Past Suicide Attempts Research Articles

Contents of the Standardized Suicide Prevention Program for Gatekeeper Intervention in Korea, Version 2.0.

ObjectiveSuicide is a huge nationwide problem that incurs a lot of socio-economic costs. Suicide also inflicts severe distress on the people left behind. The government of the Republic of Korea has been making many policy efforts to reduce suicide rate. The gatekeeper program, ‘Suicide CARE’, is one of the meaningful modalities for preventing suicide. MethodsMultidisciplinary research team collaborated to update the ‘Suicide CARE’ to version 2.0. ResultsIn the ‘Introductory part’, the authors have the time to think about the necessity and significance of the program before conducting full-scale gatekeeper training. In the ‘Careful observation’ part, trainees learn how to understand and recognize the various linguistic, behavioral, and situational signals that a person shows before committing suicide. In the ‘Active listening’ part, trainees learn how to ask suicide with a value-neutral attitude as well listening empathetically. In the ‘Risk evaluation and Expert referral’ part, trainees learn intervening strategies to identify a person’s suicidal intention, plan, and past suicide attempts, and connect the person to appropriate institutes or services. ConclusionSubsequent studies should be conducted to verify the efficacy of the gatekeeper program.

Worldwide prevalence of suicide attempt in pregnant and postpartum women: a meta-analysis of observational studies.

Past suicide attempts (SA) are a major contributor to suicide. The prevalence of SA in pregnant and postpartum women varied significantly across studies. Therefore, this meta-analysis was conducted to examine the prevalence of SA and its mediating factors in this population. Relevant articles published in PubMed, EMBASE, Web of Science, PsycINFO, Medline complete, Chinese National Knowledge Infrastructure database (CNKI), Chinese Wanfang and Chongqing VIP database were systematically searched from inception to March 28, 2019. Titles, abstracts and full texts were reviewed independently by three researchers. Studies were included if they reported data on SA prevalence or provided relevant data that enabled the calculation of SA prevalence. Data were extracted by two researchers and checked by one senior researcher. The random-effects model was used to analyze data by the CMA 2.0 and Stata 12.0, with the high degree of statistical heterogeneity present. The primary outcomes were prevalence of SA with 95% CI during pregnancy and during the first-year postpartum. Fourteen studies covering 6,406,245 pregnant and postpartum women were included. The pooled prevalence of SA was 680 per 100,000 (95% confidence interval 0.10-4.69%) during pregnancy and 210 per 100,000 (95% confidence interval 0.01-3.21%) during the first-year postpartum. Data source was significantly associated with prevalence of SA in the subgroup analysis (pregnancy, p < 0.001; the first-year postpartum, p = 0.013). The prevalence of SA is not high in pregnant and postpartum women. Due to the potential loss of life and negative impact of SA on health outcomes, however, careful screening and effective preventive measures should be implemented for this population.

Connectome-based functional connectivity markers of suicide attempt

BackgroundFunctional brain markers of suicidality can help identify at-risk individuals and uncover underlying neurocognitive mechanism(s). Although some converging evidence has implicated dysfunction in several brain networks, suicide-related neuroimaging markers are inconsistent across studies, due to heterogeneity of neuroimaging approaches, clinical populations, and experimental methods. MethodsThe current study aimed to address these limitations by examining resting-fMRI connectivity in a sample of post-9/11 veterans with a past suicide attempt (SA; n = 16) compared to a psychiatric control group (PC; n = 124) with no SA history but comparable past and present symptomatology, as well as a trauma control group (TC; n = 66) of trauma-exposed healthy controls. We used both a novel graph-analytic and seed-based approach to characterize SA-related connectivity differences across brain networks. ResultsFirst, the graph-analytic approach identified the right amygdala and a region in the cognitive control network (right middle temporal gyrus; MTG) as regional SA-related hubs of dysfunction (HoD), or regions that exhibited a high number of SA-related connections. Aberrant SA-related connectivity between these hubs spanned multiple networks, including the cognitive control, default mode and visual networks. Second, the seed-based connectivity analysis that identifies SA-related differences in the strength of neural connections across the whole brain further implicated the right amygdala. LimitationsSmall sample size and potential underreporting of SA. ConclusionsThese two analytic approaches preliminarily suggest that the right amygdala and right MTG may be specific neural markers of SA that can be differentiated from neural markers of psychopathology more broadly.

The Prevalence and Correlates of Suicidal Ideation, Plans and Suicide Attempts among 15- to 69-Year-Old Persons in Eswatini.

