Recurrence and Lethality in a Cohort of Minors With Suicidal Behaviour: 2010-2024.

BACKGROUND: Suicidal behaviour in children and adolescents has increased significantly over the last decade, generating growing concern among healthcare professionals. However, clinical and evolutionary differences between minors and adults after a suicide attempt are not sufficiently defined. This study analyses the differential profile of minors treated for suicide attempts in a large provincial cohort to identify specific vulnerabilities and risk patterns. METHODS: Retrospective cohort study (MCOSUL Cohort) that included all suicide attempts treated in provincial psychiatric emergency services between 2010 and 2024. Sociodemographic variables, psychiatric diagnoses, substance use, method and lethality of the index attempt, recurrence, and mortality were collected. High lethality was defined according to Beautrais criteria. χ2, Fisher, Student's t, Kruskal-Wallis tests, and survival analyses for recurrence were applied. RESULTS: Minors represented 8% of the cohort, with a female predominance (83%). They presented a higher prevalence of neurodevelopmental disorders and eating disorders (EDs), as well as a differential consumption pattern dominated by tetrahydrocannabinol (THC). They used more violent methods, especially cutting, without an increase in lethality. The Cox model shows that being a minor is significantly associated with earlier recurrence of suicidal behaviour (HR = 1.36), even after adjusting the analysis for sex, neurodevelopmental disorders, THC use, and the method employed. Adults showed higher lethality, mortality, and more frequent use of sedative medications as a suicide method. Recurrence of subsequent suicidal behaviour was similar but occurred earlier in minors. CONCLUSIONS: Adolescent suicidal behaviour appears to present a distinct clinical phenotype, characterized by a predominance of female adolescents, frequent neurodevelopmental vulnerabilities, THC use, low-lethality violent methods, and relatively rapid recurrence, highlighting the need for tailored prevention strategies.