DEPRESSION AND ANXIETY 31:19–26 (2014) Research Article LONGITUDINAL FOLLOW-UP STUDY OF ADOLESCENTS WHO REPORT A SUICIDE ATTEMPT: ASPECTS OF SUICIDAL BEHAVIOR THAT INCREASE RISK OF A FUTURE ATTEMPT Regina Miranda, Ph.D., 1,2∗ Eva De Jaegere, M.Sc., 3 Kathleen Restifo, Ph.D., 4 and David Shaffer, F.R.C.P., F.R.C.Psych 2 Background: Previous studies have noted that a past suicide attempt (SA) pre- dicts a future SA, but few studies have reported whether previous SAs that predict a future attempt differ from those that do not. Knowing which characteristics of previous SAs predict future attempts would assist in evaluating adolescents at risk of attempt repetition. This longitudinal study of an unreferred sam- ple examined which characteristics of adolescent SAs increased risk for repeat attempts. Methods: Fifty-four adolescents who had attempted suicide were iden- tified through a two-stage screening of 1,729 high school students. Adolescents reported details of their past SA on the Adolescent Suicide Interview and were reassessed 4–6 years later by telephone. Results: Eighteen of the 54 teens (33%) reported that they had made another SA since baseline, and 17 of these reported characteristics of their later attempt. The odds of a further attempt were signifi- cantly increased by being alone (OR = 6.1, 95% CI = 1.1–34.8), retrospectively reporting a serious wish to die (OR = 5.2, 95% CI = 1.2–22.7), and planning the attempt for an hour or more (OR = 5.1, 95% CI = 1.1–25.0). The method of attempt remained consistent from baseline to follow-up attempt (κ = .67). Conclusions: Screening high school students to identify those who are at risk for making future SAs should include questions about number of previous SAs and such indicators of risk as isolation, wish to die, and extent of planning prior to a SA. Depression and Anxiety 31:19–26, 2014. C  2013 Wiley Periodicals, Inc. Key words: suicide/self-harm; child/adolescent; cognition; depression; mood disorders 1 Department of Psychology, Hunter College and the Graduate Center, City University of New York, New York 2 Division of Child and Adolescent Psychiatry, College of Physi- cians and Surgeons, Columbia University, New York, New York 3 Department of Psychiatry and Medical Psychology, Ghent University, Belgium 4 Department of Psychology and Neuroscience, Maastricht Uni- versity, The Netherlands ∗ Correspondence to: Regina Miranda, Division of Child and Ado- lescent Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Unit 78, New York, NY 10032. E-mail: regina.miranda@hunter.cuny.edu Received for publication 7 March 2013; Revised 19 July 2013; Ac- cepted 27 August 2013 DOI 10.1002/da.22194 INTRODUCTION Reviews of studies conducted in clinical and commu- nity samples suggest that up to 42% of adolescents who attempt suicide go on to make another attempt within 2 years of their original attempt, [1,2] with girls who at- tempt suicide in adolescence at higher risk of repetition than boys. [3] Repeated suicide attempts (SAs) are, in turn, associated with higher rates of psychiatric diagnosis, [4] particularly major depression, [2] and with difficulties in emotion regulation, hopelessness, [5] and risk for further SAs. [4,6,7] Given that adolescence is a time period of in- creased psychosocial stressors that may impact risk for suicidal behavior, [1] identifying more specific risk fac- tors for repetition of SAs during this period of develop- ment is a particularly useful goal, with implications for Published online 18 September 2013 in Wiley Online Library (wileyonlinelibrary.com). C  2013 Wiley Periodicals, Inc.