The study aimed to assess the prevalence and associated factors of ever suicide attempt and past 12-month suicidal ideation, plans and/or attempts among persons aged 15–69 years in Eswatini. Cross-sectional nationally representative data from 3281 persons (33 years median age, range 15–69) of the 2014 Eswatini STEPS Survey were analysed. Results indicate that 3.6% of participants had attempted suicide, and 10.1% engaged in past 12-month suicidal ideation, plan and/or attempts. In adjusted logistic regression analysis, having family members who died from suicide and childhood sexual abuse were associated with ever suicide attempt. In addition, in unadjusted analysis, female sex, adult sexual abuse, threats and family member attempted suicide were associated with ever suicide attempt. In adjusted logistic regression, female sex, childhood sexual abuse, adult sexual abuse, threats, family alcohol problems and having family members who died from suicide were associated with past 12-month suicidal ideation, plan and/or attempts. In addition, in unadjusted analysis, 25–34-year-old participants, unemployed and other, childhood physical abuse, violent injury, family member attempted suicide and having had a heart attack, angina or stroke were associated with past 12-month suicidal ideation, plans and/or attempts. One in ten participants were engaged in suicidal ideation, plans and/or attempts in the past 12 months, and several associated factors were identified that can inform intervention programmes.

Association between neurocognitive functioning and suicide attempts in U.S. Army Soldiers

Suicide is a serious public health problem, including among U.S. Army personnel. There is great interest in discovering objective predictors of suicide and non-fatal suicidal behaviors. The current study examined the association between neurocognitive functioning and pre-military history of suicide attempts (SA) and post-enlistment onset of SA. New Soldiers reporting for Basic Combat Training (N=38,507) completed a comprehensive computerized neurocognitive assessment battery and self-report questionnaires. A subset of Soldiers (n=6216) completed a follow-up survey, including assessment of lifetime SA, 3-7 years later. Six hundred eighty-nine Soldiers indicated lifetime SA at baseline and 210 Soldiers indicated new-onset SA at follow-up. Regression analyses, adjusted for demographic variables, revealed significant bivariate associations between neurocognitive performance on measures of sustained attention, impulsivity, working memory, and emotion recognition and lifetime SA at baseline. In a multivariable model including each of these measures as predictors, poorer impulse control and quicker response times on an emotion recognition measure were significantly and independently associated with increased odds of lifetime SA. A second model predicted new-onset SA at follow-up for Soldiers who did not indicate a history of SA at baseline. Poorer impulse control on a measure of sustained attention was predictive of new-onset SA. Effect sizes are small and of unlikely clinical predictive utility. We simultaneously examined multiple neurocognitive domains as predictors of SA in a large, representative sample of new Army Soldiers. Impulsivity most strongly predicted past and future SA over and beyond other implicated cognitive-emotional domains.

Self-reported history of concussions is associated with risk factors for suicide completion among middle school students: A cross-sectional study

PurposeThis study aims to examine the relationship between self-reported history of concussion and risk factors for completed suicide among middle school students. MethodsWe analyzed state-level data from the 2017 YRBS. The study sample was n = 19,254 middle school students in 7 States: Delaware, Florida, Hawaii, Kentucky, Nevada, Rhode Island, and Virginia. We conducted multi-level, multivariate logistic regression models to assess the relationship between self-reported concussions and suicidal ideations, planned suicide attempt, and past suicide attempt. ResultsApproximately 17.8% of the sample self-reported a history of concussion. Self-reported history of concussion was significantly associated with greater odds for history of suicidal ideation (Adj OR: 1.31), planned suicide attempt (Adj OR: 1.36), and past suicide attempt (Adj OR: 1.67). ConclusionsThis is the first study to examine the relationship between self-reported concussion and risk factor for completed suicide among middle school students. Research findings mirror similar study done among high school students and young adults. Findings suggest the need to expand prevention programs, intervention strategies and education campaigns to include middle school students.

