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. 2025 Jan 10;68(1):e4.
doi: 10.1192/j.eurpsy.2024.1807.

Symptomatic networks in suicide attempt and reattempt: Relevance of psychiatric comorbidity

Andres Pemau  1 , Alejandro de la Torre-Luque  2   3 , Carolina Marin-Martin  1 , Marina Diaz-Marsa  2   3   4 , Jorge Andreo-Jover  5   6 , Wala Ayad-Ahmed  4 , Maria Fe Bravo Ortiz  3   5   6   7 , Maria Teresa Bobes-Bascarán  3   8   9   10   11 , Manuel Canal-Rivero  3   12   13 , Irene Canosa García  3   14 , Ana Isabel Cebrià  3   15   16 , Benedicto Crespo-Facorro  3   12   13 , María Ángeles Boti  17   18   19 , Matilde Elices  14 , Ana González-Pinto  3   20 , Iria Grande  3   17   18   19 , Luis Jiménez-Treviño  3   8   9   10   11 , Diego J Palao  3   15   21 , Angela Palao-Tarrero  5   6   7 , Carla Pérez-Guerra  2 , Natalia Roberto  17   18   19 , Miguel Ruiz Veguilla  3   12   13 , Pilar A Sáiz  3   8   9   10   11 ; SURVIVE Consortium; Víctor Pérez  3   14   22
Affiliations

Symptomatic networks in suicide attempt and reattempt: Relevance of psychiatric comorbidity

Andres Pemau et al. Eur Psychiatry. .

Abstract

Background: One of the most relevant risk factors for suicide is the presence of previous attempts. The symptomatic profile of people who reattempt suicide deserves attention. Network analysis is a promising tool to study this field.

Objective: To analyze the symptomatic network of patients who have attempted suicide recently and compare networks of people with several attempts and people with just one at baseline.

Methods: 1043 adult participants from the Spanish cohort "SURVIVE" were part of this study. Participants were classified into two groups: single attempt group (n = 390) and reattempt group (n = 653). Different network analyses were carried out to study the relationships between suicidal ideation, behavior, psychiatric symptoms, diagnoses, childhood trauma, and impulsivity. A general network and one for each subgroup were estimated.

Results: People with several suicide attempts at baseline scored significantly higher across all clinical scales. The symptomatic networks were equivalent in both groups of patients (p > .05). Although there were no overall differences between the networks, some nodes were more relevant according to group belonging.

Conclusions: People with a history of previous attempts have greater psychiatric symptom severity but the relationships between risk factors show the same structure when compared with the single attempt group. All risk factors deserve attention regardless of the number of attempts, but assessments can be adjusted to better monitor the occurrence of reattempts.

Keywords: impulsivity; network analysis; suicide; suicide reattempt; trauma.

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Conflict of interest statement

PAS has been a consultant to and/or has received honoraria or grants from Adamed, Alter Medica, Angelini Pharma, CIBERSAM, Ethypharm Digital Therapy, European Commission, Government of the Principality of Asturias, Instituto de Salud Carlos III, Johnson & Johnson, Lundbeck, Otsuka, Pfizer, Plan Nacional Sobre Drogas and Servier. AGP has received grants and served as a consultant, advisor, or CME speaker for the following entities: Janssen-Cilag, Lundbeck, Otsuka, Alter, Angelini, Novartis, Rovi, Takeda, the Spanish Ministry of Science and Innovation (CIBERSAM), the Ministry of Science (Carlos III Institute), the Basque Government, and the European Framework Program of Research. NR contract is co-funded by the Instituto de Salud Carlos III, with file code CD23/00088, by virtue of Resolution of the Direction of the Instituto de Salud Carlos III, O.A., M.P. of December 13, 2023, awarding the Sara Borell and “Co-funded by the European Union” Contracts. IG has received grants and has served as a consultant, advisor or CME speaker for the following entities (unrelated to the present work): ADAMED, Angelini, Casen Recordati, Esteve, Ferrer, Gedeon Richter, Janssen Cilag, Lundbeck, Lundbeck-Otsuka, Luye, SEI Healthcare, Viatris outside the submitted work. She also receives royalties from Oxford University Press, Elsevier, Editorial Médica Panamericana. The remaining authors have no conflicts to declare.

Figures

Figure 1.
Figure 1.
(a) Network displaying the relationship between Symptoms in the full sample. (b) Centrality indices of Symptoms. Edges in blue indicate positive relationship. Edges in red indicate negative relationship. Thicker edges represent stronger associations. The colors of the nodes group the scores of the CTQ, the BIS, the BSI, suicide-related behaviors, and other covariates. The gray border on the nodes reflects predictability. Subs_abuse = Does the patient have substance abuse; N_Diagnosis = number of diagnoses; N_behaviors = Total number of suicidal behaviors (completed, interrupted, and aborted attempts). CTQ (Childhood trauma Questionnaire): sex_ab = sexual abuse; phys_neg = physical negligence; phys_ab = physical abuse; emot_neg = emotional negligence; emot_ab = emotional abuse. CSS (Columbia suicide severity rating scale): SH = self-harm; Intense = most intense ideation; Freq = ideation frequency; Dur = Duration of ideation; Control = controllability of suicidal thoughts. BSI (Brief Symptoms Inventory): Somat = somatization; Sens = interpersonal sensitivity; Psy = psychoticism; Phob = phobias; Par = paranoia; OCD = obsessive-compulsive; Host = hostility; Dep = depression; Anx = anxiety. BIS (Barratt impulsivity scale): Nplan = unplanned impulsivity; Mot = motor impulsivity; Att = attentional impulsivity. ACSS (Acquired Capability for Suicide Scale Fearlessness About Death).
Figure 2.
Figure 2.
(a) Network displaying the relationship between symptoms in the reattempt group. (b) Network displaying the relationship between symptoms in the single attempt group. (c) Centrality indices of Symptoms. Edges in blue indicate positive relationship. Edges in red indicate negative relationship. Thicker edges represent stronger associations. The colors of the nodes group the scores of the CTQ, the BIS, the BSI, suicide-related behaviors and other covariates. The gray border on the nodes reflects predictability. Subs_abuse = Does the patient have substance abuse; N_Diagnosis = number of diagnoses; N_behaviors = Total number of suicidal behaviors (completed, interrupted, and aborted attempts). CTQ (Childhood trauma Questionnaire): sex_ab = sexual abuse; phys_neg = physical negligence; phys_ab = physical abuse; emot_neg = emotional negligence; emot_ab = emotional abuse. CSS (Columbia suicide severity rating scale): SH = self-harm; Intense = most intense ideation; Freq = ideation frequency; Dur = Duration of ideation; Control = controllability of suicidal thoughts. BSI (Brief Symptoms Inventory): Somat = somatization; Sens = interpersonal sensitivity; Psy = psychoticism; Phob = phobias; Par = paranoia; OCD = obsessive-compulsive; Host = hostility; Dep = depression; Anx = anxiety. BIS (Barratt impulsivity scale): Nplan = unplanned impulsivity; Mot = motor impulsivity; Att = attentional impulsivity. ACSS = Acquired Capability for Suicide Scale Fearlessness About Death.
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