CONTEXT AND OBJECTIVE: Knowledge of socioeconomic impact of attempted suicide may sensitize managers regarding prevention strategies. There are no published data on this in Brazil. The aim here was to describe the direct and indirect costs of care of hospitalized cases of attempted suicide and compare these with the costs of acute coronary syndrome cases. DESIGN AND SETTING: Cost-of-illness study at a public university hospital in Brazil. METHOD: The costs of care of 17 patients hospitalized due to attempted suicide were compared with those of 17 acute coronary syndrome cases at the same hospital, over the same period. The direct costs were the summation of the hospital and out-of-hospital costs resulting from the event, determined from the medical records. The indirect costs were estimated through the human capital lost. The Mann-Whitney test and analysis of covariance (ANCOVA) with transformation adjusted for age were used for comparisons. RESULTS: The average costs per episode of attempted suicide were: direct cost, US$ 6168.65; indirect cost, US$ 688.08; and total cost, US$ 7163.75. Comparative analysis showed a difference between the indirect costs to family members, with significantly higher costs in the attempted suicide group (P = 0.0022). CONCLUSION: The cost of care relating to attempted suicide is high and the indirect cost to family members reinforces the idea that suicidal behavior not only affects the individual but also his social environment. © 2015, Associacao Paulista de Medicina. All right reserved.1333218226http://www.who.int/whr/2003/en/, World Health Organization. World health report. The world health report 2003–shaping the future. Available from, Accessed in 2014 (Jul 24)Kerkhof, A., Calculating the burden of disease of suicide, attempted suicide, and suicide ideation by estimating disability weights (2012) Crisis, 33 (2), pp. 63-65McDaid, D., Kennely, B., An economic perspective on suicide across the five continents (2009) Oxford Textbook of Suicidology and Suicide Prevention: A Global Perspective, pp. 359-367. , In: Wasserman D, Wasserman C, editors, New York: Oxford University PressCastro, J.D., Instrumentos Para Avaliação Econômica Dos Serviços De Saúde, , http://www.ans.gov.br/portal/upload/forum_saude/forum_bibliografias/financiamentodosetor/EE%202%20Instrumentos%20para%20Avaliação%20Econômica%20dos%20Serviços%20de%20Saúde.pdf, Available from, Accessed in 2014 (Jul 24)Smith, K., Shah, A., Wright, K., Lewis, G., The prevalence and costs of psychiatric disorders and learning disabilities (1995) Br J Psychiatry, 166 (1), pp. 9-18Drummond, M.F., O’Brian, B., Stodddart, G.L., Torranca, G.W., (1997) Methods for the Economic Evaluation of Health Care Programmes, , 2, nd, ed. Oxford: Oxford Medical PublicationsDrummond, M.F., Pang, F., Transferability of economic evaluation results (2001) Economic Evaluation in Health Care: Merging Theory with Practice, pp. 256-276. , In: Drummond M, McGuirre A, editors, New York: Oxford University PressMurray, C.J., Evans, D.B., Acharya, A., Baltussen, R.M., Development of WHO guidelines on generalized cost-effectiveness analysis (2000) Health Econ, 9 (3), pp. 235-251Hutubessy, R.C., Van Tulder, M.W., Vondeling, H., Bouter, L.M., Indirect costs of back pain in the Netherlands: A comparison of the human capital method with the friction cost method (1999) Pain, 80 (1-2), pp. 201-207Singh, B., Hawthorne, G., Vos, T., The role of economic evaluation in mental health care (2001) Aust N Z J Psychiatry, 35 (1), pp. 104-117Evans, D.B., Edejer, T.T., Adam, T., Lim, S.S., Methods to assess the costs and health effects of interventions for improving health in developing countries (2005) BMJ, 331 (7525), pp. 1137-1140Lovisi, G.M., Santos, S.A., Legay, L., Abelha, L., Valencia, E., Análise epidemiológica do suicídio no Brasil entre 1980 e 2006 [Epidemiological analysis of suicide in Brazil from 1980 to 2006] (2009) Rev Bras Psiquiatr, 31, pp. S86-S94Värnik, P., Suicide in the world (2012) Int J Environ Res Public Health, 9 (3), pp. 760-771http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sim/cnv/ext10uf.def, Brasil. Ministério da Saúde. Datasus Tecnologia da