MedWire News: The risk for completed suicide among individuals with a previous failed attempt is especially high in the year after the initial bid, research shows.

In addition, individuals with a diagnosis of schizophrenia were more likely to complete suicide after an initial attempt than those with other psychiatric disorders.

Dag Tidemalm and colleagues from the Karolinska Institutet in Stockholm, Sweden, say this trend is "particularly worrying" and call for "more focused care during at least the first 2 years after a suicide attempt."

Studies have shown that around 7-13% of individuals with a previous failed suicide attempt make a completed suicide bid after 5-37 years of follow-up.

While this represents a 30-40-fold increased risk for death by suicide relative to the general population, it is still a "comparatively rare event," which can be prevented, argue Tidemalm and colleagues.

"It is therefore vital to identify those at highest risk for completed suicide in this group," they add.

To investigate, the team analyzed data on 39,685 individual (53% female) who were admitted to hospital for attempted suicide between 1973 and 1982.

Reviewing death records in the proceeding 25 years, they found that over half of all completed suicides took place within the first year of follow-up.

The strongest predictor for completed suicide throughout the entire follow-up was a diagnosis of schizophrenia, with a hazard ratio (HR) of 4.1 in men and 3.5 in women compared with individuals with no major psychiatric disorder.

Meanwhile, a diagnosis of bipolar or unipolar depressive disorder carried a HR for completed suicide of 3.5 in men and 2.5 in women relative to individuals with no major psychiatric disorder.

"Psychiatric case management should focus on more intensive aftercare during at least the first 2 years after a suicide attempt in patients with co-existent bipolar and unipolar disorder or schizophrenia," Tidemalm and colleagues conclude in the British Medical Journal.

Free abstract