Conference Agenda

Background: Suicidal behaviour is a major public health challenge, and between 20–30 non-fatal suicide attempts occur for every suicide death. A history of suicide attempt is among the strongest predictors of future attempts, yet longitudinal multicentre studies with standardized clinical assessment are critical. This study aimed to identify predictors of suicide reattempt within 12 months after an index attempt in the SURVIVE cohort.

Methods: SURVIVE is a prospective, multicentre cohort study conducted in Spanish hospitals including individuals aged ≥12 years assessed within 15 days of an index suicide attempt. Baseline assessment comprised sociodemographic and clinical interviews, the Columbia-Suicide Severity Rating Scale (C-SSRS), MINI 7.0.2, depressive and anxiety symptoms (PHQ-9, GAD-7), impulsivity (BIS-11), and childhood maltreatment (CTQ-SF). Participants were re-assessed at 12 months with the same battery and information on new suicidal behaviour. Kaplan–Meier analyses estimated cumulative risk of reattempt, and Cox regression models (overall sample and stratified by age: adolescents vs adults) examined independent predictors.

Results: Of 1,730 participants with baseline and 12-month data, 340 (19.6%) presented at least one reattempt. The median time to reattempt was 140 days; 25% of reattempts occurred within the first 61 days after the index attempt. In multivariable models, higher number of psychotropic medications, NSSI, more frequent suicidal ideation, and childhood emotional neglect independently predicted reattempt in the total sample.

Conclusions: One in five patients reattempted suicide within a year of an index attempt, with a particularly high-risk window in the first two months. Early, intensive follow-up, careful review of polypharmacy, targeted interventions for NSSI, and trauma-informed care addressing childhood emotional neglect are key priorities for secondary prevention after a suicide attempt.

Background: Non-suicidal Self-Injury (NSSI) constitutes a critical risk factor for suicide. It is crucial to understand the dynamic course of NSSI over time and its association with risk of suicide reattempt over time. This study aims to characterize the baseline clinical and psychological profiles of distinct patterns of NSSI over a 12-month follow-up period; and to study how these NSSI patterns relate to suicide reattempt risk.

Methods: A sample of 685 participants (72.4% female, mean age 42) was used. Participants were assessed within 15 days post-index attempt and followed up for one year. NSSI was assessed at baseline and 12 months. Four patterns were observed: No NSSI to No NSSI (NN, 53.4%), Onset (No NSSI to Yes NSSI, 5.7%), Remission (Yes NSSI to No NSSI, 23.9%), and Persistence (Yes NSSI to Yes NSSI, 16.9%).

Results: the Persistence pattern was significantly associated with a more severe clinical profile at baseline. Within this high-risk Persistence subgroup, post-traumatic stress disorder (PTSD) was found to be a specific predictor of reattempt. While Onset was linked to earlier reattempts, Persistence showed a modest descriptive delay in reattempt timing. Overall, 22.2% of the sample reattempted, with a median time-to-reattempt of 138 days. Multivariable Cox regression showed that older age was associated with a lower reattempt hazard (HR=0.98), while a greater number of prior attempts increased the hazard (HR=1.02). Notably, both Remission (HR=0.56) and Persistence (HR=0.58) patterns, were associated with a statistically significant reduced 12-month hazard of reattempt.

Conclusion: Although the presence of intermittent NSSI (Remission or Persistence patterns) paradoxically signaled a reduced 12-month reattempt hazard, the Persistence pattern remains a critical indicator of elevated risk. The findings suggest that while NSSI may serve as a short-term down-regulator of severe affect, the persistent engagement in this behavior highlights a significant and complex clinical vulnerability requiring targeted intervention.