Informação a Serviço do SUS. Óbitos por causas externas - Brasil, 2011. Available from, Accessed in 2014 (Jul 24)Griffith, E.E., Bell, C.C., Recent trends in suicide and homicide among blacks (1989) JAMA, 262 (16), pp. 2265-2269Knox, K.L., Conwell, Y., Caine, E.D., If suicide is a public health problem, what are we doing to prevent it? (2004) Am J Public Health, 94 (1), pp. 37-45Knox, K.L., Caine, E.D., Establishing priorities for reducing suicide and its antecedents in the United States (2005) Am J Public Health, 95 (11), pp. 1898-1903Cerqueira, D., Carvalho, A., Lobão, W., Rodrigues, R.I., Análise Dos Custos E conseqüências Da violência No Brasil, , http://www.ipea.gov.br/portal/images/stories/PDFs/TDs/td_1284.pdf, Brasília: IPEA2007. Available from, Accessed in 2014 (Jul 24)O’Dea, D., Tucker, S., (2005) The Cost of Suicide to Society, , Wellington: Ministry of HealthCzernin, S., Vogel, M., Flückiger, M., Cost of attempted suicide: A retrospective study of extent and associated factors (2012) Swiss Med Wkly, 142Palmer, C.S., Revicki, D.A., Halpern, M.T., Hatziandreu, E.J., The cost of suicide and suicide attempts in the United States (1995) Clinical Neuropharmacology, 18, pp. S25-S33. , http://journals.lww.com/clinicalneuropharm/Abstract/1995/18003/The_Cost_of_Suicide_and_Suicide_Attempts_in_the.4.aspx, Available from, Accessed in 2014 (Jul 24)Clayton, D., Barcel, A., The cost of suicide mortality in New Brunswick, 1996 (1999) Chronic Dis Can, 20 (2), pp. 89-95Kennelly, B., The economic cost of suicide in Ireland (2007) Crisis, 28 (2), pp. 89-94Law, C.K., Yip, P.S., Chen, Y.Y., The economic and potential years of life lost from suicide in Taiwan, 1997-2007 (2011) Crisis, 32 (3), pp. 152-159Luna, G.K., Kendal, K., Pilcher, S., Copass, M., Herman, C., The medical and social impact of nonaccidental injury (1988) Arch Surg, 123 (7), pp. 825-827Yeo, H.M., The cost of treatment of deliberate self-harm (1993) Arch Emerg Med, 10 (1), pp. 8-14Runeson, B., Wasserman, D., Management of suicide attempters: What are the routines and the costs? (1994) Acta Psychiatr Scans, 90 (3), pp. 222-228D’Mello, D.A., Finkbeiner, D.S., Kocher, K.N., The cost of antidepressant overdose (1995) Gen Hosp Psychiatry, 17 (6), pp. 454-455Yip, P.S., Chiu, L.H., Teenage attempted suicide in Hong Kong (1998) Crisis, 19 (2), pp. 67-72Byford, S., Harrington, R., Torgerson, D., Cost-effectiveness analysis of a home-based social work intervention for children and adolescents who have deliberately poisoned themselves. Results of a randomised controlled trial (1999) Br J Psychiatry, 174, pp. 56-62O’Sullivan, M., Lawlor, M., Corcoran, P., Kelleher, M.J., The cost of hospital care in the year before and after parasuicide (1999) Crisis, 20 (4), pp. 178-183Kapur, N., House, A., Creed, F., General hospital services for deliberate self-poisoning: An expensive road to nowhere? (1999) Postgrad Med J, 75 (888), pp. 599-602Kapur, N., House, A., Creed, F., Cost of antidepressant overdose: A preliminary study (1999) Br J Gen Pract, 49 (446), pp. 733-734Ramchandani, P., Murray, B., Hawton, K., House, A., Deliberate self poisoning with antidepressant drugs: A comparison of the relative hospital costs cases of overdose of tricyclics with those of selective-serotonin re-uptake inhibitors (2000) J Affect Disord, 60 (2), pp. 97-100Kapur, N., House, A., Dodgson, K., May, C., Creed, F., Hospital management and costs of antidepressant overdose: Multicentre comparison of tricyclic antidepressants and selective serotonin reuptake inhibitors (2001) Journal of Medical Economics, 4 (1-4), pp. 193-197. , http://informahealthcare.com/doi/abs/10.3111/200104193197, Available from, Accessed in 2014 (Jul 24)Kapur, N., House, A., May, C., Creed, F., Service provision and outcome for deliberate self-poisoning in adults--results from a six-centre descriptive study (2003) Soc Psychiatry Psychiatr Epidemiol, 38 (7), pp. 390-395Shahid, M., Khan, M.M., Naqvi, H., Razzak, J., Cost of treatment of deliberate self-harm. A study from Pakistan (2008) Crisis, 29 (4), pp. 213-215Sut, N., Memis, D., Intensive care costs of acute poisoning cases (2008) Clin Toxicol (Phila), 46 (5), pp. 