{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T13:24:23Z","timestamp":1767965063479,"version":"3.49.0"},"reference-count":63,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T00:00:00Z","timestamp":1632700800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003107","name":"Bundesministerium f\u00fcr Gesundheit","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003107","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>More than 800,000 individuals die from suicide each year in the world, which has a devastating impact on families and society. Ten to twenty times more attempt suicide. Previous studies showed that suicide attempters represent a heterogeneous group regarding demographic characteristics, individual characteristics of a suicidal attempt, and the assumed clinical factors, e.g., hopelessness or impulsivity, thus differently contributing to the likelihood of suicidal behavior. Therefore, in the present study, we aim to give a comprehensive clinical description of patients with repeated suicide attempts compared to single attempters. We explored putative differences between groups in clinical variables and personality traits, sociodemographic information, and specific suicide attempt-related information. A sample of patients with a recent suicide attempt (<jats:italic>n<\/jats:italic>= 252), defined according to DSM-5 criteria for a suicidal behavior disorder (SBD), was recruited in four psychiatric hospitals in Thuringia, Germany. We used a structured clinical interview to assess the psychiatric diagnosis, sociodemographic data, and to collect information regarding the characteristics of the suicide attempt. Several clinical questionnaires were used to measure the suicide intent and suicidal ideations, depression severity, hopelessness, impulsivity, aggression, anger expression, and the presence of childhood trauma. Univariate and multivariate statistical methods were applied to evaluate the postulated risk factors and, to distinguish groups based on these measures. The performed statistical analyses indicated that suicide attempters represent a relatively heterogeneous group, nevertheless associated with specific clinical profiles. We demonstrated that the re-attempters had more severe psychopathology with significantly higher levels of self-reported depression, suicidal ideation as well as hopelessness. Furthermore, re-attempters had more often first-degree relatives with suicidal behavior and emotional abuse during childhood. They also exhibited a higher degree of specific personality traits, i.e., more \u201curgency\u201d as a reaction to negative emotions, higher excitability, higher self-aggressiveness, and trait anger. The multivariate discriminant analysis significantly discriminated the re-attempters from single attempters by higher levels of self-aggressiveness and suicidal ideation. The findings might contribute to a better understanding of the complex mechanisms leading to suicidal behavior, which might improve the early identification and specific treatment of subjects at risk for repeated suicidal behavior.<\/jats:p>","DOI":"10.3389\/fpsyt.2021.754402","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T16:48:03Z","timestamp":1632761283000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Identifying Distinguishable Clinical Profiles Between Single Suicide Attempters and Re-Attempters"],"prefix":"10.3389","volume":"12","author":[{"given":"Marlehn","family":"L\u00fcbbert","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lydia","family":"Bahlmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Josfeld","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"B\u00fcrger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Schulz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl-J\u00fcrgen","family":"B\u00e4r","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Udo","family":"Polzer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Walter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrich W.","family":"Kastner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Sobanski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerd","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,9,27]]},"reference":[{"key":"B1","year":"2019","journal-title":"Suicide in the World: Global Health Estimates"},{"key":"B2","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.encep.2020.06.008","article-title":"Trente ans de recherche en suicidologie en France: une \u00e9tude bibliom\u00e9trique","volume":"47","author":"Astraud","year":"2021","journal-title":"L'Enc\u00e9phale."},{"key":"B3","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1001\/jamapsychiatry.2017.1044","article-title":"Suicide rates after discharge from psychiatric facilities: a systematic review and meta-analysis","volume":"74","author":"Chung","year":"2017","journal-title":"JAMA Psychiatry."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.psychres.2017.02.004","article-title":"Psychiatric heterogeneity of recent suicide attempters: a latent class analysis","volume":"251","author":"Ginley","year":"2017","journal-title":"Psychiatry Res."