Clinical Summary: Risk Factors for Reattempt and Suicide Within 6 Months After an Attempt in the French ALGOS Cohort: A Survival Tree Analysis
After a suicide attempt, the next 6 months are a high-risk window for both reattempt and suicide, but bedside risk assessment often does not capture how multiple clinical factors interact. This analysis offers a simple way to sort recently suicidal patients into higher- and lower-risk groups using information available in routine emergency and psychiatric evaluation.
Key Findings
- Of 880 participants (90.5%) with known 6-month status, 117 (13.3%) had repeated suicide attempts, 11 (1.1%) of whom completed suicide.
- The highest-risk subgroup was patients with AUD and acute alcohol use (AAU): among those 127 patients, 38 (29.9%) repeated suicide attempt or died by suicide, with RER = 2.2 and RR (95% CI) = 2.92 (2.08 to 4.10).
- Among 46 individuals without AUD and with a history of more than 2 suicide attempts in the past 3 years, 12 individuals repeated suicide attempt; the RER was 2, and the RR (95% CI) was 2.11 (1.25 to 3.54).
- The lowest-risk subgroup was 361 individuals without AUD, with fewer than 2 previous suicide attempts in the past 3 years, and without anxiety disorder; 23 repeated suicide attempt during the 6 months, with RER = 0.49 and RR (95% CI) = 0.36 (0.23 to 0.55).
- The simplified clinician algorithm identified a poor prognosis group with HR = 1.78; 95% CI, 1.42 to 2.24; P < .01 and AUC of 0.63, with sensitivity of 0.8 (95% CI, 0.73 to 0.87), specificity of 0.47 (95% CI, 0.42 to 0.50), positive predictive value of 0.19 (95% CI, 0.15 to 0.22), and negative predictive value of 0.94 (95% CI, 0.92 to 0.96).
In the first 6 months after a suicide attempt, the clearest high-risk patterns were alcohol use disorder with acute alcohol use during the index attempt and more than 2 suicide attempts in the past 3 years. The simplified algorithm can support post-attempt risk stratification, but its modest AUC of 0.63 means it should guide follow-up planning rather than replace clinical judgment.
Practice Implications
- Ask specifically about alcohol use disorder and acute alcohol use during the index suicide attempt, because among patients with AUD, 38 of 127 (29.9%) with AAU reattempted or died by suicide, whereas none of the 19 patients with AUD without AAU repeated suicide attempt.
- Treat more than 2 suicide attempts in the past 3 years as a major near-term warning sign; in this subgroup, 12 of 46 patients reattempted, with RR (95% CI) of 2.11 (1.25 to 3.54).
- Screen for anxiety disorder during post-attempt assessment, since patients without AUD, with a history of 1 or 2 previous suicide attempts in the past 3 years, and anxiety disorder had 42 reattempts among 325 subjects.
- Use the simplified algorithm to help structure follow-up intensity rather than to decide care in isolation, because its sensitivity was 0.8 and negative predictive value was 0.94, but specificity was 0.47 and positive predictive value was 0.19.
