Intensity and density of stressful life events in first suicide attempters with psychiatric morbidity and comorbidity: A case–control study

Background: Stressful life events (LEs) have been pivotal to suicidal behavior in vulnerable individuals, although its quantum and clustering have remained unclear. This study aimed to estimate and compare the quantum and clustering of LEs across three time periods, three suicide intentionality–lethality categories, and three diagnostic groups in survivors of first suicide attempt (SoFSA). Materials and Methods: One hundred SoFSA were compared to 100 age- and sex-matched controls for LEs across psychiatric and/or personality comorbidity. Presumptive Stressful LE Scale, Risk-Rescue Rating Scale, Hamilton Depression- and Anxiety-Rating Scales, and structured and semi-structured clinical interviews were administered for comprehensive mental health evaluation. Results: SoFSA with age ≥30 years, male gender, schooling <10 years, middle-lower socioeconomic class, married, extended/joint family living, family history of psychiatric disorders/suicide, and concomitant depression–anxiety exhibit significantly higher undesirable, ambiguous, and total LEs across time periods. One-way analysis of variance with post hoc analysis revealed SoFSA who attempted medically serious suicide suffered higher undesirable (F[2,97] = 4.43; P = 0.014) and total (F[2,97] = 3.39; P = 0.038) LEs during recent 6 months compared to medically nonlethal group. SoFSA diagnosed with comorbid psychiatric and personality disorders experienced higher undesirable, ambiguous, and total LEs across all time periods (P < 0.0001), compared to either disorder alone. Desirable LE did not significantly differ across all time periods and diagnostic categories, but ambiguous LE was the only significant finding among SoFSA with personality disorders. Conclusion: This study sheds newer insights that quantitative estimation (intensity and density) of LEs has a potential role in suicide-risk evaluation, with clustering of total or undesirable LE (>3 within 1 year or >10 lifetimes) and ambiguous LE (≥1 within 1 year or > 3 lifetimes) posing risk for psychiatric morbidity and medically serious suicidal behavior (especially, if lifetime total LE > 10). SoFSA with comorbid psychiatric and personality disorders experience higher intensity and density of LEs than either disorder alone, across all time periods.