Objective and subjective suicidal intent are differentially associated with attempt lethality based on age of onset of suicidal behavior

Abstract

Predicting the medical seriousness, or lethality, of suicide attempts remains challenging for clinicians, as impulsive and planned attempts can both be fatal and risk may vary with age and suicidal intent. We investigated whether attempt lethality is driven by practical preparedness (objective suicidal intent) and/or psychological resolve (subjective suicidal intent) and whether these associations vary with age of onset of suicidal behavior. The study used a cross-sectional lifespan sample (N = 95; age range 16-76 years) with current depression and recent suicidal behavior (≤ 5 years). Linear regression models indicated that older age of onset of suicidal behavior (B = 0.86, SE = 0.20, p < 0.001), and both higher objective intent (B = 0.69, SE = 0.19, p < 0.001) and subjective intent (B = 0.50, SE = 0.20, p = 0.014) were associated with more severe lethality at the most recent attempt, although the association with subjective intent was driven by its shared portion with objective intent. The association between objective intent and lethality was stronger with older age of onset (interaction B = 0.75, SE = 0.20, p < 0.001), whereas the association between subjective intent and lethality was stronger with younger age of onset (interaction B = - 0.42, SE = 0.20, p = 0.036). Our findings suggest that contextualizing suicidal intentions with age of onset, rather than age at the current suicidal crisis, can help clinicians better appraise suicide risk.

Keywords: Age; Attempt lethality; Lifespan; Suicidal behavior; Suicidal intent; Suicide attempt.

Fig. 1

Spearman correlations between main independent variables of interest. Note: The numbers represent Spearman’s rho, and the shading indicates their magnitude and direction from − 1 (dark red) to 1 (dark blue). Correlation values marked with a star are statistically significant. Age of onset of suicidal behavior corresponds to age at the first lifetime attempt. SIS suicidal intent scale, CIRSG cumulative illness rating scale-geriatric.

Fig. 2

Objective intent-by-age of onset of suicidal behavior (left panel) and subjective intent-by-age of onset of suicidal behavior (right panel) effects from the main model for H2, predicting lethality of the most recent attempt. Note: Age of onset of suicidal behavior corresponds to the age at the first lifetime attempt. The objective and subjective suicidal intent scores were measured with the corresponding subscales of the Beck suicidal intent scale and suicidal lethality total scores with the Beck lethality scale. Points represent ß^ estimates and bars represent standard errors.