Suicide Trends in At-Risk Territories (START)
Component Four of START (the Follow-Up of Medically Serious Suicide Attempters) is a longitudinal study that, starting from standardized baselines and definitions, will concentrate on subjects that are most exposed to repetition of suicidal behaviour. This is an area of importance as these people have been identified as being of higher subsequent risk of suicide morbidity or mortality (Beautrais, 2003; 2004; O’Donnell, Arthur & Farmer, 1994; O’Donnell, Farmer & Catalan, 1996).
START will base the definition of medically serious non-fatal behaviour on the lethality of the chosen suicide method used (Maris, Berman & Silverman, 2000). Participants will be identified in Component One and Two of the START study through the clinical notes made about the patient in emergency departments and medical wards, as well as the Self-Inflicted Injury Severity Form (SIISF) which is contained in the START Assessment Battery. Lethality refers to the probability or medical certainty that an action, method or condition will in fact lead to a fatal outcome. For example, a high-calibre hand gun shot to the brain would have almost a 100% lethality, whereas trying to hold your breath until you die has virtually a zero lethality (Maris et al., 2000). The definition of near-lethal non-fatal suicidal behaviour are those cases where methods were used with a high case fatality ratio (Douglas et al., 2004) such as:
- hanging, drowning, self-poisoning with car exhaust fumes, or jumping from a high place;
- self injury to a vital body area such as the throat, chest or abdomen (not wrists or arms); or
- self poisoning that requires admission to an intensive care unit or is judged to be potentially lethal by a doctor (or other health care worker).