title: Socioeconomic and clinical characteristics associated with repeat suicide attempts among young people.
abstract: OBJECTIVE
  Repeat suicidal behaviors in young people are a critical public health concern. The study investigates individual socioeconomic and episode-dependent clinical factors predicting repeat suicide attempts among youth by gender.
  
  
  METHODS
  Using a retrospective cohort study, we identified a total of 4,094 male and 3,219 female youths who had the index suicide episode at the ages of 15-24 years from the 1996-2007 National Health Insurance Research Database in Taiwan. The recurrence of suicide attempt was assessed within 1 year after the index suicide. Information pertaining to suicide management and postsuicide treatment was obtained from healthcare records. Repeated event survival analyses were used to estimate episode-dependent risk of suicide attempt.
  
  
  RESULTS
  The occurrence of repeat suicide attempts was more common in males, yet the phenomenon of risk aggravation appears more prominent in females. The estimate for peak hazard of the second repeat attempt was 2-fold higher than that of the first repeat event in males, and approximately 6-fold in females. Socioeconomic (e.g., labor market participation: adjusted Hazard Ratio [aHR] = 1.14, 95% CI = 1.01-1.28) and index suicide management characteristics (e.g., receiving treatment at clinic, aHR = 1.54, 95% CI = 1.19-1.99) were found to play important roles for repeat suicide attempts in males. For females, postsuicide treatment of mental disorders appears more influential.
  
  
  CONCLUSIONS
  The relationships between socioeconomic and clinical factors with repeat suicide attempts in young people vary by gender. School/workplace-based post suicide attempt consultation and clinical management for youth may be planned and delivered on a gender-appropriate basis.
authors: Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Center for Neuropsychiatric Research, National Health Research Institutes, Taipei, Taiwan. Electronic address: chuanychen@gmail.com.
authors: Chuan-Yu
authors: CY
authors: Chen
authors: Center for Neuropsychiatric Research, National Health Research Institutes, Taipei, Taiwan; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan.
authors: Hsueh-Han
authors: HH
authors: Yeh
authors: Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
authors: Nicole
authors: N
authors: Huang
authors: Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
authors: Yun-Chen
authors: YC
authors: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D010507:Periodicity; D012189:Retrospective Studies; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data*; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: Adolescents; Gender; Repeat suicide attempt; Survival analysis; Young adults