Risk Factors for First-Attempt Suicide Fatalities: Evidence From the MCOSUL Cohort

AI Summary

32.5% of suicide deaths occurred at first attempt (38 of 117); 67.5% followed one or more prior non-fatal attempts.
Unemployment and recognised disability were less frequent among first-attempt fatalities (OR 0.17 and 0.20), indicating association with repeat-attempt deaths.
No significant differences by age, sex, alcohol use, psychiatric diagnosis or fatal method between first and repeat-attempt fatalities.

AI Summary

BACKGROUND: Individuals who die by suicide may differ depending on whether the fatal act is their first attempt or follows previous non-fatal attempts.

Sociodemographic, clinical, and method-related variables were compared between first-attempt and repeat-attempt fatalities.

CONCLUSIONS: Unemployment and recognized disability (formal legal/administrative disability certification issued by relevant regional authorities, which may encompass physical and/or psychiatric disabilities) appear to characterize individuals who die by suicide after a series of non-fatal attempts, suggesting a subgroup with a more prolonged suicidal course that may benefit from sustained engagement and prevention strategies.

Basic summary

Actas Esp Psiquiatr. 2026 Jun 15;54(3):657-662. doi: 10.62641/aep.v54i3.2220.

ABSTRACT

BACKGROUND: Individuals who die by suicide may differ depending on whether the fatal act is their first attempt or follows previous non-fatal attempts. Understanding these differences may help refine prevention strategies.

METHODS: We conducted a cross-sectional analysis within the MCOSUL Cohort, a clinical registry of all patients treated for a suicide attempt in two general hospitals in Lleida, Spain. We included all cohort members who died by suicide between January 2009 and December 2022. Sociodemographic, clinical, and method-related variables were compared between first-attempt and repeat-attempt fatalities. Variables with p < 0.20 in bivariate analyses were entered into a multivariable logistic regression model to identify independent predictors of first-attempt fatalities.

RESULTS: Among 117 suicide deaths, 38 (32.5%) occurred at the first attempt and 79 (67.5%) after one or more prior non-fatal attempts. Repeat-attempt fatalities had a mean of 1.89 (SD = 1.73) attempts from cohort entry to death. In multivariable analysis, unemployment (OR = 0.17, 95% CI: 0.04-0.66, p = 0.011) and recognized disability (OR = 0.20, 95% CI: 0.04-0.80, p = 0.035) were less frequent among first-attempt fatalities, indicating they were more common in those who died after repeated attempts. No significant differences were found for age, sex, alcohol use, psychiatric diagnosis, or fatal attempt method.

PMID:42343720 | DOI:10.62641/aep.v54i3.2220

Document this CPD