Repeated Suicide Attempts and Suicide Among Individuals With a First Emergency Department Contact for Attempted Suicide: A Prospective, Nationwide, Danish Register-Based Study

J Clin Psychiatry. 2016 Jun;77(6):832-40. doi: 10.4088/JCP.15m09793.


Objective: Emergency departments are important, albeit underutilized, sites for suicide prevention. Preventive strategies and interventions could benefit from a greater understanding of factors influencing the course of suicide risk after emergency department contact due to attempted suicide. The aim of our study was 2-fold: to identify predictors of repeated suicide attempts and suicide and to investigate the timing of these events.

Methods: Data from Danish nationwide, longitudinal registers were used in this prospective, population-based study of all individuals first presenting to an emergency department after attempted suicide (index attempt) between January 1, 1996, and December 31, 2011 (N = 11,802). Cox regression analysis identified predictors, and Kaplan-Meier survival analysis modeled the time to repeated suicide attempts and suicide.

Results: Sixteen percent of the sample repeated suicide attempt, and 1.4% died by suicide. Repetition was less likely among men than women (adjusted hazard ratio [AHR] = 0.70; 95% CI, 0.63-0.79), whereas those most prone to repeated attempts were individuals with recent psychiatric treatment (AHR = 2.19; 95% CI, 1.97-2.43) and those with recent psychiatric treatment (AHR = 2.19; 95% CI, 1.97-2.43). Predictors of suicide included age over 35 years (AHR = 5.56; 95% CI, 2.89-10.69); hanging, strangling, or suffocation as the method of the index attempt (AHR = 2.55; 95% CI, 1.29-5.01); and receiving psychiatric hospitalization for the index attempt (AHR = 1.74; 95% CI, 1.22-2.49). The cumulative rates of repeated attempts and suicide deaths in the total sample were particularly high within the first week of the index attempt, reaching 3.6% and 0.1%, respectively.

Conclusions: Preventive efforts need to target the period close to discharge from emergency departments.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Child
  • Comorbidity
  • Cross-Sectional Studies
  • Denmark
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Mental Disorders / mortality
  • Mental Disorders / psychology
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Recurrence
  • Registries
  • Risk Factors
  • Sex Factors
  • Suicide / prevention & control
  • Suicide / psychology*
  • Suicide / statistics & numerical data*
  • Suicide, Attempted / prevention & control
  • Suicide, Attempted / psychology*
  • Suicide, Attempted / statistics & numerical data*
  • Young Adult