Suicide reattempts remain one of the strongest predictors of future suicide conduct and represent a major public health concern, particularly among adolescents and young adults. Although previous research has identified numerous risk factors for repeated suicidal behaviour, less is known about how these factors interact over time to shape different clinical trajectories after an initial suicide attempt.
To address this gap, the SURVIVE research team, led by Pérez et al. (2026), conducted the largest prospective multicentre cohort study in Spain, with the aim of identifying baseline characteristics associated with suicide reattempt. The study included 1.730 individuals aged 12 years or older from eight tertiary hospitals receiving care in mental health services across multiple Spanish centres. Participants underwent a comprehensive clinical assessment during 12 months after an index attempt, including suicide reattempts, sociodemographic, clinical, and psychological variables to determine which factors independently predicted suicide reattempt during this 12-month follow-up.
The complexity of suicide reattempt phenomen: key clinical predictors
During the 12-month follow-up period, several baseline characteristics emerged as significant independent predictors of suicide reattempt. Individuals reporting more frequent suicidal ideation were substantially more likely to reattempt suicide, with daily or near-daily suicidal thoughts representing one of the strongest predictors. Likewise, participants with one to three prior attempts had an elevated risk, while those with four or more previous attempts exhibited an even greater likelihood of recurrence.
Moderate-to-severe childhood emotional neglect emerged as an important predictor, highlighting the long-term impact of adverse childhood experiences on suicidal behaviour. Additionally, individuals prescribed four or more psychotropic medications were at increased risk, suggesting that greater pharmacological burden may reflect underlying clinical complexity or treatment resistance. One particularly important finding concerned the role of age. Although non-suicidal self-injury was considerably more prevalent among adolescents, it predicted suicide reattempt only in adults.
Clinical implications for suicide reattempt prevention
These findings reinforce the importance of dynamic and individualized suicide risk assessment. Indeed, Pérez et al. (2026) argue that rather than relying exclusively on a single clinical evaluation immediately following a suicide attempt, clinicians should continuously monitor patients throughout follow-up, particularly those presenting multiple high-risk characteristics.
In addition, the authors state that patients with frequent ideation, prior attempts, emotional neglect history, high psychotropic medication load, or non-suicidal self-injury may benefit from intensive follow-up, trauma-informed care, safety planning, and evidence-based interventions. Importantly, the study highlights that these factors should be interpreted as prognostic markers rather than direct causal mechanisms, meaning that further intervention studies are needed to determine whether modifying these characteristics reduces the likelihood of future suicide attempts.
Additionally, adolescents and young people may differ from adults in the way they struggle with non-suicidal self-injury. In this regard, self-injurious behaviours during adolescence may often serve emotional regulation functions rather than reflecting imminent suicidal intent, whereas in adulthood they may indicate a more persistent vulnerability to suicidal behaviour. These findings emphasize the importance of considering developmental differences when evaluating suicide risk and planning interventions.
Despite these robust findings, the authors emphasize the need to complement baseline assessment with ecological momentary assessment (EMA) and other dynamic monitoring approaches capable of capturing short-term fluctuations in suicidal ideation and psychological distress.
Overall, this large multicentre prospective study provides robust real-world evidence regarding the baseline factors associated with suicide reattempt after an index attempt. Its findings support a more personalized and age-sensitive approach to suicide prevention, demonstrating that clinical assessment should extend beyond traditional static risk factors to incorporate developmental differences, trauma history, and ongoing changes in suicidal thoughts. These results have important implications for improving risk stratification, guiding clinical decision-making, and optimizing follow-up care for individuals at elevated risk of repeated suicidal behaviour.