Background: Understanding why some individuals transition from suicidal ideation (SI) to suicidal behavior (SB) remains a central challenge. Evidence suggests this transition emerges from the interaction of transdiagnostic features—psychopathology, impulsivity, trauma exposure, cognitive deficits and neurobiological alterations. To integrate these dimensions, we examined converging evidence from a clinical network analysis and a systematic review of fMRI decision-making studies, and outline how these findings inform the rationale for the RECONCILE intervention trial. This study aims to identify clinical network structures distinguishing SI with versus without intention to act after a suicide attempt; to synthesize neurobiological findings on decision-making alterations in suicide attempters; and to propose a unified framework supporting a multimodal intervention targeting functioning, cognition and neural circuits after a suicide attempt.

Methods: Data were drawn from the SURVIVE cohort (n=1,265 adults). Network analysis examined relationships among psychopathology, impulsivity and childhood maltreatment. A complementary systematic review summarized fMRI studies assessing neural activation during decision-making tasks in suicide attempters, focusing on ACC, DLPFC, VLPFC, OFC, insula and striatum.

Results: Individuals with SI and intention to act showed a densely interconnected and rigid symptom network, with emotional abuse and motor impulsivity acting as key bridge nodes. In contrast, networks in SI without intention were weaker and less integrated. The fMRI review revealed consistent deficits in circuits supporting cognitive control, reward processing and interoceptive integration. Together, these findings suggest that cognitive-affective rigidity and impaired decision-making processes may underlie the progression from ideation to behavior.

Conclusion: Integrating clinical network dynamics with neural mechanisms provides a multi-level understanding of the suicidal spectrum. Building on this evidence, the RECONCILE Study will evaluate whether a targeted psychological intervention can improve functioning and cognition and modulate decision-making circuits in individuals who recently attempted suicide, advancing precision approaches to suicide prevention.

Background: Suicide is a major global public health issue and one of the leading causes of preventable death worldwide. Psychological factors play a central role in suicidal behavior, with psychological pain (psychache) emerging as a key predictor of suicidal ideation and attempts. Despite robust theoretical and empirical evidence, assessment and treatment of psychache are not yet standard in clinical practice. This study aims to design and implement a cognitive-behavioral intervention focused on reducing psychological pain in individuals at high risk of suicide, with the ultimate goal of lowering suicide risk through personalized, evidence-based care.

Methods: The proposed intervention combines Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) with Treatment as Usual (TAU) across ten weekly one-hour online group sessions. Each session addresses specific components: psychoeducation on depression, psychological pain, hopelessness, and negative emotional experiences; cognitive restructuring of maladaptive thoughts; coping skills and emotion regulation training; and relapse prevention. Psychache will be measured using the Psychache Scale (Holden et al., 2001) and Psychological-Physical-Pain Visual Analogue Scale (PPP-VAS; Jollant et al., 2019). Clinical monitoring ensures immediate referral to mental health services if acute risk is detected.

Expected Impact: By directly addressing psychological pain—a modifiable and central factor in suicidal behavior—this intervention seeks to enhance prevention strategies, personalize psychotherapy, and provide a validated framework for integrating psychache assessment into routine clinical settings.

Background: Adolescents who attempt suicide face a high risk of reattempts after hospital discharge, while evidence-based brief interventions remain scarce. This study examined the efficacy of the Self-Awareness of Mental Health (SAM) program, a brief individual psychological intervention, in addition to treatment as usual (TAU), compared with TAU alone.

Methods: We conducted a multicentre randomized clinical trial in Spanish hospitals including adolescents aged 12–17 years who had made a recent suicide attempt. Participants were randomly allocated to SAM+TAU or TAU and were followed for 12 months. Outcomes included occurrence and timing of suicide reattempts, as well as psychological and clinical risk factors.

Results: Overall, SAM did not significantly reduce suicide reattempts compared with TAU alone. However, exploratory analyses highlighted distinct patterns of risk, suggesting that specific aspects of impulsivity, suicidal intent, trauma, and psychiatric comorbidity may differentially influence reattempt risk across treatment conditions.

Conclusion: A brief post-attempt psychological intervention delivered in routine clinical settings did not show clear superiority over standard care in reducing adolescent suicide reattempts. Nevertheless, the findings underscore the complexity of suicidal behaviour in youth and point to key psychological targets that may inform the refinement of future tailored, mechanism-focused interventions.