Dans cette étude préliminaire, 124 cas consécutifs d’intoxication médicamenteuse volontaire ont été recueillis pour étudier les caractéristiques de la létalité perçue par les patients de leur geste et la relation entre létalité perçue et récidive d’une conduite suicidaire. La létalité perçue a été évaluée par une échelle visuelle analogique, l’intentionnalité suicidaire par l’échelle de Beck sur laquelle une analyse factorielle a été faite. Les scores étaient liés négativement à un geste impulsif (p<0,0001) et positivement à l’intentionnalité suicidaire (rhô_s=0,77 ; p<0,0001), en particulier dans sa dimension subjective (rhô_s=0,78 ; p<0,0001). Après un suivi de 32-38 mois, il n’a pas été constaté de lien avec la récidive (p=0,80), sauf chez les primo-suicidants (p<0,01). La très bonne acceptabilité de la mesure et sa facilité d’usage pourraient lui donner une place pour évaluer le désir de mourir dans sa dimension subjective.

Aims of this preliminary study were to assess characteristics of expected lethality by the patient at the time of a deliberate self-poisoning, and relationship between expected lethality and recurrence of suicidal related behaviour.

We included 124 consecutive cases in a prospective study and descriptive data including Beck Suicide Intent Scale (SIS) and medical lethality score. In response to “how dangerous did you think the drugs were when you took them?” patients rated on a Visual Analog Scale (VAS) from 0=would be harmless, to 10=certain to cause death. The follow-up took place 32–38 months after the patients were discharged.

Of 106 patient included, 70 were women. First-ever attempter were 31%. Fifteen per cent of the cases were medically serious. VAS mean score was 51mm (SD 26; CI 95%: 47–56), median 51.5mm (IQ 35.5). Median score was higher for men (59mm; P=0.02). High VAS scores (i.e. higher than median score) were associated with a premeditated behaviour (OR 29; P<0.0001), when low VAS scores were associated with impulsive behaviour (P<0.0001). There was no association between VAS and medical lethality (P=0.19). SIS scores were low (mean score 8.6, SD 5.3). Three factors were extracted from a factorial analysis of the SIS. Correlations between VAS and SIS, and VAS and first factor patient's subjective thoughts F1 conception were strong (rhô_s=0.77, P<0.0001; rhô_s=0.78, P<0.0001), when only moderate between VAS and F2 preparation of the behaviour second factor (rhô_s=0.50, P<0.0001), and weak between VAS and F3 precaution against discovery third factor (rhô_s=0.18, P=0.05). Fifty-seven of the index cases were followed by a further episode of suicide related behavior. We found no evidence of relationship between recurrence and expected lethality scores (P=0.80) for either men (P=0.54) or women (P=0.54), with the exception of first-ever attempter subgroup (P<0.01) where a high score was associated with recurrence (OR 5.6; P=0.01).

Expected lethality scores determined distinct populations in terms of suicidal intent and impulsivity of the behaviour. The very good acceptability of the measure and its ease to use could give it a place as part of the clinical assessing process of subjective dimension of the wish to die. For researchers this measure could help to better determine suicide related behaviours subgroups and to make comparisons between studies easier.