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Take a chance of re-attempts and suicide decease subsequently a suicide attempt: A survival analysis

  • Hilario Blasco-Fontecilla ORCID: orcid.org/0000-0002-2864-6298 iii,iv,
  • Gemma Garcia-Parés5,
  • Luis Martínez-Naval6,
  • Oliver Valero-Coppin7,
  • Annabel Cebrià-Mecaone,4,
  • Maria A. Oquendoviii &
  • Diego Palao-Vidalone,2,four

BMC Psychiatry volume 17, Commodity number:163 (2017) Cite this commodity

  • 27k Accesses

  • 62 Citations

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Abstract

Groundwork

Suicide is the primary cause of unnatural decease in Spain, and suicide re-attempts a major economic burden worldwide. The risk factors for re-endeavor and suicide after an index suicide attempt are different.

This study aims to investigate run a risk factors for re-attempt and suicide after an index suicide try.

Methods

This observational study is part of a one-yr telephone management plan. We included all first-time suicide attempters evaluated in the emergency department at Parc Taulí-Academy Hospital (n = 1241) recruited over a five-twelvemonth period (January 2008 to December 2012). Suicide attempters were evaluated at baseline using standardized instruments. Bivariate logistic regression models were used to identify hazard factors. Kaplan-Meier curves were used to compare the time to re-attempt betwixt categorical variables. Comparisons were performed using Log-Rank and Wilcoxon tests. Variables with a p-value lower than 0.2 were included in a multivariate Cox regression model. Bivariate logistic regression models were considered to identify hazard factors for suicide. The significance level was set up to 0.05.

Results

Suicide re-attempters were more probable diagnosed with cluster B personality disorders (36.8% vs. sixteen.6%; p < 0.001), and alcohol use disorders (nineteen.8 vs. xiii.9; p = 0.02). Several [i.2% (15/1241)] of them died by suicide. Attempters who suicide were more than likely alcohol users (33.3% vs. 17.2%; p = 0.047), and older (50.nine ± 11.9 vs. twoscore.7 ± 16.0; p = 0.004).

Conclusions

Alcohol apply, personality disorders and younger age are risk factors for re-attempting. Older age is a risk factor for suicide amongst suicide attempters. Current prevention programs of suicidal behaviour should be tailored to the specific profile of each grouping.

Peer Review reports

Groundwork

Suicide is a global health result and since 2008, information technology is the main cause of unnatural death in Spain [1]. A history of previous suicide attempt is the strongest predictor for future suicidal ideation and behaviour (SIB), including suicide ideation, suicide attempts, and suicide [2,3,iv,5]. For instance, in a v years follow-up of 302 individuals admitted to an inpatient psychiatric unit for medically serious suicide attempts, 37% of them made at least one further suicide try, and half-dozen.7% eventually died by suicide [half-dozen]. Furthermore, most suicides occur in people with mental disorders [1], but nearly people with mental disorders, even severe, never attempt suicide [seven]. In other words, this run a risk factor and many others have poor predictive power. Therefore, a meliorate differentiation between suicide attempters who somewhen suicide and suicide attempters who will non is critical to developing preventive plans.

In a systematic review of fourteen cohorts (n = 21,385), Neeleman estimated that individuals with antecedents of self-harm were 25 times more likely to die by suicide than the general population [eight]. Owens et al. [9] reviewed lxxx observational and empirical studies and ended that the risk of another SIB ranged between xvi% (first year) and 23% (follow-up of 4 years or longer), whereas for suicide it ranged from 2% (kickoff twelvemonth) to 7% (follow-up of 9 years). Christiansen et al. [10] estimated the adventure of another SIB in a five-year follow-upward study at nigh 31%. These authors stressed that the risk of another SIB was higher during the first two-years subsequently the index suicide attempt. Female gender and the presence of mental disorders are well-known chance factors for repeated SIB [x]. Other authors have stressed the role of personality disorders, particularly borderline personality disorder, in future SIB [11]. On the other paw, between i and 6% of individuals evaluated because of a suicide attempt eventually suicide in the year following. The risk of suicide is higher in older patients and those individuals with a higher number of lifetime suicide attempts [12,thirteen,14,15], counter to clinical lore well-nigh frequent attempters non being at adventure for suicide considering they just engage in low risk SIB.

