Hawton K, Houston K, Haw C, Townsend E, Harriss L. Comorbidity of axis I and axis II disorders in patients who attempted suicide. Am J Psychiatry. 2003;160:1494–500.
- Yen S, Shea MT, Pagano M, Sanislow CA, Grilo CM, McGlashan TH, et al. Axis I and axis II disorders as predictors of prospective suicide attempts: findings from the collaborative longitudinal personality disorders study. J Abnorm Psychol. 2003;112:375–81.
- Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry. 1999;56:617–26.
- Suominen KH, Isometsa ET, Henriksson MM, Ostamo AI, Lonnqvist JK. Inadequate treatment for major depression both before and after attempted suicide. Am J Psychiatry. 1998;155:1778–80.
- Hegerl U, Wittmann M, Arensman E, Van Audenhove C, Bouleau JH, Van Der Feltz-Cornelis C, et al. The 'European Alliance Against Depression (EAAD)': a multifaceted, community-based action programme against depression and suicidality. World J Biol Psychiatry. 2008;9:51–8.
- Denning DG, Conwell Y, King D, Cox C. Method choice, intent, and gender in completed suicide. Suicide Life Threat Behav. 2000;30:282–88.
- Bermejo I, Kriston L, Berger M, Harter M. Patients' language proficiency and inpatient depression treatment in Baden-Wurttemberg (South Germany). Psychiatr Serv. 2009;60:545–48.
- White JB. Turks in the New Germany. American Anthropologist. 1997;99:754–69.
- Gulfi A, Castelli Dransart DA, Heeb JL, Gutjahr E. The impact of patient suicide on the professional reactions and practices of mental health caregivers and social workers. Crisis. 2010;31:202–10.