Extended suicide attempt: psychopathology, personality and risk factors

Delinquency among depressed patients plays a minor role in criminal behavior. Among the most tragic associations between depression and criminality are cases of extended suicide or suicide attempt. We studied psychopathology, personality, and psychosocial stressors of 9 Austrian females who committed a serious extended suicide attempt. They were admitted for treatment at a special department of the Justizanstalt Wien-Josefstadt, Aussenstelle Wilhelmshöhe. Patients were diagnosed according to ICD-10 as severely depressed with (n = 6) or without (n = 3) psychotic features. After stabilization we diagnosed the following personality disorders: anxious-avoidant (n = 5), paranoid (n = 1), combined (n = 1) and borderline type (n = 1). Traits of the typus melancholicus were found in 5 patients. Seven females were pretreated before the offence by a psychiatrist or a psychologist; 4 of them had committed at least one suicide attempt in the past. Main psychosocial stressors mentioned by patients in the context of the offence were overstrain, marital and/or financial problems. One female killed her child under the influence of acoustic hallucinations. Patients with traits of the melancholic type showed an altruistic and hypernomic motive for killing as well as a psychotic identification with the victim, whereas in the other cases egocentric motives were in the forefront. Potential risk factors for an extended suicide attempt will be discussed.