Suicide risk factors across suicidal ideators, single suicide attempters, and multiple suicide attempters

Few studies have compared the three suicidality groups—suicidal ideators (SIs), single suicide attempters (SSAs), and multiple suicide attempters (MSAs)—in relation to the suicidal process. This cross-sectional study investigated trends and differences in suicide risk factors across suicidality groups. Using the baseline data of the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior, we analyzed trends (Jonckheere-Terpstra or Mantel-Haenszel χ2 test) and differences (analysis of covariance or logistic regression) in sociodemographic and clinical factors, psychiatric diagnoses, as well as clinical rating scores on psychopathology (suicidal ideation, depressive symptoms, anxiety symptoms, and problem drinking), trait impulsiveness, and stress across suicidality groups. Across suicidality groups comprising 193 SIs, 207 SSAs, and 376 MSAs, we observed a decreasing trend in age and increasing trends in history of early trauma, familial histories of suicide attempts and suicide, most diagnoses and psychopathologies (suicidal ideation, anxiety symptoms, and problem drinking), trait impulsiveness, and stress—with MSAs more likely to have histories of early trauma and familial suicide, almost uniformly higher proportions of diagnoses, and higher psychopathology rating scores. Overall, increasing trends in suicide risk factors were found across all suicidality groups. Notably, MSAs presented greater proportions of most psychiatric diagnoses and higher degrees of most psychopathologies, motor impulsiveness, and stress, indicating they were at more severe clinical states and were closer to suicide. Mental health professionals should ascertain the number of suicide attempts to identify MSAs, implement more thorough evaluations, and employ additional measures for reducing motor impulsiveness. •Suicidality groups include ideators, single attempters, and multiple attempters.•These groups represent the suicidal process (from thought to action in severity).•Increasing trends of suicide risk factors were observed across the suicidality groups.•Multiple suicide attempters are in more severe clinical states, closer to suicide.•Multiple suicide attempters must be identified and given more thorough evaluations.