title: The repetition of suicidal behavior: a multicenter cohort study.
abstract: OBJECTIVE
  To determine the proportion of individuals who repeated nonfatal suicidal behavior within 12 months of an index episode, to investigate the timing of repetition, and to investigate risk factors associated with repetition and their population impact.
  
  
  METHODS
  We carried out a prospective cohort study (1997-2002) in 4 large hospitals in North West England. We included subjects aged 15 years and over who attended with "self-harm" (an act of intentional self-poisoning or injury irrespective of the apparent purpose of the act). Following the episode, a standard assessment form, which included detailed demographic and clinical data, was completed by a clinician.
  
  
  RESULTS
  9213 individuals presented during the study period. The incidence of repetition within 12 months of the index episode was 13.6% (95% CI: 12.9% to 14.4%). The median time to first repetition was 73.5 days (interquartile range, 20 to 187 days). One in 10 subjects repeated within 5 days of the index episode. Independent risk factors for repetition included previous suicidal behavior, psychiatric treatment, being unemployed or registered sick, self-injury, alcohol misuse, and reporting suicidal plans or hallucinations at the time of the index episode. The combined population attributable fraction (an indicator of the potential population impact) for these variables was 65%.
  
  
  CONCLUSIONS
  The repetition of suicidal behavior is common and occurs quickly. On a population level, our study suggests that the most important strategies to reduce repetition might include primary prevention of suicidal behavior, targeting psychiatric illness, and tackling social factors such as unemployment. Specific interventions may be required for individual subgroups.
authors.affiliation: Centre for Suicide Prevention, Department of Psychiatry and Behavioural Sciences, University of Manchester, Manchester, United Kingdom. nav.kapur@manchester.ac.uk
authors.forename: Navneet
authors.initials: N
authors.lastname: Kapur
authors.forename: Jayne
authors.initials: J
authors.lastname: Cooper
authors.forename: Sarah
authors.initials: S
authors.lastname: King-Hele
authors.forename: Roger
authors.initials: R
authors.lastname: Webb
authors.forename: Martin
authors.initials: M
authors.lastname: Lawlor
authors.forename: Cathryn
authors.initials: C
authors.lastname: Rodway
authors.forename: Louis
authors.initials: L
authors.lastname: Appleby
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D004739:England / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D011322:Primary Prevention; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data*; D013997:Time Factors; D014478:Unemployment / Q000523:psychology / Q000706:statistics & numerical data