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1001\/archgenpsychiatry.2011.113","article-title":"Absolute risk of suicide after first hospital contact in mental disorder","volume":"68","author":"Nordentoft","year":"2011","journal-title":"Arch Gen Psychiatry."},{"key":"B6","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1192\/bjp.2018.27","article-title":"Depression and hopelessness as risk factors for suicide ideation, attempts and death: meta-analysis of longitudinal studies","volume":"212","author":"Ribeiro","year":"2018","journal-title":"Br J Psychiatry."},{"key":"B7","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1176\/ajp.142.5.559","article-title":"Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation","volume":"142","author":"Beck","year":"1985","journal-title":"Am J Psychiatr."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1262","DOI":"10.1016\/j.jpsychires.2009.04.013","article-title":"Personality and attempted suicide. Analysis of anger, aggression and impulsivity","volume":"43","author":"Giegling","year":"2009","journal-title":"J Psychiatr Res."},{"key":"B9","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1080\/13811118.2011.565265","article-title":"Aggression, impulsivity, and suicide behavior: a review of the literature","volume":"15","author":"Gvion","year":"2011","journal-title":"Arch Suicide Res."},{"key":"B10","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1016\/j.psychres.2017.06.082","article-title":"Childhood trauma and suicide attempt: a meta-analysis of longitudinal studies from the last decade","volume":"256","author":"Zatti","year":"2017","journal-title":"Psychiatry Res."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.1017\/S0033291718003823","article-title":"Childhood maltreatment and adult suicidality: a comprehensive systematic review with meta-analysis","volume":"49","author":"Angelakis","year":"2019","journal-title":"Psychol Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1603557","DOI":"10.1080\/20008198.2019.1603557","article-title":"Childhood maltreatment and risk for suicide attempts in major depression: a sex-specific approach","volume":"10","author":"Goldberg","year":"2019","journal-title":"Eur J Psychotraumatol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1037\/bul0000084","article-title":"Risk factors for suicidal thoughts and behaviors: a meta-analysis of 50 years of research","volume":"143","author":"Franklin","year":"2017","journal-title":"Psychol Bull."},{"key":"B14","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1001\/archpsyc.56.7.617","article-title":"Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey","volume":"56","author":"Kessler","year":"1999","journal-title":"Arch Gen Psychiatry."},{"key":"B15","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1146\/annurev-clinpsy-021815-093204","article-title":"Suicide, suicide attempts, and suicidal ideation","volume":"12","author":"Klonsky","year":"2016","journal-title":"Annu Rev Clin Psychol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1001\/2013.jamapsychiatry.55","article-title":"Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement","volume":"70","author":"Nock","year":"2013","journal-title":"JAMA Psychiatry."},{"key":"B17","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1037\/a0038657","article-title":"Suicide attempts in a longitudinal sample of adolescents followed through adulthood: evidence of escalation","volume":"83","author":"Goldston","year":"2015","journal-title":"J Consult Clin Psychol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1097\/chi.0b013e31815a56cb","article-title":"Suicide attempt characteristics, diagnoses, and future attempts: comparing multiple attempters to single attempters and ideators","volume":"47","author":"Miranda","year":"2008","journal-title":"J Am Acad Child Adolesc Psychiatry."},{"key":"B19","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1093\/epirev\/mxn002","article-title":"Suicide and suicidal behavior","volume":"30","author":"Nock","year":"2008","journal-title":"Epidemiol Rev."},{"key":"B20","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1111\/sltb.12395","article-title":"Accuracy of clinician predictions of future self-harm: a systematic review and meta-analysis of predictive studies","volume":"49","author":"Woodford","year":"2019","journal-title":"Suicide Life Threat Behav."},{"key":"B21","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1037\/ccp0000498","article-title":"The differences between suicide ideators and suicide attempters: simple, complicated, or complex?","volume":"88","author":"Huang","year":"2020","journal-title":"J Consult Clin Psychol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"71","DOI":"10.2147\/RMI.S55532","article-title":"Neural, cognitive, and neuroimaging markers of the suicidal brain","volume":"8","author":"Sobanski","year":"2015","journal-title":"Rep Med Imaging."