457-460Serinken, M., Karcioglu, O., Sengul, C., Turcuer, I., Keysan, M.K., Hospital costs of managing deliberate self-poisoning in Turkey (2008) Med Sci Monit, 14 (3)Rodrigues, R.I., Cerqueira, D., Carvalho, A.X., Lobão, W., Custo Da violência Para O Sistema público De saúde No Brasil, , http://www.ipea.gov.br/portal/images/stories/PDFs/TDs/td_1295.pdf, Brasília: IPEA2007. Available from, Accessed in 2014 (Jul 24)Pietro, D., Tavares, M., Fatores de risco para suicídio e tentativa de suicídio: Incidência, eventos estressores e transtornos mentais [Risk factors for suicide and suicide attempt: Incidence, stressful events and mental disorders] (2005) J Bras Psiquiatr, 54 (2), pp. 146-154Rapelli, C.B., (2001) Tentativas De suicídio Com Risco De Vida: Intencionalidade Suicida, Letalidade médica E análise De Agrupamento [Thesis], , Campinas: Faculdade de Ciências Médicas da Universidade Estadual de CampinasRapeli, C.B., Botega, N.J., Perfis clínicos de indivíduos que fizeram tentativas graves de suicídio internados em um hospital universitário: Análise de agrupamento [Clinical profiles of serious suicide attempters consecutively admitted to a university-based hospital: A cluster analysis study] (2005) Rev Bras Psiquiatr, 27 (4), pp. 285-289Hasley, J.P., Ghosh, B., Huggins, J., A review of “suicide intent” within the existing suicide literature (2008) Suicide Life Threat Behav, 38 (5), pp. 576-591(2011), http://www.who.int/cardiovascular_diseases/publications/atlas_cvd/en/, World Health Organization. World Health Federation. World Stroke Organization. Global atlas on cardiovascular diseases prevention and control. Policies, strategies and interventions. Geneva: World Health Organization, Available from, Accessed in 2014 (Jul 24)Elnour, A.A., Harrison, J., Lethality of suicide methods (2008) Inj Prev, 14 (1), pp. 39-45Rosen, D.H., The serious suicide attempt. Five-year follow-up study of 886 patients (1976) JAMA, 235 (19), pp. 2105-2109Beck, A.T., Shuyler, D., Herman, I., Development of suicidal intent scale (1974) The Prediction of Suicide, pp. 45-56. , In: Beck AT, Resnick HIP, Lettiari DJ, editors, Philadelphia: Charles PressGRACE Investigators, Rationale and design of the GRACE (Global Registry of Acute Coronary Events) Project: A multinational registry of patients hospitalized with acute coronary syndromes (2001) Am Heart J, 141 (2), pp. 190-199Botega, N.J., Cano, F.O., Kohn, S.C., Tentativa de suicídio e adesão ao tratamento: Um estudo descritivo em hospital geral [Attempted suicide and treatment compliance: a descriptive study in the general hospital] (1995) J Bras Psiquiatr, 44 (1), pp. 19-25Sheehan, D.V., Lecrubier, Y., Sheehan, K.H., The Mini-International Neuropsychiatric Interview (M.I.N.I): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD- 10 (1998) J Clin Psychiatry, 59, pp. 22-33. , quiz 34-57Amorim, P., Mini-International Neuropsychiatric Interview (MINI): Validação de entrevista breve para diagnóstico de transtornos mentais [Mini-International Neuropsychiatric Interview (MINI): Validation of a short structured diagnostic psychiatric interview] (2000) Rev Bras Psiquiatr, 22 (3), pp. 106-115Cho, D.Y., Tsao, M., Lee, W.Y., Chang, C.S., Socioeconomic cost of open surgery and gamma knife radiosurgery for benign cranial base tumors (2006) Neurosurgery, 58 (5), pp. 866-873. , discussion 866-73Guh, S., Xingbao, C., Poulos, C., Comparison of cost-of-illness with willingness-to-pay estimates to avoid shigellosis: Evidence from China (2008) Health Policy Plann, 23 (2), pp. 125-136http://www4.bcb.gov.br/pec/conversao/conversao.asp, Banco Central do Brasil. Conversão de moedas. Available from, Accessed in 2014 (Jul 24)Conover, W.J., (1999) Practical Nonparametric Statistics, , 3rd ed. New York: John Wiley and Sons IncTeich, V., Araujo, D.V., Estimativa de custo da síndrome coronariana aguda no Brasil [Estimated cost of acute coronary syndrome in Brasil] (2011) Rev Bras Cardiol (Impr), 24 (2), pp. 85-94Fleischmann, A., Bertolote, J.M., Wasserman, D., Effectiveness of brief intervention and contact for suicide attempters: A randomized controlled trial in five countries (2008) Bull World Health Organ, 86 (9), pp. 703-709