Conference Agenda

This presentation will synthesize a decade of work leveraging nationwide registry data from Spain and the United States to examine suicide risk in vulnerable populations. By comparing two high-income countries with markedly different social structures, migration patterns, and lethal means availability, the talk will highlight how cross-national epidemiologic analyses can illuminate shared mechanisms and context-specific risk factors. The first part will focus on Spain, drawing on population-based analyses from 2000–2023. Recent national registry studies show steep increases in non-lethal intentional self-harm (NLISH), particularly among adolescents and young adults, alongside relatively stable suicide mortality. Detailed stratification reveals patterns by sex, age, clinical comorbidity, and notably suicide method, with increasing use of high-lethality methods in selected groups. The presentation will emphasize geographic heterogeneity and the critical role of rurality as a structural determinant: older adults in rural provinces exhibit higher suicide rates, distinct method profiles, and unique temporal trajectories. Age-period-cohort analyses further show that foreign-born individuals remain a persistently high-risk group, with method-specific vulnerabilities and strong cohort effects. The second part will present complementary findings from the United States. Nationwide demographic, spatial, and method-specific studies show rising suicide risk in underserved populations, including the recent acceleration of suicide among Black girls and women. U.S. research using county-level modeling highlights pronounced socioeconomic and geographic gradients, strong associations with firearm availability, and clear spatial clustering of youth suicides. Age-period-cohort analyses illustrate how sex, race, and firearm involvement shape generational differences in suicide risk. Additional studies of COVID-19-related mobility restrictions and economic distress provide insight into how acute societal shocks affect mental health and suicide-related behaviors. Taken together, the evidence from Spain and the United States demonstrates how advanced time-series modeling, spatial epidemiology, and method-specific analyses can uncover population vulnerabilities and guide targeted, contextually appropriate suicide prevention strategies across very different health and social systems.

While suicide in pre-teens aged 8-12 remains relatively rare in the United States, the rates have substantially increased across the last 10 years. Understanding patterns and risk factors is critical for developing targeted prevention strategies during this developmentally sensitive period. This presentation examines temporal trends and disparities in suicide deaths among pre-teens aged 8-12 years in the United States, utilizing data from the National Violent Death Reporting System (NVDRS) from 2016 to 2023. We analyze demographic characteristics, precipitating circumstances, and method-specific patterns across the eight-year study period. Our analysis reveals significant disparities by race/ethnicity, with particular attention to elevated rates among Black youth and American Indian/Alaska Native children. Sex differences in both rates indicate emerging shifts in the traditional male-to-female ratio observed in older adolescent populations. We identify distinct patterns in precipitating factors, including family relationship problems, school difficulties, and history of trauma or abuse. The analysis also examines geographic variation and the role of means availability, particularly focusing on firearm access patterns. Youth with documented mental health treatment history, those experiencing recent crises, and children exposed to suicide contagion are particularly vulnerable, suggesting ample opportunities for scaling interventions. These findings have important implications for suicide prevention efforts, suggesting the need for developmentally appropriate, culturally responsive interventions among increasingly young children that address the unique vulnerabilities of pre-teen populations while acknowledging substantial heterogeneity in risk factors across demographic groups.

Sexual abuse in childhood is a major public health concern, affecting millions worldwide and placing survivors at heightened vulnerability for a wide range of mental health difficulties. These experiences may disrupt emotional regulation, interpersonal functioning, and neurobiological development, contributing to long-term psychological fragility. Identifying the specific pathways that link early trauma with later mental health crises is essential for guiding prevention and early intervention strategies.

Against this backdrop, we present evidence from a large UK population-based cohort, providing insights into how early sexual abuse relates to later self-injurious thoughts and behaviours (SITB). In a sample of 219,581 individuals followed from childhood into young adulthood, a recorded history of sexual abuse between ages 8 and 14 emerged as a strong marker of later SITB. These findings highlight the long temporal span over which early traumatic experiences may shape vulnerability.

We have found similar associations in a cohort of 388 Chilean adolescents attending an outpatient mental health clinic. Thus, among adolescents receiving psychiatric care, sexual abuse was highly prevalent and increased the odds of suicide attempts, even after adjusting for psychiatric comorbidity and emotional dysregulation.