},{"key":"B23","doi-asserted-by":"publisher","first-page":"902","DOI":"10.1176\/appi.ajp.2020.20081224","article-title":"A brain-centric model of suicidal behavior","volume":"177","author":"J. John Mann","year":"2020","journal-title":"Am J Psychiatry."},{"key":"B24","volume-title":"Why People Die by Suicide","author":"Joiner","year":"2005"},{"key":"B25","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1037\/a0018697","article-title":"The interpersonal theory of suicide","volume":"117","author":"Van Orden","year":"2010","journal-title":"Psychol Rev."},{"key":"B26","first-page":"7","article-title":"The classification of suicidal behavior","volume-title":"The Oxford Handbook of Suicide and Self-injury","author":"Posner","year":"2014"},{"key":"B27","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1521\/suli.2006.36.5.519","article-title":"The language of suicidology","volume":"36","author":"Silverman","year":"2006","journal-title":"Suicide Life Threat Behav."},{"key":"B28","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1002\/wps.20116","article-title":"Suicidal behavior disorder as a diagnostic entity in the DSM-5 classification system: advantages outweigh limitations","volume":"13","author":"Oquendo","year":"2014","journal-title":"World Psychiatry."},{"key":"B29","doi-asserted-by":"publisher","first-page":"112486","DOI":"10.1016\/j.psychres.2019.112486","article-title":"Suicidal subtypes, stress responsivity and impulsive aggression","volume":"280","author":"Stanley","year":"2019","journal-title":"Psychiatry Res."},{"key":"B30","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1080\/13811110902835130","article-title":"Sociodemographic and psychopathological risk factors for repetition of attempted suicide: a 5-year follow-up study","volume":"13","author":"Scoliers","year":"2009","journal-title":"Arch Suicide Res."},{"key":"B31","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1097\/HRP.0000000000000001","article-title":"Suicide reattempters: a systematic review","volume":"21","author":"Mendez-Bustos","year":"2013","journal-title":"Harvard Rev Psychiatry."},{"key":"B32","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1016\/j.jpsychires.2010.09.017","article-title":"Distinguishing the relevant features of frequent suicide attempters","volume":"45","author":"Lopez-Castroman","year":"2011","journal-title":"J Psychiatr Res."},{"key":"B33","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1176\/appi.ajp.161.3.437","article-title":"History of multiple suicide attempts as a behavioral marker of severe psychopathology","volume":"161","author":"Forman","year":"2004","journal-title":"Am J Psychiatry."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1177\/0093854820983853","article-title":"The heterogeneity of suicide attempters: an analysis of single- and repeat-suicide attempters among people in custody","volume":"48","author":"Stoliker","year":"2021","journal-title":"Crim Justice Behav"},{"key":"B35","volume-title":"Diagnostic and Statistical Manual of Mental Disorders (DSM-5)","year":"2013"},{"key":"B36","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1192\/bjp.139.5.391","article-title":"The predictive validation of a suicide intent scale: a five year follow-up","volume":"139","author":"Pierce","year":"1981","journal-title":"Br J Psychiatry."},{"key":"B37","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1037\/t18597-000","article-title":"The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10","volume":"59","author":"Sheehan","year":"1998","journal-title":"J Clin Psychiatry."},{"key":"B38","first-page":"63","volume-title":"Manual for the Beck Scale for Suicide Ideation","author":"Beck","year":"1991"},{"key":"B39","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1192\/bjp.134.4.382","article-title":"A new depression scale designed to be sensitive to change","volume":"134","author":"Montgomery","year":"1979","journal-title":"Br J Psychiatry."},{"key":"B40","article-title":"BDI-II. Beck-Depressions-Inventar. Revision","author":"Hautzinger","year":"2009"},{"key":"B41","volume-title":"Skalen zur Erfassung Von Hoffnungslosigkeit (h-Skalen)","author":"Krampen","year":"1994"},{"key":"B42","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/B978-0-12-404480-7.50012-5","article-title":"Cognitive therapy of depression","volume-title":"Cogn Behav Interv","author":"Hollon","year":"1979"},{"key":"B43","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1024\/1421-0185.67.2.107","article-title":"A German adaptation of the UPPS impulsive behavior scale: psychometric properties and factor structure","volume":"67","author":"Schmidt","year":"2008","journal-title":"Swiss J Psychol"},{"key":"B44","volume-title":"Kurzfragebogen zur Erfassung von Aggressivit\u00e4tsfaktoren K-FAF","author":"Heubrock","year":"2008"},{"key":"B45","volume-title":"Das State-Trait-\u00c4rgerausdrucks-Inventar - 2. Deutschsprachige Adaptation des State-Trait Anger Expression Inventory-2 (STAXI-2) von Charles D. Spielberger","author":"Rohrmann","year":"2013"},{"key":"B46","volume-title":"CTQ: Childhood Trauma Questionnaire Manual","author":"Bernstein","year":"1998"},{"key":"B47","volume-title":"Kurzfragebogen zur Erfassung von Aggressivit\u00e4tsfaktoren (K-FAF)","author":"Heubrock","year":"2008"},{"key":"B48","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1001\/jamapsychiatry.2019.0174","article-title":"Prediction models for suicide attempts and deaths: a systematic review and simulation","volume":"76","author":"Belsher","year":"2019","journal-title":"JAMA Psychiatry."