Suicidal behavior remains a major public health concern, with particularly high risk of recurrence following a first suicide attempt. While non-suicidal self-injury (NSSI) has been identified as a relevant risk factor, its temporal dynamics after an attempt are not well understood. Although several studies indicate some risk indicators related to distinct clinic profiles, such as impulsivity, emotion dysregulation, and substance use, these phenotypes frequently co-occur, complicating differential delineation.
To address this literature gap and further contribute to suicide research, Arqueros et al. (2026) examined how different post-attempt NSSI trajectories were related to the risk and timing of subsequent suicide reattempts. In addition, this study aimed at improving risk stratification and prevention of suicide attempt among NSSI individuals.
This study is based on the SURVIVE project: a longitudinal clinical cohort of individuals who had recently attempted suicide. For this study, 1,441 adults completed a baseline assessment within 15 days of suicide attempt and were prospectevely followed for 12 months (with a final sample size of 685 participants after 12-months assessment). Participants were followed over time to assess both frequency and evolution of NSSI behaviors and occurrence and timing of suicide reattempts. To further capture dynamic changes in risk, rather tahn relying on single-point assessments, NSSI trajectories were identified and examined their association with time-to-reattempt suicide.
Non-suicidal self-injury may predict suicide post-attempt
Several distinct trajectories of NSSI emerged from the analyses: a) no NSSI – maintained; b) onset; c) remission; d) persistence. The multinomial logistic regression demonstrated individuals with persistent or increasing NSSI patterns showed higher probability of suicide reattempt and shorter time to this reattempt. Conversely, individuals with lower levels of NSSI or decreasing trajectories had significantly lower post-attempt suicide risk.
The findings of this study suggest that not only the presence of NSSI, but its evolution over time, is critical for understanding suicide risk. Moreover, this study highlights the heterogeneity of post-attempt recovery pathways, emphasizing that patients do not follow a single trajectory. For instance, the persistent NSSI trajectory reflected several deleterious characteristics, such as ongoing emotional dysregulation, maladaptative coping strategies and elevated vulnerability to prospect suicidal behaviour.
Reattempt risk and timing: implications for monitoring and intervention windows
These findings reinforce the importance of continuous monitoring, particularly in the months following an attempt. Arqueros et al. (2026) not only argue for moving beyond static risk factors toward dynamic, longitudinal assessment models, but insist on tracking NSSI trajectories as warning signs to further enable timely interventions.
Therefore, incorporating time-sensitive behavioral data into clinical practice could significantly improve prevention strategies. In this regard, NSSI trajectories are a robust and clinically meaningful predictor of suicide reattempt risk, but additional actions are required to guarantee preventive mental health interventions. Furthermore, personalized follow-up care after suicide attempts and tools and monitoring systems predictive capacity improvement may positively contribute to reduce post-attempt suicide risk.
