Incident and Recurrent Suicide Attempts in Adolescents With Major Depressive Disorder: Baseline Correlates and Prospective Predictors in a One-Year Follow-Up

Background Suicidal behavior in adolescents with major depressive disorder (MDD) remains a critical public health concern. While prior research has identified numerous correlates of suicide attempts, few longitudinal studies have distinguished between factors associated with incident versus recurrent suicidal behavior. Methods In this prospective follow-up study, adolescents diagnosed with MDD were assessed at baseline (T0) and followed for one year (T1). Suicide attempts were evaluated longitudinally, and participants were categorized according to baseline and follow-up suicide attempt status. Multivariable logistic regression models were used to examine baseline correlates of suicide attempt history and prospective predictors of incident and recurrent suicide attempts. Results At baseline, several social and environmental factors—including peer suicide attempts (OR = 14.07), parental consanguinity (OR = 6.32), witnessing domestic violence (OR = 3.57), labeling distress (OR = 1.36), and cybervictimization (OR = 1.07)—were associated with a history of suicide attempts. Longitudinal analyses revealed distinct risk profiles: witnessing domestic violence (OR = 30.00) and alcohol use (OR = 16.67) were most strongly associated with incident suicide attempts, whereas trauma-related factors such as physical neglect (OR = 1.24) and sleep disturbances such as insomnia (OR = 2.00) were more prominently associated with recurrent attempts. Parental consanguinity also emerged as a potentially relevant and underexplored risk marker. Conclusions Incident and recurrent suicide attempts among adolescents with MDD may involve partly distinct clinical correlates and prospective risk patterns. These findings support stage-sensitive suicide prevention strategies and highlight parental consanguinity as a culturally relevant factor warranting further investigation.