Predictors of suicide attempt recurrence after an index suicide attempt in Spain: a prospective multicentre cohort study

Background Suicide attempts are a critical public health concern, with a high risk of recurrence after an index attempt. We aimed to identify predictors of suicide reattempt within 12 months. Methods In this prospective cohort study, we enrolled individuals aged 12 years or older from eight Spanish public hospitals after a suicide attempt (Nov 1, 2020–May 18, 2022). Participants were assessed within 15 days of the index suicide attempt and followed for 12 months. The primary outcome was time to suicide reattempt, documented in electronic clinical records. Cox proportional hazards models were used to identify predictors, adjusting for sex, age, and recruitment site. Individuals with lived experience were involved in the study design. Findings Of 1730 participants, the mean age was 36.5 years (SD 17.2); 1259 (72.8%) were women and 471 (27.2%) were men. Within 12 months, 340 of 1730 participants (19.7%) reattempted suicide, the median time to reattempt was 140 days (IQR 175, range 7–365). Risk was highest in the first months following the index attempt. Five independent predictors were identified: high psychotropic medication burden (four or five prescribed medications: aHR 2.55, 95% CI 1.57–4.15; p < 0.001), more frequent suicidal ideation (weekly: aHR 1.87, 95% CI 1.25–2.79; p=0.001; several times per day: aHR 2.07, 95% CI 1.39–3.07; p < 0.001), prior suicide attempts (one to three: aHR 1.62, 95% CI 1.19–2.20; p=0.002; four or more: aHR 1.80, 95% CI 1.25–2.61; p=0.001), moderate to severe childhood emotional neglect (aHR 1.56, 95% CI 1.16–2.08; p=0.002), and non-suicidal self-injury (aHR 1.45, 95% CI 1.09–1.93; p=0.009). Interpretation Nearly one in five individuals reattempted suicide within a year of an index attempt. Identified predictors underscore the need for early, targeted, and trauma-sensitive post-attempt interventions. Funding Instituto de Salud Carlos III and co-funded by the European Union (FEDER).

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Publication Details

Journal
The Lancet Regional Health - Europe
Published
2026-07-30
DOI
https://doi.org/10.1016/j.lanepe.2026.101787
Primary Topic
Suicide and Self-Harm Studies
Type
article
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article

Predictors of suicide attempt recurrence after an index suicide attempt in Spain: a prospective multicentre cohort study

Teresa Bobes-Bascarán, Elisa Seijo Zazo, Carlos Schmidt, Verónica Fernández-Rodrigues et al.
The Lancet Regional Health - Europe
Suicide and Self-Harm Studies
article

Predictors of suicide attempt recurrence after an index suicide attempt in Spain: a prospective multicentre cohort study

Teresa Bobes-Bascarán, Elisa Seijo Zazo, Carlos Schmidt, Verónica Fernández-Rodrigues, Andrés Pemau, Alejandro de la Torre‐Luque, Benedicto Crespo‐Facorro, Irene Canosa-García, Marina Díaz‐Marsá, Jennifer Fernández Fernández, Matilde Elices, Jorge Andreo-Jover, Luisa Lázaro, Elvira Lara, Noelia Iglesias, José Luís Ayuso‐Mateos, Ainoa García-Fernández, Laura Comendador, P. Mola-Cardenes, Anna Pedrola-Pons, Iván Pérez-Díez, Natalia Angarita, Sandra Gómez‐Vallejo, Mireia Vázquez, Natalia Roberto, Miguel Velasco Santos, Itziar Leal‐Leturia, Purificación López, Julia Rodríguez-Revuelta, Guillermo Cano-Escalera, Ángela Palao-Tarrero, Miguel Ruiz-Vegüilla, Alba Toll, Iñaki Zorrilla, Victor Perez, Ares Ramos, Lara Suárez-Soto, Mara Dolores Saiz-Gonzalez, María Ángeles Botí, Luis Jiménez-Treviño, Guillermo Juarez, María Fe Bravo-Ortiz, Diego J. Palao, Wala Ayad-Ahmed, Carlamarina Rodríguez-Pereira, Cristina Díaz-Tellez, Pilar Alejandra Saiz, Eduard Vieta, Ana González-Pinto, Ana I. Cebria, Iria Grande, Iñigo Alberdi-Paramo, Javier Curto Ramos, Luis Vicenete Valor
article en

Abstract

Background Suicide attempts are a critical public health concern, with a high risk of recurrence after an index attempt. We aimed to identify predictors of suicide reattempt within 12 months. Methods In this prospective cohort study, we enrolled individuals aged 12 years or older from eight Spanish public hospitals after a suicide attempt (Nov 1, 2020–May 18, 2022). Participants were assessed within 15 days of the index suicide attempt and followed for 12 months. The primary outcome was time to suicide reattempt, documented in electronic clinical records. Cox proportional hazards models were used to identify predictors, adjusting for sex, age, and recruitment site. Individuals with lived experience were involved in the study design. Findings Of 1730 participants, the mean age was 36.5 years (SD 17.2); 1259 (72.8%) were women and 471 (27.2%) were men. Within 12 months, 340 of 1730 participants (19.7%) reattempted suicide, the median time to reattempt was 140 days (IQR 175, range 7–365). Risk was highest in the first months following the index attempt. Five independent predictors were identified: high psychotropic medication burden (four or five prescribed medications: aHR 2.55, 95% CI 1.57–4.15; p < 0.001), more frequent suicidal ideation (weekly: aHR 1.87, 95% CI 1.25–2.79; p=0.001; several times per day: aHR 2.07, 95% CI 1.39–3.07; p < 0.001), prior suicide attempts (one to three: aHR 1.62, 95% CI 1.19–2.20; p=0.002; four or more: aHR 1.80, 95% CI 1.25–2.61; p=0.001), moderate to severe childhood emotional neglect (aHR 1.56, 95% CI 1.16–2.08; p=0.002), and non-suicidal self-injury (aHR 1.45, 95% CI 1.09–1.93; p=0.009). Interpretation Nearly one in five individuals reattempted suicide within a year of an index attempt. Identified predictors underscore the need for early, targeted, and trauma-sensitive post-attempt interventions. Funding Instituto de Salud Carlos III and co-funded by the European Union (FEDER).

The Lancet Regional Health - EuropeVol. 68
Universidad Complutense de Madrid (ES), Universitat Autònoma de Barcelona (ES), Universidad de Oviedo (ES), University of the Basque Country (ES), Universitat Pompeu Fabra (ES), Gobierno del Principado de Asturias (ES), Hospital Universitario La Paz (ES), Instituto de Salud Carlos III (ES), Hospital Clínico San Carlos (ES), Centro de Investigación Biomédica en Red de Salud Mental (ES), Hospital La Paz Institute for Health Research (ES), Hospital Universitario Araba (ES), Hospital Clínic de Barcelona (ES), Hospital Del Mar (ES), Instituto de Biomedicina de Sevilla (ES), Institute of Research and Innovation Parc Tauli (ES), Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES), Instituto de Investigación Sanitaria del Principado de Asturias (ES), Universidad Autónoma de Madrid (ES), Universitat de Barcelona (ES), Universidad de Sevilla (ES)
Instituto de Salud Carlos III
Good health and well-being
Openalex Percentile: Top 7%
Suicide and Self-Harm Studies
DOIOpen Access PDFOpenAlex
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