Risk Factors for Multiple Suicide Attempts in Adolescents From 10 Years Suicide Repository

Background: While there are many studies on adolescents' suicide attempts in the western countries, studies on adolescent suicide in South Korea are relatively scarce. We compared demographical and clinical variables between the first and multiple suicide attempters and examined potential risk factors predicting multiple suicide attempts. Methods: Two hundred forty-eight suicide attempters aged from 11 to 19 years old who visited emergency department of Uijeongbu St. Mary's Hospital, South Korea were recruited and divided into two groups: first attempter (n = 139, 56%) and multiple attempter (n = 109, 44%). A psychiatric interview with the Brief Emergency Room Suicide Risk Assessment were administered to all participants, and univariate analyses to compare characteristics of the two group and a multivariable logistic regression analysis to predict multiple suicidal attempts were performed. Results: Our results showed multiple suicide attempters were mostly female (78%), more severe in psychopathology (e.g., higher rate of psychiatric family history, diagnosis of axis I history, history of major depressive disorder, higher feeling of hopelessness/helplessness) and suicidality (e.g., repetitive/severe/continuous suicide ideation, lower regret for suicide attempt). Moreover, multiple suicide attempters were lower in psychiatric resources, such as lower personal achievement, lower ability to control emotion, and less insight. Multivariate logistic regression analysis showed that suicide ideation severity (odds ratio [OR], 2.30; P = 0.004), past history of axis I diagnosis (especially major depressive disorder; OR, 2.55; P = 0.002), and the use of "cutting" (OR, 2.85; P = 0.001) predicted multiple suicide attempts. Conclusion: The present study suggests that multiple suicide attempters tend to have more severe clinical profiles than the first suicide attempters. Intervention for depression and self- mutilation behavior of suicide attempters may be important in preventing multiple suicide attempts of adolescents.