Sex-specific survival trajectories in frequent suicide reattempters: a 5-year prospective cohort study

• Eugenia Nicolau-Subires ^[1] ; Maria Irigoyen-Otiñano ^[1] ; Laura Arenas-Pijoan ^[1] ; Andrea Jiménez-Mayoral ^[1] ; Teresa Jové Miró ^[1] ; Julia Ezpeleta-Esteban ^[1] ; Núria Domenech-Martínez ^[1] ; Vicent Llorca-Bof ^[2]
  1. [1] Hospital Universitari de Santa María

     Hospital Universitari de Santa María

     Lérida, España

     
  2. [2] Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, Institut D'Investigacions Biom`ediques August Pi i Sunyer (IDIBAPS), Centro de Investigaci´on Biom´edica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Department of Medicine, University of Barcelona, Barcelona, Spain
• Localización: European journal of psychiatry, ISSN 0213-6163, Vol. 40, Nº 3, 2026
• Idioma: inglés
• DOI: 10.1016/j.ejpsy.2026.100360
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• Resumen

  • Background: Frequent repeaters (≥ 5 suicide attempts) remain poorly characterized despite their high vulnera- bility. We examined sex differences and 5-year mortality in this subgroup.

    Methods: This longitudinal study used the MCOSUL cohort (Lleida, Spain). Patients with ≥5 prior attempts and an index episode between 2009 and 2022 were followed for 5 years or until death. Baseline variables were compared by sex. Survival was analyzed using Kaplan–Meier curves (log-rank test) and a Cox model adjusted for age, sex, and somatic lethality of the index attempt.

    Results: The sample included 175 patients (71.8% women; median age = 43 years [IQR 33–51]). Women were more often employed (19%vs 6%), while men had higher unemployment (44%vs 26%) and alcohol use (58%vs 38%) (all p < 0.05). Eleven deaths (6.3%) occurred over 5 years, including 5 suicides (2.9%). Cumulative mortality was higher in men (12%vs 4%; p = 0.079). Kaplan–Meier curves showed significantly lower survival among men (log-rank p = 0.041). This pattern was confirmed in the multivariable Cox model, where female sex was associated with reduced mortality risk (HR = 0.29, 95% CI 0.09–0.98, p = 0.036). High somaticlethality of the index attempt showed a nonsignificant trend toward increased risk (HR = 2.97, 95% CI 0.86–10.3, p = 0.086).

    Conclusions: Among high-frequency attempters, men show poorer 5-year survival, while female sex indepen- dently predicts lower mortality risk. Prioritizing follow-up in men and in patients using somatic lethal methods may enhance preventive strategies.