Non-fatal deliberate self-harm
Attempted suicide is usually an impulsive response to an intolerable social situation. For instance, attempted suicide is often provoked by a family quarrel, and the overdose serves as a dramatic expression of feelings. Perhaps it is the attitudes in society which condone this fashionable way of expressing distress that need to be better understood before today's rising suicide rates can be curtailed.
None of the many theories to explain the spectacular rise in attempted suicide rates has found general acceptance, nor led to successful experiments in primary prevention. Variations in the rates of attempted suicide across major demographic and social groups show remarkably consistent patterns, changing little over the years or from one country to another. Females outnumber males in all age groups. The overall ratio of females to males is about 1.4 to 1. It is among teenagers and young adults that the rise in rates has been most marked, reaching levels that are now many times higher than among the middle-aged and elderly. There is a steep gradient of increasing rates with lower social class. The unskilled lowest social class male group has more than eight times the rate of attempted suicide as the professional highest social class male group. Divorcees have substantially higher rates than the single, married or widowed. A large proportion of patients in most series have alcohol problems, criminal, unemployment and debt records, and a history of family violence. Half of those who attempt suicide have done so before, and one fifth will attempt it again within 12 months. Again, these figures for repetition are remarkably consistent from year to year and in different centres, as is the frequency with which suicide follows attempted suicide - 1% per annum according to many follow-up studies. Underestimation of suicide attempts is likely to be much greater than for actual suicides. Surveys in general practice in Scotland and the Netherlands showed that hospital admissions underestimated the number of cases known to general practitioners by 30%. Field studies, in which everyone in a population sample was screened, suggested that 50-60% of those who admitted to suicide attempts during the previous year had not reported the fact to a doctor. In countries where primary medical care and hospital provision is less available for these cases, the errors will be even greater.