Single versus Multiple Suicide Attempts: A Prospective Examination of Psychiatric Factors and Wish to Die/Wish to Live Index

Patients with first versus multiple episodes of self-harm: how do their profiles differ?

“…Our analyses did not differentiate between specific personality disorders but we had a high prevalence of the diagnosis of borderline personality disorder in our sample (62.01%; 222/358). It is, thus, likely that this result reflects a risk with borderline personality disorders, in line with the previous research showing borderline personality disorder or traits to be associated with repetition both in adults [15,18,22,29] and in young people [13]. Persons with a borderline personality disorder should be offered specific treatment to reduce repetition, such as Dialectical Behavior Therapy [30], Mentalization-based treatment [31] or Transference-focused psychotherapy [32].…”

“…While intoxication at the time of the SH and substance use were associated to repetition in univariate analysis, this did not remain significant in multivariate analysis. One study found men repeaters to use substance more frequently [20] and a study including veterans (probably mostly men) [18] identified substance use disorders as more frequent in repeaters. We did not perform a separate gender analysis but this negative result underscores the need of specific research on pattern of repetition across women and men.…”

“…Recent studies on adults with a prospective or cross-sectional design also found several risk factors for SA or SH repetition. They included any mental disorder, impulsivity, borderline personality disorder, PTSD, substance misuse, severity of psychopathology, lethality of SA, high SI, unmarried status, living alone, younger age, low social support, no occupation, previous psychiatric treatment, history of sucide or major depression in the family, hopelessness and physical illness [14][15][16][17][18][19][20][21][22]. Finally, childhood maltreatment and/or sexual abuse have been associated with suicidal behaviors in a systematic review [23] and with repetition in two prospective studies [24,25].…”

Annual Research Review: A meta‐analytic review of worldwide suicide rates in adolescents

“…Moreover, normative developmental changes in adolescent social networks that make peers more influential may also contribute to increased potential for imitation of risky behaviors, including modeling of suicidal behavior (Pickering et al., ). Finally, individuals with histories of multiple suicide attempts are at especially high risk of later suicide death (Kochanski et al., ). Beginning at age 17, most suicide attempts are repeat attempts (Goldston et al., ); thus, older adolescents may be at increased risk of suicide death due to increased experience engaging in suicidal behavior.…”

Factors associated with single versus multiple suicide attempts in depressive disorders

“…Also, as expected, longer exposure times are related to risk of multiple suicide attempts, as indicated by younger onset of illness or of initial suicidal behavior, or simply more years of illness [Defayette et al 2019]. Other tentatively identified risk factors for multiple attempts include diagnosis of BD, occurrence of mixed affective features, co-occurring psychiatric or substance abuse disorders, chronic stress, borderline features, impulsivity, introversion, relative social isolation and being unmarried, as well as lack of access to mental health services [Michaelis et al 2003;Forman et al 2004;Boisseau et al 2013;Bryan et al 2015;Colburn et al 2017;Arici et al 2018;Kochanski et al 2018]. Increased risk of eventual suicide following multiple attempts has been reported in most studies [Rudd et al 1996;Goldberg et al 1998;Weiner et al 2011;Colburn et al 2017;Arici et al 2018;Papadopoulou et al 2020], especially with BD [Jones et al 2018], but not all [Michaelis et al 2003].…”