Risk factors for repeated suicide attempts and self-harm among suicide attempters admitted to emergency departments: A secondary analysis of the ACTION-J study

• The purpose of this study was to investigate the risk factors for the number of repeated suicide attempt episodes and repeated overall self-harm episodes among patients admitted to emergency departments after a suicide attempt by sex. • In men, age, psychiatric disorder, drinking alcohol, and visiting a psychiatrist were identified as significant factors associated with the number of repeated overall self-harm episodes. • In addition to the four factors found in men, education, employment, being married, living with a partner or family, previous suicide attempts, and drug overdose involving admission to an emergency department were significantly associated with the number of repeated overall self-harm episodes in women. • The role of psychiatric medical institutions in preventing repeat suicide attempts is considered to be important. Treating patients with repeated suicide attempts and/or self-harm episodes is an important issue. The aim of the present study was to investigate the risk factors for the number of repeated suicide attempts and overall self-harm episodes among patients admitted to emergency departments because of an index suicide attempt. This study was a secondary analysis of randomized controlled trials in Japan. The participants were adult patients who were admitted to emergency departments for a suicide attempt and had a DSM-IV-TR axis I disorder. Outcomes were the number of repeated suicide attempt episodes, and the number of repeated overall self-harm episodes per person-year. Multivariate Poisson analysis was conducted by sex. 914 patients were analyzed. The multivariate analysis in men for the number of repeated overall self-harm episodes revealed significant associations with age, substance-related disorder, drinking alcohol, and visiting a psychiatrist. In women, age, psychiatric disorder, drinking alcohol, visiting a psychiatrist, education, employment, being married, living with partner or family, previous suicide attempts, and drug overdose involving admission to an emergency department were identified as significant factors. Patients who self-harmed but were not admitted to an emergency department, and patients under 20 years old were excluded. A common risk factor for both repeated suicide attempts and repeated overall self-harm in both men and women was visiting a psychiatrist within 1 month or within >3 months before the index suicide attempt. The role of psychiatric medical institutions in preventing repeat suicide attempts is considered to be important.