Length of residence and clinical correlates of suicidal behavior in immigrant and native patients in Spain: the MCOSUL cohort

Background and objectives Evidence on the clinical profile of immigrants presenting with suicidal behavior in southern Europe is scarce. We compared immigrant and native patients attended for suicidal behavior and examined the role of length of residence. Methods Register-based retrospective study of 1918 patients attended for suicidal behavior at the psychiatric emergency service of Lleida, Spain, between 2009 and 2022 (MCOSUL cohort). Sociodemographic, diagnostic and suicidal behavior characteristics were compared, and length of residence was used as a proxy of acculturation. Multivariable logistic regression models adjusted for age, sex, employment, marital status and calendar period. Results Immigrants represented 16.4% (n = 315). Compared with natives, they were younger (33.1 vs. 42.8 years), more often women (70.8%vs. 61.2%) and more often had no psychiatric diagnosis (5.7%vs. 2.6%). After adjustment, immigrants remained more likely to have a personality disorder (aOR 1.90, 95% CI 1.39–2.59) and to use non-sedative drug overdose (aOR 1.38, 95% CI 1.00–1.90), whereas differences in depression, lethality and prior attempts were no longer significant. Among immigrants, residence >10 years was associated with suicidal ideation rather than an attempt (aOR 2.45, 95% CI 1.32–4.55) and with no prior attempt (aOR 2.51, 95% CI 1.49–4.22), independently of age. Conclusions Immigrants attended for suicidal behavior show a distinct clinical profile, with more personality disorders and non-sedative overdoses, whereas other differences are largely explained by age. Longer residence was associated with suicidal ideation rather than attempts, which should be confirmed with validated acculturation measures.