Fifty-fifty if prove is scarce, recent studies take demonstrated that information technology is possible to reduce the risk of re-attempt or even suicide in individuals at take chances [16, 17]. For case, we previously reported that a one-year telephone intervention program was effective in reducing an viii% the proportion of patients who re-attempted suicide compared to the control population [eighteen]. This is in keeping with some [xix] simply not all [20] previous literature on the effectiveness of phone intervention programs.

Aims of the report: The main objective of the current study is to identify risk factors for re-attempt and suicide using survival analysis.

Method

Samples and process

This observational study is part of a one-year telephone management programme, which forms part of the European Alliance Against Depression (EAAD) framework for the management of SIB [17]. All kickoff-time suicide attempters (index suicide try) evaluated in the emergency section (ED) at Parc Taulí-University Hospital, Spain (n = 1241) between January 1st 2008 and December 31st 2012 were approached to take part in a i-year phone follow-up prevention plan that had the objective of reducing suicide attempts rate [eighteen]. This phone management program was aimed at determining the effectiveness over 1 year of a follow-up on patients discharged from the ED after a suicide effort. The one-twelvemonth phone intervention program reduced an 8% the proportion of patients who re-attempted suicide [18].

This ED sees all medical emergencies for a catchment population of 474,778 inhabitants. On-phone call psychiatrists evaluated all suicide attempters. A suicide effort was divers as a self-harming behaviour with clear suicidal intent [21]. All suicides (due north = 142) in our infirmary's catchment area were recorded during this catamenia of time, based on directly data from the Constitute of Forensic Medicine of Catalonia, charged with making determinations about cause of death.

The primary result measures were time to new suicide behaviour (SB; either suicide attempt or suicide, but suicidal ideation was non included), and the percentage of suicide attempters who re-attempted suicide or suicide during the period of report. The data on re-attempts was extracted from the electronic medical tape. The Institute of Forensic Medicine of Catalonia provided information on suicide deaths. All first-fourth dimension suicide attempters recruited during the concluding twelvemonth (1st January 2012 to December 31st 2012) were equally offered the 1-year telephone follow-upwardly (upward to December 31st 2013). Accordingly, the information on the main outcomes of our study (re-attempts and suicides) ranges from 1 to 6 years.

All commencement fourth dimension suicide attempters provided information on sociodemographic factors (sex activity, age, marital status, place of nativity, level of education, employment status, and living arrangements), clinical factors (multiaxial psychiatric diagnosis according to DSM-Four-TR criteria, previous medical follow-up), characteristics related to the suicide effect (method used, engagement of the effort, consumption of drugs or alcohol at the time of the act, and degree of lethality (balmy: < 24 h in the ED for medical observation/intervention; moderate: 24–48 h in the ED; severe: > 48 h in the ED or surgical intervention or psychiatric inpatient hospitalization), and blazon of medical follow-up prior to the SB. Information were obtained from inpatient clinical histories and from emergency and master care electronic reports.

All first time suicide attempters discharged from the ED were scheduled for a post-discharge visit with the referring psychiatrist inside a maximum of 10 days and verbally consented to participate in a phone follow-upwardly during a twelvemonth. The telephone follow-up was conducted by a nurse specialized in mental wellness who had received specific training on the assistants of the program, detection of high gamble for suicide and management of patients with low and balmy take chances of suicide. The telephone follow-up was carried out at ane calendar week, 1 month and, thereafter at 3, half-dozen, 9 and 12 months later on the alphabetize suicide endeavor. Further information can be constitute elsewhere [eighteen].

Nosotros confirmed that all individuals were seen either in our mental health center or in the primary care center for at least 1 year afterward the terminate of study enrolment (December 31st 2012). Whenever this information was not available, a phone call confirmed that the private was alive and did not change their identify of residence.

The progress of all participants through the study is detailed in Fig. 1.

Fig. i
figure 1

Progress of participants through trial

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Statistical analysis

Descriptive statistics of socio-demographic characteristics at the index suicide attempt are presented for re-attempters, not re-attempters and globally (absolute and relative frequencies). Bivariate logistic regression models were used to place risk factors [22] and odds ratios (OR) and 95% confidence intervals were calculated.

Kaplan-Meier curves for all variables -sociodemographic and clinical factors, and characteristics related to the suicide effect- were used to compare the fourth dimension to re-try between re-attempters and non re-attempters. Comparisons were performed using Log-Rank and Wilcoxon tests. Variables with a p-value lower than 0.2 were included in a multivariate Cox regression model [23]. Hazard ratios (HR) and 95% confidence intervals were calculated.

