Predictors and causal pathways of suicide recurrence after deliberate self-poisoning: A prospective cohort study integrating psychosocial, behavioral, and biomarker profiling

J Affect Disord. 2025 Nov 6:120609. doi: 10.1016/j.jad.2025.120609. Online ahead of print.

ABSTRACT

BACKGROUND: Suicide recurrence following deliberate self-poisoning represents a critical yet understudied clinical challenge. This study aimed to identify predictors and establish causal associations for suicide recurrence to improve clinical risk stratification.

METHODS: In this prospective cohort study, 402 patients hospitalized for deliberate self-poisoning were enrolled. Comprehensive baseline assessments included demographic and lifestyle factors, psychological profiles, clinical history, and metabolic biomarkers. The primary outcome was recurrent suicide-related events within 90 days after discharging from hospitalization. Restricted cubic splines (RCS) analysis evaluated detailed relationships, and inverse probability weighting (IPW) analysis assessed causal effects on suicide recurrence.

RESULTS: Among the 402 participants, 16.7 % (67/402) experienced suicide recurrence within 90 days post-discharge. Multivariable analysis identified several independent predictors: higher Beck hopelessness score (p = 0.001), elevated anti-thyroglobulin (p = 0.002), prolonged sedentary behavior ≥6 h/day (p = 0.027), younger age (p = 0.009), intermediate personality traits (p = 0.021), and multiple prior suicide attempts (p = 0.007). Conversely, the absence of prior depression (p = 0.016) or other mental illness diagnoses (p = 0.021) were protective. RCS analyses revealed significant nonlinear relationships for anti-thyroglobulin levels (p < 0.001) and suicide ideation scores (p < 0.001), while demonstrating linear associations for psychological factors including hopelessness (p < 0.001), anxiety (p < 0.001), self-esteem scores (p < 0.001), and depression scores (p < 0.001). Causal analysis using IPW analysis confirmed hopelessness and anti-thyroglobulin level as contributing risk factors to suicide recurrence.

CONCLUSIONS: This study establishes a comprehensive risk stratification framework incorporating psychological, behavioral, and biomarker profiles for predicting suicide recurrence. The causal evidence for hopelessness and anti-thyroglobulin level as independent risk factors highlight their clinical utility.

PMID:41205927 | DOI:10.1016/j.jad.2025.120609