title: A cross-sectional study of major repeaters: a distinct phenotype of suicidal behavior.
abstract: OBJECTIVE
  The characterization of major repeaters (individuals with ≥ 5 lifetime suicide attempts) is a neglected area of research. Our aim was to establish whether or not major repeaters are a distinctive suicidal phenotype, taking into account a wide range of potential competing risks including sociodemographic characteristics, personal and familial history, psychiatric diagnoses, and personality traits.
  
  
  METHODS
  This cross-sectional study included 372 suicide attempters admitted to a specialized unit for suicide attempters in Montpellier University Hospital, Montpellier, France, between October 12, 2000, and June 10, 2010. Logistic regression models controlling for potential confounders were used.
  
  
  RESULTS
  When compared with subjects who attempted suicide < 5 times, major repeaters were more likely to be female (odds ratio [OR] = 5.54; 95% CI, 1.41-21.81), to have a lower educational level (OR = 5.1; 95% CI, 1.55-17.2), to have lifetime diagnoses of anorexia nervosa (OR = 3.45; 95% CI, 1.10-10.84) and substance dependence (OR = 5.00; 95% CI, 1.37-18.27), and to have lower levels of anger expressed outward (OR = 0.17; 95% CI, 0.06-0.47) and higher levels of trait anger (OR = 2.82; 95% CI, 1.18-6.75). Major repeaters had significantly higher suicide risk (lethality) scores (OR = 2.14; 95% CI, 1.08-4.23).
  