Additionally, bivariate logistic regression models were synthetic to identify run a risk factors for suicide. Given the small number of suicides, nosotros could not run multivariate analyses in the case of suicides.

The assay was performed with software SAS v9.3 (SAS Institute Inc., Cary, NC, USA). Blastoff was fix to 0.05.

Results

Sociodemographics

Suicide attempts represented 0.3% of all emergencies presenting to the ED during the report period and xiv.iv% of psychiatric emergencies. The suicide charge per unit in our catchment expanse was eight.3/100,000 inhabitants in 2008, half dozen.6/100,000 in 2009, vii.2/100,000 in 2010, 4.8/100,000 in 2011 and seven.two/100,000 in 2012. During the 5 years of recruitment, there were 2328 suicide attempts made by 1627 patients evaluated at the Parc Taulí Sabadell-University Infirmary. From that sample, nosotros selected first-time suicide attempters (n = 1241). Women represented 62.4% of our sample, and the hateful age was twoscore.8 (±xvi.0). The virtually frequent method used in the index suicide attempt was drug overdose (70.viii%). Effectually 20% (20.5%) were hospitalized in the acute mental health unit of measurement. Table one displays socio-demographic characteristics at the index suicide attempt.

Table 1 Distribution of socio-demographic characteristics at the index suicide effort

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Two hundred and twoscore-nine (20.1%) of start-fourth dimension suicide attempters, re-attempted suicide at least once, and 15 (1.2%) died by suicide during follow-up (mean and median fourth dimension of follow-up for re-attempts and suicides were 298 and 177 days, respectively). Here, it is important to stress that during this flow, of the 142 suicides in our catchment area, 127 [87.5%; n = 89 (70.1%) males, and n = 38 (29.ix%) women] were non evaluated in the ED, even though 35 [24.half-dozen%; xviii women (12.half-dozen%) and 17 men (12%)] of them had a previous suicide attempt. Of those 35 patients, fifteen patients had previous suicide attempts evaluated in the ED during the follow-up, and the remaining xx patients had attempted suicide earlier the follow-up (see Figure 1).

Timing of the survival curve for re-attempts and suicide

Most (88%) re-attempts and suicides (93%) took place within the start-two years of follow-upwards (run across Tables 2 and 3, and Figs. ii and 3). Figures 2 and three display the survival curve of re-attempts and completed suicides, respectively.

Table 2 Proportion of first-time suicide attempters who re-attempted suicide at 2 years follow-up

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Table 3 Proportion of first-time suicide attempters who suicide at 2 years follow-up

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Fig. 2
figure 2

Survival estimates (re-attempts)

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Fig. 3
figure 3

Survival estimates (completed suicide)

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Risk factors for re-attempts

Equally for the hazard of re-attempts after the index suicide attempt, bivariate survival analyses showed that age, booze use and personality disorders presented differences in time to re-attempt (Figs. 4, v, and 6). Compared with suicide attempters who re-attempt during follow-up, attempters who didn't re-attempt were older. Indeed, existence older than 60 years onetime was a protective factor. No statistically significant differences were observed in the rest of socio-demographic variables. Compared with non re-attempters, suicide re-attempters were besides more probable diagnosed with cluster B personality disorders (36.8% vs. 16.6%; p < 0.001), and booze employ disorders (19.viii vs. 13.9; p = 0.02).

Fig. 4
figure 4

Survival estimates (re-attempts) considering age

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Fig. 5
figure 5

Survival estimates (re-attempts) considering booze employ

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Fig. 6
figure 6

Survival estimates (re-attempts) considering personality disorders

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All hazard factors in bivariate analyses –age, alcohol use, and personality disorders- were entered into a multivariate model. Table 4 displays that all iii factors contributed independently to increasing the risk for re-attempting suicide.

