Evaluate previous parasuicide even if in the remote past

Predicting suicide is a delicate matter, certainly difficult even in groups of patients at high risk. A paper in this issue focuses on previous parasuicide as a predictor of suicide (p 1155) and shows that the risk persists without decline for two decades.1 This observation is relevant for the clinical assessment of risk of suicide and has implications for the treatment of parasuicide as well.

In a large meta-analysis, a history of parasuicide or attempted suicide increased the risk of suicide to 40 times that of the general population.2 An attempted suicide that was recognised in health care thus implied a higher risk than having a mental disorder such as major depression, personality disorder, or dependence on alcohol. The risk of suicide is generally most prominent during the first months after psychiatric care.3 The …