Recovery from past suicide attempts: Correlates of time since the last attempt in a national sample of US adults

BackgroundThis study takes a lifetime perspective on suicide attempts and examines correlates of years since the last attempt as a potential proxy for recovery from suicidality. MethodsData from 36,309 adults in the National Epidemiologic Survey on Alcohol and Related Conditions-III were used to identify 1,924 respondents (5.3%) who reported a lifetime suicide attempt. Measures included socio-demographics, behavioral factors, and DSM-5 diagnoses, as well as the age at first attempt. Bivariate and multivariate analyses were used to adjust for potentially confounding effects of age and to identify independent factors associated with not attempting suicide for >1-5 years or >5 years. ResultsOf those who reported a lifetime suicide attempt, 7.9% reported their most recent attempt in the past year, 18.6% within 1 to 5 years, and 73.5% in greater than 5 years. While absence of lifetime substance use disorder and past year psychiatric disorder prominently characterized those with no attempt in the past 1 to 5 years, many more sociodemographic advantages additionally characterized those whose last attempt was >5 years ago, including being older, married, employed, higher incomes, no recent homelessness or criminal justice involvement, more social contacts, as well as having less past year substance use or psychiatric disorders. LimitationsThe retrospective, self-report design introduces the possibility of recall bias. ConclusionsAlmost three-fourths of people with lifetime suicide attempts have not attempted for more than 5 years. Recovery involves not only psychiatric and substance use disorders but improvements in key socio-demographics and social connectedness over many years.

27.3 DIFFERENCES IN DAILY EXPERIENCES AMONG YOUTH SELF-INJURERS WITH AND WITHOUT A SUICIDE ATTEMPT HISTORY

The link between nonsuicidal self-injury (NSSI) and suicidal behavior is well-established. However, little research has examined those who engage in NSSI and have a suicide attempt history vs those who engage in NSSI but have never attempted suicide. The difference between these groups is important, because a past suicide attempt may alter the presentation and/or severity of NSSI, and in turn, NSSI can propagate future suicidal behavior. Therefore, the primary objective of the current investigation was to examine differences in daily experiences among youth who engage in NSSI and either have a suicide attempt history or do not.

Correlates and predictors of suicidal ideation and substance use among adults seeking substance use treatment with varying levels of suicidality

•Suicidality rates are high among adults seeking substance use disorder treatment. •Suicidality groups differed in demographics, substance use, and health indicators. •Suicidality groups did not differ in drug/alcohol toxicology outcomes throughout treatment. •Adults with recent suicidal ideation did not maintain reductions in severity of alcohol problems at 6-months post-treatment. •Adults with past suicide attempts showed less improvement in drug use severity from post-treatment to 6 months post-treatment.

Factors affecting medication assisted treatment success for opioid use disorder

Abstract Background In the United States (US) when opioid use disorder (OUD) is treated with medication assisted treatment (MAT), many patients in MAT will relapse into active opioid use during the recovery process. About 23% drop out of treatment within 3 months, and 40-50% drop out within 6 months of MAT start. Using the Anderson and Newman (2005) Framework for Health Services Utilization, 27 variables reflecting predisposing, enabling, and need factors were used to examine the impact on the number of days patients were retained in treatment. Methods One MAT clinic in rural Michigan used random sample of archival records (n = 390) OUD patients (DSM-V-TR code 304.00, ICD-10 code F11.20) between Jan. 1, 2014 and Nov. 21, 2018 with prescribed buprenorphine as part of MAT program. The first set of linear regressions (backward elimination) defined significant variables for each factor, and the final model included significant variables to predict length of retention in MAT. Results The first step identified legal issues (predisposing), MSHN insurance, distance to clinic, ability to drive, mental health diagnosis, and homelessness (enabling factors); Zung self-reporting depression score, starting dose, past suicide attempt, Hep-C status, and method of use (needs factor) as statistically significant to be used in the final model, controlling for age and gender. Starting dose (unstandardized b = 136.8, 95%CI 98.0, 175.6), driving license (b = 68.3, CI 13.2, 123.4), distance to clinic (b=-1.1, CI -2.2, -0.5) had statistical impact on the length of stay in MAT. Discussion This case study identified enabling factors (starting dose and access to clinic) affecting length of participation in MAT. Other factors warranting provider attention were identified for rural OUD patients. Conclusions Evidence based guidelines for starting doses are needed to increase MAT effectiveness. MAT services should consider distance to clinic as a factor of successful treatment. Key messages Evidence based guidelines for starting doses are needed to increase MAT effectiveness. Opiood treatment services should consider distance to clinic as a factor of successful treatment.

