title: How do repeat suicide attempters differ from first timers? An exploratory record based analysis.
abstract: BACKGROUND
  Evidence indicates that repeat suicide attempters, as a group, may differ from 1(st) time attempters. The identification of repeat attempters is a powerful but underutilized clinical variable.
  
  
  OBJECTIVE
  In this research, we aimed to compare individuals with lifetime histories of multiple attempts with 1(st) time attempters to identify factors predictive of repeat attempts.
  
  
  METHODS
  This was a retrospective record based study carried out at a teaching cum Tertiary Care Hospital in South India.
  
  
  METHODS
  Relevant data was extracted from the clinical records of 1(st) time attempters (n = 362) and repeat attempters (n = 61) presenting to a single Tertiary Care Center over a 4½ year period. They were compared on various sociodemographic and clinical parameters. The clinical measures included Presumptive Stressful Life Events Scale, Beck Hopelessness Scale, Coping Strategies Inventory - Short Form, and the Global Assessment of Functioning Scale.
  
  
  METHODS
  First time attempters and repeaters were compared using appropriate inferential statistics. Logistic regression was used to identify independent predictors of repeat attempts.
  
  
  RESULTS
  The two groups did not significantly differ on sociodemographic characteristics. Repeat attempters were more likely to have given prior hints about their act (χ(2) = 4.500, P = 0.034). In the final regression model, beck hopelessness score emerged as a significant predictor of repeat suicide attempts (odds ratio = 1.064, P = 0.020).
  
  
  CONCLUSIONS
  Among suicide attempters presenting to the hospital, the presence of hopelessness is a predictor of repeat suicide attempts, independent of clinical depression. This highlights the importance of considering hopelessness in the assessment of suicidality with a view to minimize the risk of future attempts.
authors.affiliation: Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Menon
authors.affiliation: Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
authors.forename: Shivanand
authors.initials: S
authors.lastname: Kattimani
authors.affiliation: Department of Psychiatry, Sree Balaji Medical College and Hospitals, Chennai, Tamil Nadu, India.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Sarkar
authors.affiliation: Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
authors.forename: Kaliaperumal
authors.initials: K
authors.lastname: Mathan
keywords: Attempted suicide; cognition; depression; hopelessness; suicide