The reasons people give for taking overdoses: a further inquiry

A representative sample of 41 cases of self-poisoning was studied in depth. In each case 'reasons' for taking the overdose, both stated spontaneously and chosen from a presented list, were recorded. The commonest spontaneous reason was the 'wish to die'. Nearly one-third indicated some non-suicidal purpose early in the interview and consistently denied suicidal intent subsequently. Apart from suicidal intent, reasons chosen from the list bore little resemblance to reasons that had been offered earlier in the interview and are therefore of uncertain relevance. Three psychiatric judges attributed reasons for each case based on common-sense criteria. Several reasons were seldom or never chosen by them; four were chosen frequently with good agreement, i.e. communicating hostility, influencing others, relieving a state of mind and suicidal intent. The first two were the most frequently chosen, attributed to 71 per cent and 54 per cent of cases respectively. They were the reasons chosen least frequently by the self-poisoners themselves. Of 23 (56 per cent) subjects indicating suicidal intent, 12 (29 per cent) were judged to be suicidal by psychiatrists. These were not clearly distinguishable on the basis of their original interviews, except that those judged suicidal tended to indicate suicidal intent early in the interviews. The clinical and research implications of these findings are discussed.