Validation and Feasibility of the ASQ Among Pediatric Medical and Surgical Inpatients

To validate the use of a brief suicide risk screening tool, the Ask Suicide-Screening Questions (ASQ) instrument, in pediatric inpatient medical and surgical settings. Pediatric patients (10-21 years) hospitalized on inpatient medical and surgical units were recruited through convenience sampling for participation in a cross-sectional instrument validation study. The Suicidal Ideation Questionnaire was used as a standard criterion to validate the ASQ. Patient opinions about screening and parent consent to enroll in a suicide risk screening study were assessed to determine the feasibility of administering the ASQ in this venue. A total of 600 pediatric medical inpatients were screened. Compared with the gold standard, the ASQ had strong psychometric properties, with a sensitivity of 96.67% (95% confidence interval [CI]: 82.78 to 99.92), a specificity of 91.05% (95% CI: 88.40 to 93.27), a negative predictive value of 99.81% (95% CI: 98.93 to 99.99), and an area under curve of 0.94 (95% CI: 0.90 to 0.97). Only 3 participants (0.5%) had acute positive screen results on the ASQ, endorsing current suicidal ideation, whereas 77 participants (12.8%) screened nonacute positive, and 48 participants (8.0%) reported a past suicide attempt. The brief 4-item ASQ is a valid tool to detect elevated suicide risk in pediatric medical and surgical inpatients. Our findings also reveal that screening is feasible in terms of detection of suicidal thoughts and behaviors and is acceptable to parents and patients.

Suicide ideation versus suicide attempt: Examining overlapping and differential determinants in a large cohort of patients with depression and/or anxiety.

Individuals with a depressive and/or anxiety disorder are known to have an elevated risk of suicide. However, these diagnoses alone are insufficient at differentiating patients with suicide ideation that attempt suicide from those that do not. Few studies examined such differences in an ideation-to-action framework. Using this framework, extensive multivariate testing was performed to examine differences between suicidal patients with and without a suicide attempt. Data were from 1576 respondents with a depressive and/or anxiety disorder, participating in the Netherlands Study of Depression and Anxiety. Logistic regression analyses were used to analyze associations between sociodemographic, clinical, personality, and psychosocial risk factors and suicide ideation and attempt. Patients with suicide ideation could be uniquely distinguished from non-suicidal patients by more years of education, presence of a depressive disorder (vs anxiety disorder) and higher introversion. Patients with suicide ideation and a past suicide attempt could be uniquely distinguished from non-suicidal patients by a younger age of onset, a lifetime alcohol use disorder, more external locus of control and lower levels of social support. Within the group of patients with suicide ideation, patients with a suicide attempt were more likely to have childhood trauma and lower education, and be of non-Western descent than patients with suicide ideation and no past attempt. This study found that although various clinical, personality and psychosocial characteristics distinguish patients with suicide ideation from non-suicidal patients, many of these often-cited factors do not distinguish patients with a suicide attempt from those who only think about suicide. However, childhood trauma, lower education and non-Western descent could aid in detecting suicide attempt risk among patients with suicide ideation.

State Anhedonia and Suicidal Ideation in Adolescents.

Background: Recent work suggests that state anhedonia and its social aspect of loss of interest in people was an important predictor of suicidal ideation in adults. Aim: The current study investigated the relationship between state anhedonia, trait anhedonia, suicidal ideation, and suicide attempts in adolescents. Method: State anhedonia was assessed using the anhedonia subscale from the Child Mood and Feelings Questionnaire, while trait social anhedonia was assessed using the Adolescent Anticipatory and Consummatory Interpersonal Pleasure Scale and the Temporal Experience of Pleasure Scale. Results: Results indicated that state anhedonia was associated with suicidal ideation but not associated with past suicide attempts after controlling for depressive symptoms. Academic stressful events moderated the relationship between state anhedonia and suicidal ideation. Symptom-level analyses revealed that loss of interest in friends was most highly predictive of suicidal ideation compared with the other anhedonia components. Limitations: The current investigation was limited by its reliance on student samples and data from a single time point. Conclusion: The current study indicated that state anhedonia and its social component may be more informative of near-term suicidal ideation than trait anhedonia in adolescents.

Violence victimization and suicide attempts among adolescents aged 12–15 years from thirty-eight low- and middle-income countries

ObjectiveThe association between violence victimization and suicide attempts in a large representative sample of adolescents from low- and middle-income-countries (LMICs) of multiple continents has never been investigated. Therefore, the aim of the present study was to examine the relationship between being a victim of physical attacks (independent variable) and suicide attempts (dependent variable) in a sample of 117,472 students aged 12–15 years [mean (SD) age 13.8 (0.9) years; girls 49.4%] from thirty-eight LMICs in Africa, the Americas, and Asia. MethodsCross-sectional data from the Global School-based Student Health Survey (GSHS) were analyzed. Self-reported data on past 12-month suicide attempts and exposure to physical attacks were collected. Logistic regression and meta-analysis were conducted. ResultsThe overall prevalence of suicide attempts and physical attacks were 10.1% and 39.4%, respectively. Overall, the results of the meta-analysis based on country-wise estimates adjusted for potential confounders (i.e., age, sex, food insecurity, alcohol consumption, bullying victimization, anxiety-induced sleep problems, low parental support/involvement, loneliness) showed that physical attacks were associated with a 1.71 (95%CI = 1.62–1.81) times higher odds for suicide attempt. ConclusionsIn this large sample of adolescents from multiple LMICs, violence victimization was associated with significantly increased odds of suicide attempts. Future longitudinal studies are required to assess causality, and whether addressing exposure to violence can positively impact on adolescent suicide rates.

