Suicide and All-Cause Mortality Within 1 Year After a Suicide Attempt in the VigilanS Cohort.

Objective: Obtaining better knowledge on the outcomes of patients who attempt suicide is crucial for suicide prevention. The aim of our study was to determine the causes of death 1 year after a suicide attempt (SA) in the VigilanS program, mortality rates, and risk factors associated with any cause of death and suicide.Methods: A prospective cohort of 7,406 people who had attempted suicide between January 1, 2017, and December 31, 2018, was included in the study. The vital status of each participant was sought, and the cause of death was established through a phone call to their general practitioner or psychiatrist. Second, the relationship between sociodemographic and clinical factors and death by suicide within 1 year of an SA was assessed using a multivariable Cox model.Results: At 1 year, 125 (1.7%) participants had died, 77 of whom died by suicide. Half of the deaths occurred within the first 4 months after an SA. Hanging (20.3%; 24/125) and self-poisoning (19.5%; 23/125) were the methods the most often used for suicide. We demonstrated that male sex (HR = 1.79 [1.13-2.82], P = .01) and being 45 years of age or older (between 45 and 64 years old, HR = 2.08 [1.21-3.56], P < .01; 65 years or older, HR = 5.36 [2.72-10.54], P < .01) were associated with a higher risk of death by suicide 1 year after an SA and that being younger than 25 years was associated with a lower risk (HR = 0.22 [0.07-0.76], P = .02).Conclusions: One out of 100 people who attempted suicide died by suicide within 1 year after an SA. Greater vigilance is required in the first months following an SA, especially for males older than 45 years.Trial Registration: ClinicalTrials.gov identifier: NCT03134885.

Assessment of a Suicide Prevention Gatekeeper Training Program for Nursing Home Staff.

INTRODUCTION: Older adults have one of the highest age-specific suicide rates in France, and the risk of suicide is higher for those living in nursing homes. The aim of our study was to assess the effectiveness of gatekeeper training for nursing home staff on the knowledge and stigmas towards suicidal crisis and the impact on suicidal behaviour rates. METHOD: A total of 427 nursing or administrative staff from 110 nursing homes received gatekeeper training in the Hauts-de-France French region between September 2016 and June 2018. First, knowledge and stigmas on suicidal crisis were assessed through a pretest and posttest survey. Second, a retrospective survey was conducted to determine suicide behaviour rates before and after training in nursing homes. Then, changes between pre- and posttraining scores and suicide rates were evaluated with a paired samples T test and rate difference calculation (P value of <0.05 was considered statistically significant). RESULTS: A total of 315 trainees completed the questionnaires on knowledge and stigmas related to suicidal crisis, and we found a significant difference in the total scores (P < 0.01). Moreover, we found a significant decrease in the incidence of suicide attempts (SAs) after training (P = 0.002), but the incidence of deaths by suicide was not significantly different prior to and after the training course (P = 0.46). CONCLUSION: We highlighted an improvement in knowledge and stigmas after training and a reduction in the rates of SAs with our gatekeeper suicide prevention program. Future research is needed to improve suicide prevention for nursing home residents.

Suicide mortality after a nonfatal suicide attempt: A systematic review and meta-analysis.

INTRODUCTION: Deliberate self-harm and suicide attempts share common risk factors but are associated with different epidemiological features. While the rate of suicide after deliberate self-harm has been evaluated in meta-analyses, the specific rate of death by suicide after a previous suicide attempt has never been assessed. The aim of our study was to estimate the incidence of death by suicide after a nonfatal suicide attempt. METHOD: We developed and followed a standard meta-analysis protocol (systematic review registration-PROSPERO 2021: CRD42021221111). Randomized controlled trials and cohort studies published between 1970 and 2020 focusing on the rate of suicide after suicide attempt were identified in PubMed, PsycInfo and Scopus and qualitatively described. The rates of deaths by suicide at 1, 5 and 10 years after a nonfatal suicide attempt were pooled in a meta-analysis using a random-effects model. Subgroup analysis and meta-regressions were also performed. RESULTS: Our meta-analysis is based on 41 studies. The suicide rate after a nonfatal suicide attempt was 2.8% (2.2-3.5) at 1 year, 5.6% (3.9-7.9) at 5 years and 7.4% (5.2-10.4) at 10 years. Estimates of the suicide rate vary widely depending on the psychiatric diagnosis, the method used for the suicide attempt, the type of study and the age group considered. CONCLUSION: The evidence of a high rate of suicide deaths in the year following nonfatal suicide attempts should prompt prevention systems to be particularly vigilant during this period.

Risk Factors for Reattempt and Suicide Within 6 Months After an Attempt in the French ALGOS Cohort: A Survival Tree Analysis.

OBJECTIVE: Understanding the cumulative effect of several risk factors involved in suicidal behavior is crucial for the development of effective prevention plans. The objective of this study is to provide clinicians with a simple predictive model of the risk of suicide attempts and suicide within 6 months after suicide attempt. METHODS: A prospective observational cohort of 972 subjects, included from January 26, 2010, to February 28, 2013, was used to perform a survival tree analysis with all sociodemographic and clinical variables available at inclusion. The results of the decision tree were then used to define a simple predictive algorithm for clinicians. RESULTS: The results of survival tree analysis highlighted 3 subgroups of patients with an increased risk of suicide attempt or death by suicide within 6 months after suicide attempt: patients with alcohol use disorder and a previous suicide attempt with acute alcohol use (risk ratio [RR] = 2.92; 95% CI, 2.08 to 4.10), patients with anxiety disorders (RR = 0.98; 95% CI, 0.69 to 1.39), and patients with a history of more than 2 suicide attempts in the past 3 years (RR = 2.11; 95% CI, 1.25 to 3.54). The good prognosis group comprised all other patients. CONCLUSIONS: By using a data-driven method, this study identified 4 clinical factors interacting together to reduce or increase the risk of recidivism. These combinations of risk factors allow for a better evaluation of a subject's suicide risk in clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01123174.

A pharmacoepidemiological study of the association of suicide reattempt risk with psychotropic drug exposure.

INTRODUCTION: Recent pharmacoepidemiological studies have suggested that consumption of certain classes of psychotropic drugs could be considered protective or risk factors for suicidal behaviour. The aim of the study was to evaluate the association between the risk of suicide reattempt within 6 and 14 months after a suicide attempt (SA) with the use of different classes of psychotropic drugs, combination pairs and treatment adequacy from inclusion through 6 and 14 months post-SA. METHOD: A prospective observational cohort of 972 subjects from the ALGOS study from January 2010 to February 2013 was used to evaluate the association of risk of suicide reattempt within 6 and 14 months with the use of different classes of psychotropic drugs (antidepressants, anxiolytics, antipsychotics, lithium, anticonvulsants, analgesics, opioid maintenance therapy and maintenance treatment for alcohol dependence). A multivariable Cox model was performed after imputation of missing data using the multiple imputation method. RESULTS: Our main results did not show an association between psychotropic drug use and suicide reattempt after 6 months of follow-up. We demonstrated that the use of benzodiazepines (HR = 1.87 [1.25; 2.81], p < 0.01) and hypnotics (HR = 1.49 [1.03; 2.17], p = 0.04) or a combination of both (HR = 1.80 [1.17; 2.72], p = 0.01) were associated with suicide reattempt within 14 months after a previous SA. CONCLUSION: The early identification of a positive association between psychotropic drugs and the risk of suicidal behaviour is extremely important for prevention of suicide reattempts. Special precautions should be considered when prescribing psychotropic drugs for these subjects, particularly those at risk of suicide reattempt.