Long-Term Risk Factors For Suicide In Suicide Attempters Examined At A Medical Emergency In Patient Unit: Results From A 32-Year Follow-Up Study

Objectives The overall aim of this study is to gain greater knowledge about the risk of suicide among suicide attempters in a very long-term perspective. Specifically, to investigate possible differences in clinical risk factors at short (<= 5 years) versus long term (>5 years), with the hypothesis that risk factors differ in the shorter and longer perspective.Design Prospective study with register-based follow-up for 21-32 years.Setting Medical emergency inpatient unit in the south of Sweden.Participants 1044 individuals assessed by psychiatric consultation when admitted to medical inpatient care for attempted suicide during 1987-1998.Outcome measures Suicide and all-cause mortality.Results At follow-up, 37.6% of the participants had died, 7.2% by suicide and 53% of these within 5 years of the suicide attempt. A diagnosis of psychosis at baseline represented the risk factor with the highest HR at long-term follow-up, that is, >5 years, followed by major depression and a history of attempted suicide before the index attempt. The severity of a suicide attempt as measured by SIS (Suicide Intent Scale) showed a non-proportional association with the hazard for suicide over time and was a relevant risk factor for suicide only within the first 5 years after an attempted suicide.Conclusions The risk of suicide after a suicide attempt persists for up to 32 years after the index attempt. A baseline diagnosis of psychosis or major depression or earlier suicide attempts continued to be relevant risk factors in the very long term. The SIS score is a better predictor of suicide risk at short term, that is, within 5 years than at long term. This should be considered in the assessment of suicide risk and the implementation of care for these individuals.