Lethality and recidivism in suicide Attempters: A longitudinal study

Abstract

Background

Lethality (or medical severity) and recidivism in suicide attempts are of particular interest due to their impact on clinical decision-making and associated risks. However, current literature has yet to clarify the relationship between recurrence and lethality.

Aim

This study examines the relationship between lethality and recidivism in suicidal behavior and their combined impact on mortality.

Methods

A longitudinal study was conducted on a cohort of 1206 individuals who had attempted suicide. Sociodemographic and clinical data—including lethality, reattempts, and mortality—were collected, with a minimum follow-up period of 5 years. Logistic regression was used to analyze associations between high lethality (>48 h of medical care), frequent reattempts (≥5), and death (suicidal and non-suicidal).

Results

High lethality was found in 28.3 % of patients, and 18.2 % were frequent reattempters. Risk factors for frequent reattempts, in decreasing order, were having an eating disorder, being female, having a substance use disorder, and high lethality. In contrast, personality disorder appeared to be protective compared to the overall sample of attempters. Factors linked to high-lethality attempts were a history of recidivism, frequent reattempts, and older age. Suicidal death risk was associated with high lethality, psychotic disorders, and older age. No correlation was found between the total number of reattempts and maximum lethality.

Conclusions

High lethality in suicide attempts is associated with frequent reattempts and higher mortality risk, highlighting the need for targeted interventions, particularly for those with repeated attempts and high-lethality behaviors. Screening for physical comorbidities in high-lethality patients is critical to reduce non-suicidal mortality.