Table 4 Multivariate analysis for suicide attempt repetition

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Risk factors for suicide

Fifteen (due north = 15) or one.two% (fifteen/1241) of first time suicide attempters evaluated eventually died by suicide. 10 (66.seven%) were women. The alphabetize suicide try was mostly (fourscore%) a drug overdose, the medical lethality was mild in 73.3% of cases, and 73.3% of cases were discharged later the index suicide attempt. The methods of suicide were jumping (n = 9), hanging (n = 5), and suffocation (n = 1). Well-nigh were depressed (six/15) or had no Axis I diagnosis (4/fifteen) at baseline. Compared with suicide attempters who did not dice by suicide, suicide attempters who did were more than likely booze dependent (33.3% vs. 17.2%; p = 0.047), and older (fifty.9 ± eleven.9 vs. twoscore.7 ± 16.0; p = 0.004). Near xc% [86.7% (3/15)] of suicides were aged 40 to 59 when they died. No other socio-demographic or clinical factors (either method used or severity of the index suicide attempt, beingness hospitalized after the index suicide endeavour, or the presence of axis I or Two diagnosis) were related to the adventure of suicide death.

Of relevance, 86.7% (thirteen/xv) of the suicide attempters who somewhen died by suicide did not complete all telephone follow-ups. Of these, iv patients had already died by suicide when telephonically contacted for the first fourth dimension, three of them during the first week in the aftermath of their evaluation in the ED, thus suggesting that the telephone call could not have done annihilation to prevent their suicide; six patients were lost to follow-up, and three patients rejected the follow-upwards because they were already beingness followed at a mental wellness clinic. On the other paw, 51.6% of those who did non suicide were followed-up until month 12 (encounter Table 5).

Tabular array 5 Rate of suicide in suicide attempters who made or not the telephonic follow-upwards

Full size table

Discussion

In keeping with the literature, we establish that younger age, and presence of personality disorders and alcohol use disorder were risk factors for re-attempting suicide in our sample of suicide attempters [x, 24, 25]. Furthermore, booze use and older historic period were risk factors for suicide. As for the telephone management plan, around 50% of suicide attempters and 90% of those who died by suicide, respectively, did not complete the telephone follow-up at month 12. Those who completed the phone follow-up were less likely to die by suicide. However, information technology was discouraging that most suicides (northward = 127, most 90% of all suicides) were not evaluated in the ED during the study flow.

Overall, at that place were more than index suicide attempts for women than men in our sample, which is consistent with literature [26], and might be explained past the higher risk of depression among women [27]. Xx percent of suicide attempters re-attempted suicide during the follow-upwardly period. This is also in keeping with previous literature [13, 28]. In i study, 25% of the initial cohort of suicide attempters (n = 150; 38% had previous suicide attempts) re-attempted suicide during the 10-years follow-up [29]. In a Danish register-based survival analysis of 2614 suicide attempters matched with 39,210 non-attempters, 31.33% of suicide attempters re-attempted suicide within the follow-upward menstruum –average follow-up flow was nearly 4 years- [10]. The authors stressed that the probability of suicide attempters re-attempting suicide was stronger during the kickoff 2 years subsequently the alphabetize suicide attempt. In a 10-twelvemonth follow-up study between 1993 and 2002, from the initial 3690 suicide attempters admitted to Christchurch Infirmary, 28.ane% were readmitted for a farther non-fatal suicide effort [26]. Again, adventure of readmission and rates of mortality from suicide were higher in the first 2 years afterward the index suicide endeavor, but occurred throughout the 10 years follow-upward period. The findings from both studies perfectly friction match our results equally 88% of suicide attempters in our sample re-attempted inside the first-2 years of follow-up.

Regarding risk factors for re-attempting suicide, we plant three risk factors: one) younger age; 2) presence of personality disorders; and iii) presence of alcohol utilize disorder, which is also in keeping with the literature. In the Danish registry-based survival analysis mentioned higher up [10], both younger age and booze abuse were gamble factors for re-attempting suicide. Our results likewise match those reported past Osvath and colleagues when comparing offset-time suicide attempters (n = 549) with repeaters (n = 609): both alcohol abuse, and peculiarly, the presence of personality disorders were associated with an increased adventure of re-attempting suicide [30]. In a study following a similar instance-control design comparing 112 showtime-time attempters and 159 repeaters, booze misuse was again one of the strongest factors associated with repetition of suicide attempts [31]. In a 20-year follow-up of first-ever suicide attempters, booze intoxication at index suicide effort predicted repetition of suicide attempt at 5 years [32]. In the x-year follow-up carried out by Gibb and colleagues, the factors associated with repetition were female gender, younger age, and use of a low-lethality suicide method [26]. In a previous study of 446 suicide attempters, we likewise reported that younger female attempters with astringent personality disorders were prone to repeat suicide attempts [11].

