Risk and Protective Factors of Near-Lethal Suicide Attempts in Adolescents

Introduction: Adolescents exhibit high rates of suicide attempts but comparatively low rates of completed suicides. While many studies focus on suicide attempts, it is unclear if findings apply to suicides. Studying near-lethal suicide attempts (NLSA) as a proxy for completed suicides is an underexplored approach. This study aimed to identify differences between low-risk suicide attempts (LRSA) and NLSA.Methods: Using a standardized clinical survey, suicidal phenomena, risk and protective factors were assessed in a clinical population at first contact from 2018 to 2022. NLSA (N = 17) were identified using strict criteria and compared with LRSA (N = 106) in terms of risk and protective factors using Χ² and t-tests for independent samples.Results: Only 58.8% of minors with NLSA reported prior suicide attempts, compared to 84.0% of LRSA (χ²(1) = 5.895; p = .015). This indicates that patients with NLSA in particular lack previous warning signs. Adolescents with NLSA (73.3%) were not (ever) approached about suicidality (LRSA: 14.1%, U = 243.500, p = .000). Active communication also differed: 60% of adolescents with NLSA did not (ever) actively talk about suicidality (LRSA: 28.4%, U = 458.500, p = .022).Conclusion: The findings highlight the role of communication in suicide prevention, underscoring the need for low-threshold pathways to mental health care. Future research should include larger NLSA samples and prospective designs to improve targeted prevention.