},{"key":"B49","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1016\/j.psychres.2013.09.026","article-title":"Risk and protective factors predicting multiple suicide attempts","volume":"210","author":"Ho Choi","year":"2013","journal-title":"Psychiatry Res."},{"key":"B50","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1111\/j.1440-1819.2005.01421.x","article-title":"Change of suicidal ideation induced by suicide attempt","volume":"59","author":"Matsuishi","year":"2005","journal-title":"Psychiatry Clin Neurosci."},{"key":"B51","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1016\/S0140-6736(72)92041-7","article-title":"SUICIDE AS CATHARSIS","volume":"300","author":"Austin","year":"1972","journal-title":"Lancet."},{"key":"B52","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/0165-1781(85)90005-8","article-title":"An empirical study on the \u201ccathartic effect\u201d of attempted suicide","volume":"16","author":"van Praag","year":"1985","journal-title":"Psychiatry Res."},{"key":"B53","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1037\/0022-006X.68.5.909","article-title":"Intensity and duration of suicidal crises vary as a function of previous suicide attempts and negative life events","volume":"68","author":"Joiner","year":"2000","journal-title":"J Consult Clin Psychol."},{"key":"B54","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1037\/a0023842","article-title":"The general aggression model: theoretical extensions to violence","volume":"1","author":"DeWall","year":"2011","journal-title":"Psychol Violence."},{"key":"B55","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1097\/YCO.0000000000000297","article-title":"The decision neuroscience perspective on suicidal behavior: evidence and hypotheses","volume":"30","author":"Dombrovski","year":"2017","journal-title":"Curr Opin Psychiatry."},{"key":"B56","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1111\/j.1943-278X.2000.tb01062.x","article-title":"The suicidal mode: a cognitive-behavioral model of suicidality","volume":"30","author":"Rudd","year":"2000","journal-title":"Suicide Life Threat Behav."},{"key":"B57","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1038\/s41572-019-0121-0","article-title":"Suicide and suicide risk","volume":"5","author":"Turecki","year":"2019","journal-title":"Nat Rev DisPrimers."},{"key":"B58","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1176\/ajp.156.2.181","article-title":"Toward a clinical model of suicidal behavior in psychiatric patients","volume":"156","author":"Mann","year":"1999","journal-title":"Am J Psychiatry."},{"key":"B59","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1016\/S2215-0366(14)00022-4","article-title":"Early life adversity, genomic plasticity, and psychopathology","volume":"1","author":"Turecki","year":"2014","journal-title":"Lancet Psychiatry."},{"key":"B60","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1037\/abn0000482","article-title":"Effects of childhood trauma, daily stress, and emotions on daily cortisol levels in individuals vulnerable to suicide","volume":"129","author":"O'Connor","year":"2020","journal-title":"J Abnorm Psychol."},{"key":"B61","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.comppsych.2009.05.003","article-title":"Is impulsivity a link between childhood abuse and suicide?","volume":"51","author":"Braquehais","year":"2010","journal-title":"Comp Psychiatry."},{"key":"B62","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.eurpsy.2008.07.005","article-title":"Childhood trauma as a correlative factor of suicidal behavior - via aggression traits. Similar results in an Italian and in a French sample","volume":"24","author":"Sarchiapone","year":"2009","journal-title":"Eur Psychiatry."},{"key":"B63","article-title":"Psychotherapeutic interventions for the prevention of suicide re-attempts - a systematic review","author":"Sobanski","year":"","journal-title":"Psychol Med"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2021.754402\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T08:41:32Z","timestamp":1673340092000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2021.754402\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,27]]},"references-count":63,"alternative-id":["10.3389\/fpsyt.2021.754402"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2021.754402","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,27]]},"article-number":"754402"}}