On the other hand, 1.ii% (15/1241) of suicide attempters evaluated died past suicide within the follow-upwardly period, which is in the lower range of reported studies. For case, in a follow-upwardly of 11,563 patients who presented to hospital later on deliberate cocky-harming, i.five% and 3% died by suicide after 5 and 15 years of follow-up, respectively [33]. Likewise, in the 10-yr follow-upward mentioned to a higher place, of the initial 3690 suicide attempters admitted to Christchurch Hospital, four.6% died past suicide [26]. In another cohort of 150 suicide attempters followed-up during 10 years in Catalonia, 12% completed suicide, and the risk was highest during the first ii years after the alphabetize suicide attempt [29].

Nosotros found that the risk factors for suicide among suicide attempters followed-up in our study were: 1) beingness older; and 2) the presence of an alcohol use disorder. These results are also in keeping with literature [34,35,36,37]. Indeed, one of the nigh consistent findings in Suicidology is that suicide rates are higher among adults aged 60 and older [38]. Accordingly, suicide prevention programs should specifically be designed for this population [38]. On the other manus, alcohol apply disorders not just increased the risk for re-attempting suicide but for suicide. Our finding is as well in keeping with previous literature [39,forty,41]. For instance, in a sample of 1018 unselected deliberate self-poisoning patients followed-upwards 14 years, of the 22.vii% who had suicided by the end of the written report, 85 (38.v%) showed clear prove of long-term alcohol misuse [41]. These authors stressed that more attending should be paid to alcohol employ disorders in suicide attempters [41].

However, our data cannot be generalized, as the almost relevant and discouraging aspect of our written report was that most suicides (127 out of 142, 87.5%) took identify in people who were not evaluated in the ED during the study period. In other words, the 15 suicides among our sample of suicide attempters are likely not representative of suicide completers in our catchment area. For instance, virtually individuals who died by suicide in our report were women with a history of previous suicide attempts. However, most suicides within our catchment area, but who were non evaluated in the ED during the study period, were men (lxx.1%). Literature is clear in this respect: most suicides are male in almost countries. Our finding that most suicides in our catchment area were non included in our sample might be explained by the fact that sixty% of suicides in our area died during the start attempt, and 92.3% of suicides occurred during the showtime or second attempt [42]. Furthermore, almost individuals who suicide are not followed up in mental wellness services, but rather in primary health services [5], thus making it hard to identify individuals at adventure.

Finally, 90% of those who somewhen died past suicide, were not followed-up at month 12. This finding, paired with the to a higher place mentioned data that most suicides are followed up in primary wellness services, strongly suggests that, for the prevention of suicide, it is critical to implement "multiple practice improvements over several years" [16].

Strengths and limitations

The major strength of our study is the sample size of suicide attempters, which immune the states to excerpt some valuable information on the run a risk of re-attempting suicide and suicide in suicide attempters. One limitation is that we did not individually follow-up our population during the 5-yr period of report, only during the first year of telephone follow-up intervention, and instead relied on the electronic medical tape of all suicide attempts evaluated at the ED. This means that suicide attempts that did non require medical intervention may accept been missed. Withal, it is likely we detected the medically astringent suicide attempts. Moreover, nosotros cannot rule out the possibility that some suicide attempts were evaluated in an ED at a different hospital during the follow-up. Nonetheless, this possibility is unlikely because all astringent suicide attempts are systematically referred to our hospital. Furthermore, the follow-up menstruum (five years) and the small number of suicides inside the initial sample of suicide attempters limited our capacity to extrapolate the results to other populations of suicide. Finally, the about important limitation is that we could not explore the effectiveness of our phone plan in preventing suicide. This is of import because most phone preventive programs have been devoted to preventing re-attempts [20, 43, 44]. The thin literature available on preventing suicide is not definitive. For instance, in a study examining long-term furnishings of a telephone helpline service, 18,641 services users were compared with a full general population grouping in Italy [45]. They reported a reduction in suicide deaths among service users, only in that location was a lack of benefit for elderly males. Furthermore, a recent meta-analysis on the potential use of letters, green cards, telephone calls and postcards to preventing suicide did non observe a "significant reduction in the odds of suicide in intervention compared with control" [46]. Accordingly, the authors recommended "farther cess of possible benefits in well-designed trials in clinical populations" before these cursory interventions could be recommended for widespread clinical implementation.

