Messages left before self-harm and their association with suicidal intent: highlights from the French-speaking Swiss program for monitoring self-harm

Suicide is a significant public health issue globally. Self-harm (SH) is major risk factors for later suicide death. The messages left by individuals who self-harm provide insight into important information about the psychopathological state they are in, and help us to better identify the seriousness of their episode, and possibly its suicidal intent. The study tests the association between suicidal message modality and sociodemographic variables. The study focus on the association between message modality and level of suicidal intent. Data were obtained from the French-speaking Swiss Programme for monitoring self-harm, including 2341 episodes of SH (N = 2012 participants) by individuals aged 18 and older to emergency departments. The data were obtained during clinical interviews conducted as part of the usual practice. Sociodemographic and clinical data were analyzed using t-tests, Chi-Square tests, and Bayesian model comparisons. Of 2341 episodes, 1100 (47%) involved a message, while 1241 (53%) did not. Common messages were oral statements (14.3%), SMS (7.3%), phone calls (6.4%), and handwritten letters (5.7%). No significant gender differences were observed. Intentionality and severity/lethality level was higher for letters than for other messages. Individuals leaving handwritten letters were older and more likely to have clear suicidal intent (79.3%) compared to those leaving electronic messages (55.5%), oral statements (43.4%), or no messages (48.7%). Leaving handwritten letters are associated with higher suicidal intent and severity/lethality level compared to other modalities. Understanding message modalities can inform clinical care strategies. Further research should qualitatively examine message content (e.g. thematic/content analysis).