Risk and protective factors of near-lethal suicide attempts in adolescents

Introduction Adolescents exhibit high rates of suicide attempts but comparatively low rates of suicides. While many studies focus on suicide attempts, it is unclear if findings apply to suicides. Studying near-lethal suicide attempts (NLSA) as approximations of suicides is an underexplored approach. This study aimed to identify differences between lower-risk suicide attempts (LRSA) and NLSA. Methods Using a standardized clinical survey, suicidal phenomena, risk and protective factors were assessed in a clinical population at first contact from 2018 to 2022. NLSA (N = 17) were identified using strict criteria and compared with LRSA (N = 106) in terms of risk and protective factors using χ² and t-tests for independent samples. Results Prior suicide attempts were less frequent in NLSA than in LRSA (58.8% vs 84.0%; χ²(1)=5.895, p=.015). This suggests that a history of suicide attempts as an explicit warning sign is less often present in patients with NLSA. Adolescents with NLSA also showed lower levels of both passive and active communication: 73.3% had never been approached by others about suicidality (LRSA: 14.1%; U = 243.500, p <.001) and 60% had never actively disclosed suicidality themselves (LRSA: 28.4%, U = 458.500, p = .022). Conclusion The findings highlight the role of communication in suicide prevention, underscoring the need for easily accessible mental health services. Given the small NLSA sample, the results should be interpreted as exploratory and require replication in larger, prospectively designed studies to inform more targeted prevention strategies.