Risk factors for fatal and nonfatal repetition of suicide attempt: a critical appraisal

PURPOSE OF REVIEW: To perform a critical appraisal of reports on suicide attempts published in 2009, looking for features and predictors of suicidal behavior. RECENT FINDINGS: We searched Psychinfo, Embase, and Pubmed in the period from 1 December 2008 to 31 December 2009 looking for papers on suicide attempt. Rates of suicide attempts are in line with previous data and confirm a north-south gradient in the suicide attempt rate. Previous attempts are the strongest risk factors for further attempt. Moreover, we point out the importance of mood disorders (in particular depression) and personality disorders, unemployment, and a medium age as risk factors. In adolescence, the repetition rate seems to overlap that of the adult population, though the samples are very small. Even in this case, the presence of a previous suicide attempt increases the risk for repeated suicide attempt. By contrast, the role of psychiatric and demographic variables is less clear. Studies on personality disorders confirm that having a personality disorder increases the risk for further attempt, but this correlation is significantly less strong for fatal repetition. In depressed patients, the presence of anxiety perhaps acts as a protective factor. SUMMARY: The risk for a suicide attempt is higher for people who had previously attempted. Having a psychiatric diagnosis and more specifically a mood disorder is also a strong predictor for both fatal and nonfatal suicide attempt.