title: Repeated Suicide Attempts and Suicide Among Individuals With a First Emergency Department Contact for Attempted Suicide: A Prospective, Nationwide, Danish Register-Based Study.
abstract: Emergency departments are important, albeit underutilized, sites for suicide prevention. Preventive strategies and interventions could benefit from a greater understanding of factors influencing the course of suicide risk after emergency department contact due to attempted suicide. The aim of our study was 2-fold: to identify predictors of repeated suicide attempts and suicide and to investigate the timing of these events.
  
  
  
  Data from Danish nationwide, longitudinal registers were used in this prospective, population-based study of all individuals first presenting to an emergency department after attempted suicide (index attempt) between January 1, 1996, and December 31, 2011 (N = 11,802). Cox regression analysis identified predictors, and Kaplan-Meier survival analysis modeled the time to repeated suicide attempts and suicide.
  
  
  
  Sixteen percent of the sample repeated suicide attempt, and 1.4% died by suicide. Repetition was less likely among men than women (adjusted hazard ratio [AHR] = 0.70; 95% CI, 0.63-0.79), whereas those most prone to repeated attempts were individuals with recent psychiatric treatment (AHR = 2.19; 95% CI, 1.97-2.43) and those with recent psychiatric treatment (AHR = 2.19; 95% CI, 1.97-2.43). Predictors of suicide included age over 35 years (AHR = 5.56; 95% CI, 2.89-10.69); hanging, strangling, or suffocation as the method of the index attempt (AHR = 2.55; 95% CI, 1.29-5.01); and receiving psychiatric hospitalization for the index attempt (AHR = 1.74; 95% CI, 1.22-2.49). The cumulative rates of repeated attempts and suicide deaths in the total sample were particularly high within the first week of the index attempt, reaching 3.6% and 0.1%, respectively.
  
  
  
  Preventive efforts need to target the period close to discharge from emergency departments.
authors.affiliation: Mental Health Centre Copenhagen, Kildegårdsvej 28, opg. 15, 4, 2900 Hellerup, Denmark. Izabela.Fedyszyn@gmail.com.|Suicide Prevention Research, Research Unit, Mental Health Center Copenhagen, Copenhagen, Denmark.
authors.forename: Izabela E
authors.initials: IE
authors.lastname: Fedyszyn
authors.affiliation: Suicide Prevention Research, Research Unit, Mental Health Center Copenhagen, Copenhagen, Denmark.|Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.
authors.forename: Annette
authors.initials: A
authors.lastname: Erlangsen
authors.affiliation: Suicide Prevention Research, Research Unit, Mental Health Center Copenhagen, Copenhagen, Denmark.
authors.forename: Carsten
authors.initials: C
authors.lastname: Hjorthøj
authors.affiliation: Suicide Prevention Research, Research Unit, Mental Health Center Copenhagen, Copenhagen, Denmark.
authors.forename: Trine
authors.initials: T
authors.lastname: Madsen
authors.affiliation: Suicide Prevention Research, Research Unit, Mental Health Center Copenhagen, Copenhagen, Denmark.
authors.forename: Merete
authors.initials: M
authors.lastname: Nordentoft
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003718:Denmark; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D001523:Mental Disorders / Q000401:mortality / Q000523:psychology; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology* / Q000706:statistics & numerical data*; D055815:Young Adult; D000092864:Suicide Prevention