Suicide mortality after suicide attempt

In a recent issue of ANZJP, Demesmaeker and associates report what they assert to be ‘the first meta-analysis on suicide mortality after a nonfatal [suicide attempt] SA’ (Demesmaeker et al., 2022, p. 613). By meta-analysing a sample of 41 primary studies, they reported cumulative suicide proportions of suicides after suicide attempts of 2.8%, 5.6% and 7.4% after 1, 5 and 10 years, respectively. In the introduction to their paper, they wrongly assert that an earlier meta-analysis of suicide mortality after discharge from emergency departments and medical settings by Wang and associates ‘excluded a lot of studies consulting for suicidal acts’ (p. 604). In fact, by meta-analysing suicide rates using the conventional mortality units of deaths per 100,000 patient years, rather than percentage mortality at arbitrary fixed intervals (of 1, 5 and 10 years as reported by Demesmaeker and associates), the Wang meta-analysis was able to include more than twice the number (n=88) of relevant primary studies reporting on suicides after suicide attempts (Wang et al., 2019). Using this larger database Wang and associates found a lower estimate of suicide mortality after a suicide attempt of 647 per 100,000 patient years. Meta-analysis is more reliable when it relies on a larger number of valid studies and authors of future meta-analysis need not needlessly criticise earlier research or claim priority for questions that have been reported on by others.