Calm after the storm? Clinical phenotypes and risk markers in suicidal patients: data from a liaison-consultation psychiatric setting.

Introduction: Suicidality represents an increasing public health matter and is more frequently associated with higher psychiatric vulnerability and with greater severity of psychopathological manifestations. Suicide risk may arise from a complex interplay of socio-environmental and clinical factors, which can be promptly explored during psychiatric consultations following a suicide attempt (SA). The present study aims at clarifying the correlates of suicidality in a liaison-consultation setting, in order to characterize risk profiles that could be targeted by preventive strategies. Methods: The present analysis is based on data collected from psychiatric consultations conducted in medical settings at the University Hospital of Perugia. We used the Columbia Suicide Severity Rating Scale for the assessment of suicidal ideation (SI), SA, and non-suicidal self-injury (NSSI). Study participants were divided in those referred after a SA (SA group) and those referred for other psychiatric reasons (non-SA group), including SI and NSSI. Bivariate analyses were performed to assess significant differences between the groups and a logistic regression model using Firth's penalized likelihood was created to evaluate the correlates of suicidality in our sample. Results: In our sample (N = 373, 61.1% females, mean age 47.99 ± 21.09 years), 129 patients (34.6%) were evaluated after a real, interrupted, or aborted SA. Patients in the SA subgroup were more frequently females (p=0.031) and younger (p<0.001), also reporting a higher prevalence of familiar psychiatric history (p=0.011), previous SA (p<0.001) and NSSI (p<0.001), life stressors in the past six months (p=0.044), and current DSM-5-TR diagnosis of depressive (p=0.028) and personality disorders (p<0.001). At the logistic regression model (p<0.001), the variables that resulted to be positively associated with SA were previous NSSI (OR = 5.92), previous SA (OR = 3.09), a diagnosis of depressive (OR = 2.65) personality disorder according to DSM-5-TR (OR = 2.36), life stressors during the past six months (OR = 1.88), whereas age was negatively associated with SA (OR = 0.97). Conclusions: Our findings underline the high prevalence of suicidality in liaison-consultation psychiatry and confirm that psychiatric consultation in the general hospital represents a crucial opportunity for comprehensive assessment of risk factors and early intervention. Younger individuals with a history of suicidal behaviors and NSSI should be considered a high-risk group and prioritized for targeted preventive strategies.