Research on suicide method substitution between last attempted and completed suicide is scarce (five studies).

The results are conflicting (three studies report persistence and two studies report switch).

To investigate this topic studying a sample of suicide victims from Greece.

We studied all recorded cases of completed suicide of the period November 2007-October 2009 in Athens Department of Forensic Medicine. We performed phone interviews with relatives of the deceased focusing, among other topics, on the characteristics of prior attempts.

335 individuals were recorded as suicide victims: 250 men (74.7%) & 85 women (35.3%). Interviews were conducted with the relatives of 246 victims: 24% had history of prior attempts (59 cases), 39 men (66.1%) & 20 women (33.9%). Most frequent last attempted suicide methods were: self-poisoning (57.6%), jumping from a height (20.3%), wrist-cutting (15.3%) & hanging (6.8%). 74.6% of the attempters became completers using a different method (p=0.016). Individuals with previous attempt by self-poisoning or wrist-cutting died by hanging or jumping while attempters by hanging or jumping became completers primarily by the same methods.

Most of the suicide completers had never been attempters in the past. Those who had attempted with low lethality methods- committed suicide choosing a different, more lethal method. Restrictions in the availability of lethal means may result in more surviving attempters while some suicides could also be prevented because a particularly lethal method is not in hand.