To the Editor: We thank Dr. Pomara for the comments on our article. We wholeheartedly agree with the importance of documenting the frequency and lethality of suicidal behavior. For each past suicide attempt, the risk of future suicidal behavior increases (1). Although low lethality attempts do not guarantee that future attempts will be of low lethality, medically dangerous attempts are an ominous indication. The notion of a sixth digit linking a diagnosis to suicidal behavior is intriguing but is perhaps less essential to the key issue, which is the systematic documentation of suicidal behavior in a clinically prominent part of a patient’s medical record such that information is not lost.
1.Oquendo MA, Bongiovi ME, Galfalvy H, Goldberg P, Ellis SP, Grunebaum MF, Burke A, Haas G, Mann JJ: Sex differences in clinical predictors of attempted suicide in major depression: a prospective study. Am J Psychiatry 2007; 164:134–141
The author’s disclosures accompany the original editorial.
This letter (doi: 10.1176/appi.ajp.2008.08111666r) was accepted for publication in December 2008.