Risk factors for re-attempt and suicide within 6 months after an attempt in the French ALGOS cohort: a survival tree analysis

Alice Demesmaeker, Emmanuel Ch

Abstract

  INTRODUCTION: 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 (SAs) and suicide within 6 months after SA. METHOD: A prospective observational cohort of 972 subjects was used to perform a survival tree analysis with all sociodemographic and clinical variables available at inclusion. Then, the results of the decision tree were used to define a simple predictive algorithm for clinicians. RESULTS: The results of survival tree analysis highlighted three subgroups of patients with an increased risk of SA or death by suicide within 6 months after SA: patients with alcohol use disorder and a previous SA with acute alcohol use (risk ratio (RR) 2.92 [2.08; 4.10]), patients with anxiety disorders (RR 0.98 [0.69; 1.39]), or patients with a history of more than 2 SAs in the past 3 years (RR 2.11 [1.25; 3.54]). The good prognosis group comprised all other patients. CONCLUSION: By using a data-driven method, we identified four 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.