Since suicide is a rare event, the much more frequent suicide attempts are often used as a “proxy measure” - in such diverse fields as the ongoing debate about the potential increase of “suicidality” by SSRIs and the public health challenge of suicide prevention. Most authors dealing with these topics implicitly assume that there is a continuity between suicidal ideation > first suicide attempt > repeated suicide attempt and > completed suicide. They obviously take no notice of an important literature casting doubt on this unitarian process model of “suicidality”. The pooled findings of studies show that the risk of suicide is raised after an attempted suicide, but generally not very much – in fact most people who “attempt a suicide”, never commit suicide.

A thirty year prospective population based actuarial follow up study of 261 persons who had attempted suicide in 1971.

(1) the risk of suicide was 9 times higher than in a comparable sample of the general population, but with 8% rather small in absolute figures; (2) most of the suicides occurred in the 5 to 10 years immediately following the attempt; (3) general mortality was slightly increased in men but not in women.

Given the rather low transition probability from attempted to completed suicide, the above mentioned debates should become more differentiated. It will also be discussed, whether subtypes of suicide attempts have different prognostic implication with regard to completed suicide.