Moreover, our data from two Emergency Departments in Spain, comprising 1837 children and adolescents, shows that sexual abuse is associated with a higher risk of reattempting suicide.

These findings from different countries and different clinical settings highlight the relevance of sexual abuse as a predictor of SITB in young populations.

To explore the mechanisms of this associations, we carried out a meta-analysis and identified impulsivity as a significant mediator in the association between childhood trauma suicidal behaviour. This mechanistic pathway suggests that early trauma may alter affective and cognitive control systems in ways that heighten vulnerability to high-risk behaviours later in life.

Socio-economic precarity and sex are major determinants of suicidal behaviour, yet in biological research deprivation is usually adjusted away and sex effects are rarely examined.

In this cross-sectional analysis of 10,353 adults from the French Constances cohort, we defined three age- and sex-matched groups (N=3,451 each): healthy controls without psychiatric history, affective controls without lifetime suicide attempt, and individuals with a suicide attempt history. Precarity was captured by the EPICES deprivation score. From fasting blood, we derived markers of insulin-resistant dyslipidaemia (TyG index, triglycerides), erythrocyte indices (red blood cell (RBC) count, MCV-to-RBC ratio), platelet-to-RBC ratio, and neutrophil-to-lymphocyte ratio. Standardised linear regression models with hierarchical adjustment for age, sex, BMI, deprivation, depressive symptoms, alcohol use and smoking compared markers across groups. Models were repeated in strata defined by deprivation (EPICES ≤30 vs >30), sex and age (<50 vs ≥50 years as a proxy for menopausal status in women).

Social deprivation affected 12%, 25% and 45% of healthy controls, affective controls and suicide attempters, respectively. Beyond this social gradient, suicide attempters showed a distinctive biological profile: higher TyG vs affective controls (β = 0.08, 95% CI 0.03–0.13) and triglycerides, lower RBC, and higher MCV-to-RBC and platelet-to-RBC ratios in adjusted models, whereas inflammatory indices were largely explained by deprivation, health behaviours and depressive symptoms. In stratified analyses, observed signatures were stronger among non-deprived, and attenuated in deprived individuals. In addition, in women, particularly those aged ≥50 years, an erythrocyte–macrocytosis pattern predominated, while in men a more insulin-resistant and platelet-rich profile was seen.

In conclusion, biological profiles associated with a history of suicide attempt differed across levels of precarity and between men and women. These findings challenge “one-size-fits-all” biomarker approaches and support suicide prevention strategies that combine structural interventions on deprivation with sex- and context-aware use of biological information.

This presentation summarises findings from a prospective cohort study conducted at a major child and adolescent psychiatry emergency department in Madrid. The study examined how a migrant background influences suicidal behavior in adolescents. Using data from 1,281 young people followed for twelve months, it identified clear differences between non-migrant, first-generation, and second-generation adolescents, showing how migration-related factors and psychosocial adversity shape risk. Suicidal behavior was the leading reason for emergency consultation, with migrants presenting proportionally more suicidal episodes, while non-migrants more often sought care for emotional or behavioral concerns without self-harm. Method-specific patterns reinforced this gradient, as migrants more frequently presented with drug ingestion and cutting, indicating a more severe baseline self-harm profile. These baseline patterns provide essential context for understanding later risk trajectories.

Longitudinal analyses showed that these disparities persisted. Survival curves revealed that second-generation migrants transitioned to suicidal behavior most rapidly, followed by first-generation youths, whereas non-migrants experienced the longest survival. This pattern suggests that vulnerabilities associated with migration accumulate over time, particularly among adolescents born in the host country to foreign-born parents. Multivariable Cox models identified female sex, older age, prior suicidal behavior, and psychosocial adversities—abuse, family conflict, bullying, eating problems, low socioeconomic status, and family psychiatric history—as strong predictors of suicidal acts. Notably, a migrant versus non-migrant comparison showed no adjusted differences, but distinguishing between generations revealed that only second-generation status significantly increased risk.

Overall, the findings indicate that second-generation adolescents are particularly vulnerable. They show more severe self-harm behaviors and progress more rapidly to suicidal behavior over time, even when extensive sociodemographic and clinical factors are considered. This pattern highlights the heterogeneity within migrant populations and underscores the need for suicide prevention strategies that account for generational status, structural adversity, and the psychosocial context shaping the daily lives of migrant families.