Incident and Recurrent Suicide Attempts in Adolescents With Major Depressive Disorder: Baseline Correlates and Prospective Predictors in a One-Year Follow-Up

Abstract

Background

Suicidal behavior in adolescents with major depressive disorder (MDD) remains a critical public health concern. While prior research has identified numerous correlates of suicide attempts, few longitudinal studies have distinguished between factors associated with incident versus recurrent suicidal behavior.

Methods

In this prospective follow-up study, adolescents diagnosed with MDD were assessed at baseline (T0) and followed for one year (T1). Suicide attempts were evaluated longitudinally, and participants were categorized according to baseline and follow-up suicide attempt status. Multivariable logistic regression models were used to examine baseline correlates of suicide attempt history and prospective predictors of incident and recurrent suicide attempts.

Results

At baseline, several social and environmental factors—including peer suicide attempts (OR = 14.07), parental consanguinity (OR = 6.32), witnessing domestic violence (OR = 3.57), labeling distress (OR = 1.36), and cybervictimization (OR = 1.07)—were associated with a history of suicide attempts. Longitudinal analyses revealed distinct risk profiles: witnessing domestic violence (OR = 30.00) and alcohol use (OR = 16.67) were most strongly associated with incident suicide attempts, whereas trauma-related factors such as physical neglect (OR = 1.24) and sleep disturbances such as insomnia (OR = 2.00) were more prominently associated with recurrent attempts. Parental consanguinity also emerged as a potentially relevant and underexplored risk marker.

Conclusions

Incident and recurrent suicide attempts among adolescents with MDD may involve partly distinct clinical correlates and prospective risk patterns. These findings support stage-sensitive suicide prevention strategies and highlight parental consanguinity as a culturally relevant factor warranting further investigation.

Plain Language Summary

Suicide attempts are a major concern for teenagers with depression, but not all suicide risk looks the same. In this study, we followed adolescents with major depressive disorder for one year to better understand which factors were linked to first-time suicide attempts and which were linked to repeat attempts. We found that different patterns may be involved. Teenagers who had their first suicide attempt during follow-up were more likely to have been exposed to domestic violence and alcohol use. Repeat suicide attempts were more strongly linked to physical neglect and sleep problems. At the start of the study, other factors such as peer suicide attempts, cybervictimization, and distress related to self-harm were also more common in adolescents with a history of suicide attempts. These findings suggest that suicide risk in depressed adolescents is not one single pattern. Some risk factors may be more important in the beginning, while others may help maintain risk over time. Understanding these differences may help clinicians identify high-risk adolescents earlier and provide more targeted support.