Conclusions

Younger age and the presence of either a personality disorder or an alcohol utilize disorder are risk factors for re-endeavour in suicide attempters. Booze apply and older historic period were risk factors for suicide. Most suicides within the menstruation of study were not included in our study. Thus, our study raises an important question: longitudinal, follow-up studies are methodologically sound studies that allow drawing etiological connections between run a risk factors and suicide. The problem is that, if previously published follow-up studies on suicide had the same trouble that we faced in our written report –that well-nigh suicides were not "detected"-, almost literature published to date on follow-ups could be extrapolating data from populations affected by a selection bias, thus not reflecting the real predictive characteristics of suicide deaths. Furthermore, research is articulate on this: most who die by suicide do non even seek mental health services, and attempters and completes are different, although partially overlapping, populations [37, 47]. Thus, until we are able to detect about individuals at take a chance, and begetting always in heed that the prediction of suicide is incommunicable, probably the virtually intelligent interventions to decrease the daunting suicide charge per unit are reducing access to means and a population-based strategy [47] directed to the prevention of depression in the general population by using unlike measures at different levels of the health system as recommended by the EAAD [16, 17, 48].

Abbreviations

SB:

Suicide behaviour

SIB:

Suicidal ideation and behaviour

EAAD:

European Alliance Against Depression

ED:

Emergency Department

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Acknowledgements

Institute of Legal Medicine of Catalonia, Barcelone, Spain. Anna Escayola, nurse of MH Parc Taulí-University Hospital, Kingdom of spain.

Funding

No other specific funding has been provided for the enquiry.

Availability of data and materials

We don't wish to freely share our information. However, if any researcher would similar to accept them, nosotros volition send our database to him/her provided he/she states a sound reason.

Authors' contributions

DP, IP, and HB originated the thought. OV performed the statistical analyses. LM and IP contributed to information collection. IP and HB wrote the manuscript draft. MO participated in the statistical designing and interpretation of the data, and revised the text. All authors, IP, HB, DP, OV, AC, GG, MO and LM contributed in the estimation of the results and the writing and disquisitional reviewing of the terminal manuscript. All authors read and approved the concluding manuscript.

Competing interests

In the final 24 months Hilario Blasco-Fontecilla received lecture fees from Eli Lilly, AB-Biotics, and Shire; Diego Palao has acted equally a consultant of Lundbeck; and Maria A. Oquendo received royalties for the commercial utilise of the Columbia Suicide Severity Rating Scale and her family owns stock in Bristol Myers Squibb.

The remaining authors declare that they have no competing interests.

Consent for publication

Not applicable.

Ethics approving and consent to participate

This report was performed in accord with the Announcement of Helsinki and approved by the Parc Taulí ethical committee.

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Author information

Affiliations

  1. Department of Mental Health, Parc Tauli-University Hospital, Parc Taulí 1, 08208, Sabadell, Barcelone, Espana

    Isabel Parra-Uribe, Annabel Cebrià-Meca & Diego Palao-Vidal

  2. Section of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelone, Kingdom of spain

    Isabel Parra-Uribe & Diego Palao-Vidal

  3. Department of Psychiatry, IDIPHIM-Puerta de Hierro University Infirmary, Autonoma Academy of Madrid, Avenida Manuel de Falla s/northward, Madrid, Spain

    Hilario Blasco-Fontecilla

  4. CIBERSAM, Madrid, Spain

    Isabel Parra-Uribe, Hilario Blasco-Fontecilla, Annabel Cebrià-Meca & Diego Palao-Vidal

  5. Department of Mental Health, Meritxell Hospital, Andorra la Vella, Andorra

    Gemma Garcia-Parés

  6. Constitute of Legal Medicine of Catalonia, Barcelone, Spain

    Luis Martínez-Naval

  7. Statistical Department, Universitat Autònoma de Barcelona, Barcelona, Kingdom of spain

    Oliver Valero-Coppin

  8. Perelman School of Medicine, Academy of Pennsylvania, Pennsylvania, U.s.a.

    Maria A. Oquendo

Corresponding authors

Correspondence to Hilario Blasco-Fontecilla or Diego Palao-Vidal.

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Parra-Uribe, I., Blasco-Fontecilla, H., Garcia-Parés, G. et al. Hazard of re-attempts and suicide death afterward a suicide attempt: A survival analysis. BMC Psychiatry 17, 163 (2017). https://doi.org/10.1186/s12888-017-1317-z

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Keywords

  • Suicidal behaviour
  • Alcohol use disorders
  • Personality disorders

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Source: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1317-z

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