Risk Assessment of Repeated Suicide Attempts Among Youth in Saudi Arabia

Introduction: Although the incidence of suicide attempts continues to increase among youth in Saudi Arabia, no risk assessment tool has been established for suicide attempt repetition in the country's youth population. The objective of the study was to develop risk assessment of suicide attempt repetition among youth in Saudi Arabia.

Methods: This is a retrospective study of youth (10-24 years) with intentional suicide attempt(s) who presented to the emergency departments (ED) at King Abdullah Specialist Children's Hospital (KASCH) and King Abdulaziz Medical City-Riyadh (KAMC-R), Saudi Arabia between 1 January 2015 and 31 December 2017. We excluded youth having unintentional suicide attempts. Data were retrieved for the 157 eligible as having attempted suicide.

Results: Forty-one of 157 (26.1%) had repeated suicide attempts (95% confidence limits: 19.433.7%). Four independent factors were identified that were associated with an increased risk of repeated suicide attempts: age (adjusted odds ratio [aOR] = 1.147, 95% confidence interval (CI) = 11.015-1.297, P=0.028), family problems (aOR = 4.218, 95% CI = 1.690-10.528, P=0.002), psychiatric disorders (aOR = 3.497, 95% CI = 1.519-8.051, P=0.003), and hospitalization (aOR = 5.143, 95% CI = 1.421-18.610, P=0.013). This risk model showed adequate utility with an area under the receiver operating characteristic (ROC) curve (AUC): 77.9%, 95% CI: 69.486.3% with optimism-corrected AUC = 71.8%. Youden index defined a probability of ≥0.38 to predict a high risk of repeated suicide attempts.

Conclusion: The risk of repeated suicide attempts among Saudi youth was high, compatible with what has been reported among youth in England and in France. Age, family problems, psychiatric disorders, and hospitalization are risk factors for repeated suicide attempts. A prevention program for suicide attempts in youth may take into account family problems, screening for psychiatric disorders, and suicidal behavior.