title: Repetition of attempted suicide among immigrants in Europe.
abstract: OBJECTIVE
  To compare frequencies of suicide attempt repetition in immigrants and local European populations, and the timing of repetition in these groups.
  
  
  METHODS
  Data from 7 European countries, comprising 10 574 local and 3032 immigrant subjects, were taken from the World Health Organization European Multicentre Study on Suicidal Behaviour and the ensuing Monitoring Suicidal Behaviour in Europe (commonly referred to as MONSUE) project. The relation between immigrant status and repetition of suicide attempt within 12-months following first registered attempt was analyzed with binary logistic regression, controlling for sex, age, and method of attempt. Timing of repetition was controlled for sex, age, and the recommended type of aftercare.
  
  
  RESULTS
  Lower odds of repeating a suicide attempt were found in Eastern European (OR 0.50; 95% CI 0.41 to 0.61, P < 0.001) and non-European immigrants (OR 0.68; 95% CI 0.51 to 0.90, P < 0.05), compared with the locals. Similar patterns were identified in the sex-specific analysis. Eastern European immigrants tended to repeat their attempt much later than locals (OR 0.58; 95% CI 0.35 to 0.93, P < 0.05). In general, 32% of all repetition occurred within 30 days. Repetition tended to decrease with age and was more likely in females using harder methods in their index attempt (OR 1.29; 95% CI 1.08 to 1.54, P < 0.01). Large variations in the general repetition frequency were identified between the collecting centres, thus influencing the results.
  
  
  CONCLUSIONS
  The lower repetition frequencies in non-Western immigrants, compared with locals, in Europe stands in contrast to their markedly higher tendency to attempt suicide in general, possibly pointing to situational stress factors related to their suicidal crisis that are less persistent over time. Our findings also raise the possibility that suicide attempters and repeaters constitute only partially overlapping populations.
authors.affiliation: Doctoral Graduate, National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institute and Stockholm County Council's Centre for Suicide Research and Prevention, Stockholm, Sweden.
authors.forename: Cendrine Bursztein
authors.initials: CB
authors.lastname: Lipsicas
authors.affiliation: Professor, Department of Sociology, Uppsala University, Uppsala, Sweden; Professor, Stockholm Centre on Health of Societies in Transition, School of Social Sciences, Södertörn University, Södertörn, Sweden.
authors.forename: Ilkka Henrik
authors.initials: IH
authors.lastname: Mäkinen
authors.affiliation: Professor, National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institute and Stockholm County Council's Centre for Suicide Research and Prevention, Stockholm, Sweden; Head of World Health Organization Lead Collaborating Centre of Mental Health Problems and Suicide across Europe, Stockholm, Sweden.
authors.forename: Danuta
authors.initials: D
authors.lastname: Wasserman
authors.affiliation: Professor, Feinberg Child Study Center and the Department of Child and Adolescent Psychiatry, Schneider Children Medical Center, Petah-Tikva, Israel.
authors.forename: Alan
authors.initials: A
authors.lastname: Apter
authors.affiliation: Professor, Department of Clinical Psychology, Vrije Universiteit, Amsterdam, the Netherlands.
authors.forename: Ad
authors.initials: A
authors.lastname: Kerkhof
authors.affiliation: Professor, University Psychiatric Services, Bern, Switzerland.
authors.forename: Konrad
authors.initials: K
authors.lastname: Michel
authors.affiliation: Professor, Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden.
authors.forename: Ellinor Salander
authors.initials: ES
authors.lastname: Renberg
authors.affiliation: Professor, University Department of Psychiatry and Medical Psychology, Unit for Suicide Research, University Hospital, Gent, Belgium.
authors.forename: Kees
authors.initials: K
authors.lastname: Van Heeringen
authors.affiliation: Professor, Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia; Professor, Tallinn University, Tallinn, Estonia.
authors.forename: Airi
authors.initials: A
authors.lastname: Värnik
authors.affiliation: Professor, Unit for Clinical Psychology, Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Schmidtke
mesh_terms: D000328:Adult; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005060:Europe / Q000208:ethnology; D005260:Female; D006801:Humans; D008297:Male; D013406:Suicide, Attempted / Q000208:ethnology / Q000706:statistics & numerical data*; D013997:Time Factors