Role of Outpatient Engagement and Medication Adherence in Managing Recurrent Suicidality Amidst Adverse Social Determinants: A Case Series

Recurrent suicidality is a persistent clinical challenge characterized by frequent emergency department (ED) utilization and limited response to acute care models. We present a case series of four patients followed over three years with repeated suicidal ideation, multiple suicide attempts, and recurrent hospitalizations. Shared risk factors included major depressive disorder (MDD), borderline personality disorder (BPD), repetitive self-injury, medication overdose, family history of suicide, and social isolation. These vulnerabilities were compounded by trauma, polysubstance use involving cocaine, cannabis, and prescription or over-the-counter medications, as well as adverse social determinants of health, particularly housing instability and unemployment. Poor outpatient engagement and medication non-adherence were linked to increased suicide attempts, ED visits, and rapid readmissions. In contrast, improved outpatient continuity, treatment adherence, and structured support were linked to reduced suicidality and healthcare utilization. These findings underscore the importance of longitudinal, multidisciplinary care in managing recurrent suicide risk.