Psychosocial Characteristics of Transgender Youth Seeking Gender-Affirming Medical Treatment: Baseline Findings From the Trans Youth Care Study

PurposeThis study aimed to characterize two developmental cohorts of transgender and nonbinary youth enrolled in the Trans Youth Care Network Study and describe their gender identity–related milestones and baseline mental health and psychosocial functioning. MethodsTrans Youth Care participants were recruited from four pediatric academic medical centers in the U.S. before initiating medical treatment for gender dysphoria either with gonadotropin-releasing hormone agonists (GnRHa) or gender-affirming hormones (GAH). GnRHa cohort data were collected from youth and a parent; GAH cohort data were collected from youth only. ResultsA total of 95 youth were enrolled in the GnRHa cohort. Mean age was 11.22 years (standard deviation = 1.46), and the majority were white (52.6%) and designated male at birth (51.6%). Elevated depression symptoms were endorsed by 28.6% of GnRHa cohort youth, and 22.1% endorsed clinically significant anxiety. Approximately one fourth (23.6%) endorsed lifetime suicidal ideation, with 7.9% reporting a past suicide attempt. A total of 316 youth were enrolled in the GAH cohort. The mean age was 16.0 years (standard deviation = 1.88), and the majority were white (62%) and designated female at birth (64.9%). Elevated depression symptoms were endorsed by 51.3% of the GAH cohort, and 57.3% endorsed clinically significant anxiety. Two-thirds (66.6%) endorsed lifetime suicidal ideation, with 24.6% reporting a past suicide attempt. Life satisfaction was lower among both cohorts compared with population-based norms. ConclusionsGnRHa cohort youth appear to be functioning better from a psychosocial standpoint than GAH cohort youth, pointing to possible benefits of accessing gender-affirming treatment earlier in life.

Development and Feasibility of a Safety Plan Mobile Application for Adolescent Suicide Attempt Survivors

Past suicide attempts are a powerful predictor of suicide. This study developed and evaluated the feasibility of a mobile application for creating safety plans, which include coping strategies that can be immediately accessed and used by suicide attempt survivors during a crisis. A safety plan mobile application, called Brake of My Mind, was developed (study 1). Heuristic evaluation (for experts) and user evaluations (for health professionals and adolescent suicide attempt survivors) were performed. A pilot test was then conducted based on the theory of planned behavior to evaluate the feasibility of Brake of My Mind (study 2). Three adolescent suicide attempt survivors used a pilot version of Brake of My Mind. Attitude toward suicide attempts, subjective norms, perceived behavioral control, and suicide intentions were assessed before, immediately after, and 1 week after using Brake of My Mind. Brake of My Mind showed very few low-priority usability problems, and it was considered a "good" and "acceptable" application. In study 2, median scores for attitudes toward suicide attempts, perceived behavioral control, and suicide intentions decreased over time after using Brake of My Mind. The subjective norm scores did not change. Brake of My Mind is an acceptable application for adolescent suicide attempt survivors that appears effective in decreasing their positive attitude toward suicide attempts.

Instability of Suicidal Ideation in Patients Hospitalized for Depression: An Exploratory Study Using Smartphone Ecological Momentary Assessment

This study used ecological momentary assessment (EMA) to explore the correlates of suicidal ideation (SI) instability in patients hospitalized for depression and SI. Thirty-nine adult inpatients were given smartphones with visual analogue scales to rate current depressed mood, anger/irritability, feeling socially connected, and SI three times a day throughout hospitalization. Affective Lability Scales (ALS) were also completed at baseline. SI instability was correlated with SI intensity, depressed mood instability, and social connection instability. Social connection instability was not associated with SI instability after controlling for depressed mood instability. ALS scores were not associated with EMA-derived SI instability. Participants with multiple past suicide attempts experienced greater SI instability. More research examining the clinical significance of SI instability is warranted.

