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

BMC Psychiatry. 2017 May 4;17(1):163. doi: 10.1186/s12888-017-1317-z.


Background: 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.

Methods: This 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.

Results: Suicide 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).

Conclusions: Alcohol 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.

Keywords: Alcohol use disorders; Personality disorders; Suicidal behaviour.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Age Factors
  • Alcoholism
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Risk Factors
  • Spain / epidemiology
  • Suicidal Ideation
  • Suicide / prevention & control
  • Suicide / psychology*
  • Suicide, Attempted / prevention & control
  • Suicide, Attempted / psychology
  • Survival Analysis
  • Young Adult