The Repetition of Suicidal Behavior: A Multicenter Cohort Study
J Clin Psychiatry 2006;67:1599-1609
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objectives: To determine the proportion
of individuals who repeated nonfatal suicidal
behavior within 12 months of an index episode, to
investigate the timing of repetition, and to
investigate risk factors associated with repetition
and their population impact.
Method: We carried out a prospective
cohort study (1997-2002) in 4 large hospitals in
North West England. We included subjects aged 15 years and over who attended with "self-harm"
(an act of intentional self-poisoning or injury
irrespective of the apparent purpose of the act).
Following the episode, a standard assessment form, which included detailed demographic and
clinical data, was completed by a clinician.
Results: 9213 individuals presented during
the study period. The incidence of repetition
within 12 months of the index episode was 13.6%
(95% CI: 12.9% to 14.4%). The median time to first repetition was 73.5 days (interquartile range,
20 to 187 days). One in 10 subjects repeated within
5 days of the index episode. Independent risk factors for repetition included previous suicidal
behavior, psychiatric treatment, being unemployed or registered sick, self-injury, alcohol misuse,
and reporting suicidal plans or hallucinations at
the time of the index episode. The combined population attributable fraction (an indicator of the
potential population impact) for these variables
Conclusion: The repetition of suicidal
behavior is common and occurs quickly. On a population level, our study suggests that the most
important strategies to reduce repetition might
include primary prevention of suicidal behavior,
targeting psychiatric illness, and tackling social
factors such as unemployment. Specific
interventions may be required for individual subgroups.