Risk of re-attempts and suicide death after a suicide attempt: A survival analysis

Isabel Parra-Uribe,Oliver Valero-Coppin,Diego Palao-Vidal,Maria A Oquendo,Gemma Garcia-Parés,Luis Martínez-Naval,Hilario Blasco-Fontecilla,Annabel Cebrià-Meca

doi:10.1186/s12888-017-1317-z

Abstract

BackgroundSuicide is the primary cause of unnatural death in Spain, and suicide re-attempts a major economic burden worldwide. The risk factors for re-attempt and suicide after an index suicide attempt are different.This study aims to investigate risk factors for re-attempt and suicide after an index suicide attempt.MethodsThis observational study is part of a one-year telephone management program. We included all first-time suicide attempters evaluated in the emergency department at Parc Taulí-University Hospital (n = 1241) recruited over a five-year period (January 2008 to December 2012). Suicide attempters were evaluated at baseline using standardized instruments. Bivariate logistic regression models were used to identify risk factors. Kaplan-Meier curves were used to compare the time to re-attempt between categorical variables. Comparisons were performed using Log-Rank and Wilcoxon tests. Variables with a p-value lower than 0.2 were included in a multivariate Cox regression model. Bivariate logistic regression models were considered to identify risk factors for suicide. The significance level was set to 0.05.ResultsSuicide re-attempters were more likely diagnosed with cluster B personality disorders (36.8% vs. 16.6%; p < 0.001), and alcohol use disorders (19.8 vs. 13.9; p = 0.02). Several [1.2% (15/1241)] of them died by suicide. Attempters who suicide were more likely alcohol users (33.3% vs. 17.2%; p = 0.047), and older (50.9 ± 11.9 vs. 40.7 ± 16.0; p = 0.004).ConclusionsAlcohol use, personality disorders and younger age are risk factors for re-attempting. Older age is a risk factor for suicide among suicide attempters. Current prevention programs of suicidal behaviour should be tailored to the specific profile of each group.

Highlights

Suicide is the primary cause of unnatural death in Spain, and suicide re-attempts a major economic burden worldwide
In a systematic review of 14 cohorts (n = 21,385), Neeleman estimated that individuals with antecedents of self-harm were 25 times more likely to die by suicide than the general population [8]
The risk of suicide is higher in older patients and those individuals with a higher number of lifetime suicide attempts [12,13,14,15], counter to clinical lore about frequent attempters not being at risk for suicide because they only engage in low risk suicidal ideation and behaviour (SIB)

Summary

Introduction

Suicide is the primary cause of unnatural death in Spain, and suicide re-attempts a major economic burden worldwide. The risk factors for re-attempt and suicide after an index suicide attempt are different. This study aims to investigate risk factors for re-attempt and suicide after an index suicide attempt. Christiansen et al [10] estimated the risk of another SIB in a fiveyear follow-up study at about 31%. These authors stressed that the risk of another SIB was higher during the first two-years after the index suicide attempt. Between 1 and 6% of individuals evaluated because of a suicide attempt eventually suicide in the year following. The risk of suicide is higher in older patients and those individuals with a higher number of lifetime suicide attempts [12,13,14,15], counter to clinical lore about frequent attempters not being at risk for suicide because they only engage in low risk SIB

Methods

Results

Discussion

Conclusion