  
  CONCLUSIONS
  Major repeaters are a distinctive suicidal phenotype characterized by a distinctive sociodemographic (ie, female gender, low education) and clinical profile (ie, trait anger, substance dependence, anorexia nervosa). If our results are replicated, specific preventive plans should be tailored to major repeaters.
authors: Department of Psychiatry, IDIPHIM-Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain (Drs Blasco-Fontecilla and Artieda-Urrutia); CIBERSAM (Dr Blasco-Fontecilla), Madrid, Spain; Inserm, U1061 and Université Montpellier I (Drs Jaussent, Olié, Guillaume, and Courtet and Ms Béziat), Montpellier, France; Psychiatric Emergency and Post Emergency Department, Centre Hospitalier Regional Universitaire Montpellier, Hôpital Lapeyronie, Montpellier, France (Drs Guillaume, Olié, and Courtet); Department of Psychiatry, IIS-FJD, CIBERSAM, Madrid, Spain (Dr Baca-Garcia); and Mental Health Research Center, Eastern State Hospital, Lexington, Kentucky (Dr de Leon).
authors: Hilario
authors: H
authors: Blasco-Fontecilla
authors: Department of Psychiatry, IDIPHIM-Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain (Drs Blasco-Fontecilla and Artieda-Urrutia); CIBERSAM (Dr Blasco-Fontecilla), Madrid, Spain; Inserm, U1061 and Université Montpellier I (Drs Jaussent, Olié, Guillaume, and Courtet and Ms Béziat), Montpellier, France; Psychiatric Emergency and Post Emergency Department, Centre Hospitalier Regional Universitaire Montpellier, Hôpital Lapeyronie, Montpellier, France (Drs Guillaume, Olié, and Courtet); Department of Psychiatry, IIS-FJD, CIBERSAM, Madrid, Spain (Dr Baca-Garcia); and Mental Health Research Center, Eastern State Hospital, Lexington, Kentucky (Dr de Leon).
authors: Isabelle
authors: I
authors: Jaussent
authors: Department of Psychiatry, IDIPHIM-Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain (Drs Blasco-Fontecilla and Artieda-Urrutia); CIBERSAM (Dr Blasco-Fontecilla), Madrid, Spain; Inserm, U1061 and Université Montpellier I (Drs Jaussent, Olié, Guillaume, and Courtet and Ms Béziat), Montpellier, France; Psychiatric Emergency and Post Emergency Department, Centre Hospitalier Regional Universitaire Montpellier, Hôpital Lapeyronie, Montpellier, France (Drs Guillaume, Olié, and Courtet); Department of Psychiatry, IIS-FJD, CIBERSAM, Madrid, Spain (Dr Baca-Garcia); and Mental Health Research Center, Eastern State Hospital, Lexington, Kentucky (Dr de Leon).
authors: Emilie
authors: E
authors: Olié
authors: Department of Psychiatry, IDIPHIM-Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain (Drs Blasco-Fontecilla and Artieda-Urrutia); CIBERSAM (Dr Blasco-Fontecilla), Madrid, Spain; Inserm, U1061 and Université Montpellier I (Drs Jaussent, Olié, Guillaume, and Courtet and Ms Béziat), Montpellier, France; Psychiatric Emergency and Post Emergency Department, Centre Hospitalier Regional Universitaire Montpellier, Hôpital Lapeyronie, Montpellier, France (Drs Guillaume, Olié, and Courtet); Department of Psychiatry, IIS-FJD, CIBERSAM, Madrid, Spain (Dr Baca-Garcia); and Mental Health Research Center, Eastern State Hospital, Lexington, Kentucky (Dr de Leon).
authors: Severine
authors: S
authors: Béziat
authors: Department of Psychiatry, IDIPHIM-Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain (Drs Blasco-Fontecilla and Artieda-Urrutia); CIBERSAM (Dr Blasco-Fontecilla), Madrid, Spain; Inserm, U1061 and Université Montpellier I (Drs Jaussent, Olié, Guillaume, and Courtet and Ms Béziat), Montpellier, France; Psychiatric Emergency and Post Emergency Department, Centre Hospitalier Regional Universitaire Montpellier, Hôpital Lapeyronie, Montpellier, France (Drs Guillaume, Olié, and Courtet); Department of Psychiatry, IIS-FJD, CIBERSAM, Madrid, Spain (Dr Baca-Garcia); and Mental Health Research Center, Eastern State Hospital, Lexington, Kentucky (Dr de Leon).
authors: Sebastien
authors: S
authors: Guillaume
authors: Department of Psychiatry, IDIPHIM-Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain (Drs Blasco-Fontecilla and Artieda-Urrutia); CIBERSAM (Dr Blasco-Fontecilla), Madrid, Spain; Inserm, U1061 and Université Montpellier I (Drs Jaussent, Olié, Guillaume, and Courtet and Ms Béziat), Montpellier, France; Psychiatric Emergency and Post Emergency Department, Centre Hospitalier Regional Universitaire Montpellier, Hôpital Lapeyronie, Montpellier, France (Drs Guillaume, Olié, and Courtet); Department of Psychiatry, IIS-FJD, CIBERSAM, Madrid, Spain (Dr Baca-Garcia); and Mental Health Research Center, Eastern State Hospital, Lexington, Kentucky (Dr de Leon).
authors: Paula
authors: P
authors: Artieda-Urrutia
authors: Department of Psychiatry, IDIPHIM-Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain (Drs Blasco-Fontecilla and Artieda-Urrutia); CIBERSAM (Dr Blasco-Fontecilla), Madrid, Spain; Inserm, U1061 and Université Montpellier I (Drs Jaussent, Olié, Guillaume, and Courtet and Ms Béziat), Montpellier, France; Psychiatric Emergency and Post Emergency Department, Centre Hospitalier Regional Universitaire Montpellier, Hôpital Lapeyronie, Montpellier, France (Drs Guillaume, Olié, and Courtet); Department of Psychiatry, IIS-FJD, CIBERSAM, Madrid, Spain (Dr Baca-Garcia); and Mental Health Research Center, Eastern State Hospital, Lexington, Kentucky (Dr de Leon).
authors: Enrique
authors: E
authors: Baca-Garcia
authors: Department of Psychiatry, IDIPHIM-Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain (Drs Blasco-Fontecilla and Artieda-Urrutia); CIBERSAM (Dr Blasco-Fontecilla), Madrid, Spain; Inserm, U1061 and Université Montpellier I (Drs Jaussent, Olié, Guillaume, and Courtet and Ms Béziat), Montpellier, France; Psychiatric Emergency and Post Emergency Department, Centre Hospitalier Regional Universitaire Montpellier, Hôpital Lapeyronie, Montpellier, France (Drs Guillaume, Olié, and Courtet); Department of Psychiatry, IIS-FJD, CIBERSAM, Madrid, Spain (Dr Baca-Garcia); and Mental Health Research Center, Eastern State Hospital, Lexington, Kentucky (Dr de Leon).
authors: Jose
authors: J
authors: de Leon
authors: Department of Psychiatry, IDIPHIM-Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain (Drs Blasco-Fontecilla and Artieda-Urrutia); CIBERSAM (Dr Blasco-Fontecilla), Madrid, Spain; Inserm, U1061 and Université Montpellier I (Drs Jaussent, Olié, Guillaume, and Courtet and Ms Béziat), Montpellier, France; Psychiatric Emergency and Post Emergency Department, Centre Hospitalier Regional Universitaire Montpellier, Hôpital Lapeyronie, Montpellier, France (Drs Guillaume, Olié, and Courtet); Department of Psychiatry, IIS-FJD, CIBERSAM, Madrid, Spain (Dr Baca-Garcia); and Mental Health Research Center, Eastern State Hospital, Lexington, Kentucky (Dr de Leon).
authors: Philippe
authors: P
authors: Courtet