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.