The association between nocturnal panic attacks and suicidal ideation, plans, and attempts

Panic and sleep disturbances are established risk factors for suicide. Nocturnal panic attacks, which occur out of sleep, represent an intersection of these risk factors. Only one study to date has examined this relationship, but measured suicidality as a unitary construct. This represents a significant gap in the literature, considering most individuals who think about suicide do not make a plan and most who make a plan never make an attempt. We sought to expand upon existing research by examining how nocturnal panic relates to suicidal ideation, plans, and attempts separately. We predicted nocturnal panic would be associated with more suicidal ideation, plan, and attempt history than daytime only panic and no panic. Participants recruited from an online community sample were thoroughly screened for nocturnal and daytime panic history and completed questionnaires about past suicidal ideation, plans, and attempts. Nocturnal and daytime panic groups did not differ in past suicidal ideation or plans, but both groups exceeded the non-panic group. The nocturnal panic group reported more suicide attempts than the daytime and non-panic groups and judged themselves as more likely to make an attempt in the future. These results indicate a promising avenue for future research and suicide prevention efforts.

Outpatient Psychiatric Care for Youth with Suicide Risk: Who is Offered Dialectical Behavioural Therapy?

Dialectical behaviour therapy for adolescents (DBT-A) has recently been adapted and tested as an intervention for suicidal youth in randomized trials. Although studies have demonstrated the efficacy of this intervention for suicidal behaviours, research examining which youth get offered DBT-A in clinical practice is lacking. This study aimed to determine the proportion of suicidal youth that were offered DBT-A in a child and youth psychiatric outpatient clinic, and how selected clinical features differ between youth offered and not offered DBT-A. Medical records of 44 youth were reviewed based on: (1) initial mental health intake assessment between January and June 2015, (2) age 13–16 years, and (3) active suicidal ideation (SI) with or without recent non-suicidal self-injury (NSSI)-or suicide attempt (SA). Twenty-four consecutive months of demographic, diagnostic, and treatment data were reviewed retrospectively. 79.5% (n = 35) of the sample endorsed SI, 63.6% (n = 28) endorsed NSSI, and 47.7% (n = 21) reported a past SA. 47.7% (n = 21) were offered DBT-A. There was a significant relationship between offering of DBT-A and endorsement of multiple suicidal risk symptoms at baseline. Youth offered DBT-A reported significantly more types of adverse childhood experiences than those not offered DBT-A. Youth mental health clinicians appear to preferentially offer DBT-A to youth who report multiple suicidal risk symptoms and adverse childhood experiences. This profile is consistent with populations of youth enrolled in randomized trials of DBT-A. A large proportion of suicidal youth are not offered DBT-A, suggesting that clinicians consider multiple factors in treatment decision-making.

Le suicide de patients hospitalisés en psychiatrie : analyse qualitative de huit cas à l’hôpital Sainte-Anne à Paris et recommandations

Inpatient suicide rates are high at the psychiatric hospital. Improvement in detecting suicidal patients and preventing suicidal acts during hospitalization is essential. As part of a working group on the evaluation of professional practices on suicide risk at Sainte-Anne Hospital in Paris, we retrospectively studied eight cases of inpatient suicides that occurred between 2009 and 2018. We conducted a qualitative analysis of multidisciplinary morbidity and mortality reviews and medical records data. In our case series, all patients had a personal history of suicide attempts (notably using a violent means), and half of them previously attempted suicide during hospitalization. In most cases, suicide occurred during weekends or public holidays and inside care units. Suicide by hanging was the most prevalent method. Regarding our results and the literature, a past personal suicide attempt is the most frequent risk factor for inpatient suicide. However, prediction of suicide remains weak and all psychiatric inpatients should be considered at significant risk of suicide during hospitalization and just after discharge. Inpatient suicide prevention is primarily based on a safer hospital environment (inventory at entry, anti-suicidal furniture, no height access and windows opening, etc.). In addition, specific and repeated suicide training for care teams, continuity of care, enhanced management with assessment and monitoring protocols, good teamwork communication and better traceability of suicide risk in records appear to be organizational requirements for inpatient suicide prevention. At the individual level, quality of contacts with the patient, interactions with relatives and significant others, and active treatment of psychiatric disorders and comorbidities are fundamental. After a suicide or suicide attempt at the hospital, experience sharing should be systematically put into place to improve care practices. The implementation of postvention measures with the aim to support other patients and caregivers in the affected medical unit, as well as the victim's relatives, should complete the actions to lead.