Characteristics differentiating near-term multiple, distal multiple, and single suicide attempters during the 12-months post-discharge from the emergency department

TL;DR

This study compares people who make multiple suicide attempts shortly after an emergency department visit to those with spaced attempts or a single attempt.

Contribution

The study identifies unique clinical and demographic characteristics of individuals making multiple suicide attempts within 30 days of an ED visit.

Findings

Near-term attempters had more prior suicide attempts and higher rates of nonsuicidal self-injury before baseline.

They were more likely to have a depressive disorder and a primary care provider, but less likely to consider reasons for living.

Near-term attempters made earlier and more frequent attempts after the ED visit compared to others.

Abstract

A history of repeated suicide attempts increases risk for subsequent attempts. Further, individuals with multiple prior attempts exhibit higher suicidal intent and make more lethal recent attempts than those with single attempt histories. However, prior research has not studied whether individuals who make multiple suicide attempts within a short time frame, ≤30-day period (“near-term attempters”), differ clinically from those who make multiple suicide attempts occurring more than 30 days apart (“distal attempters”) or a single attempt in the period following an emergency department (ED) visit. Exploratory secondary analyses were conducted using data from the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study. Clinical telephone interviews were administered at 6, 12, 24, 36, and 52 weeks after the index ED visit, supplemented by chart reviews at 6 and 12 months. Participants (N = 283) who reported at least one suicide attempt during follow-up were included and grouped based upon frequency and timing of follow-up attempts. Near-term attempters were compared to distal and single attempters on socio-demographic and clinical characteristics. Results indicated that near-term attempters had more suicide attempts prior to baseline, a higher incidence of nonsuicidal self-injury in the week before baseline, a higher prevalence of lifetime depressive disorder, and were more likely to have a primary care provider. They were also less likely to think about reasons for living and made earlier, more frequent attempts after the index ED visit. These findings could inform predictive models and interventions aimed at identifying and treating those at high risk for suicide.

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