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Objective To evaluate the incidence of suicidal outcomes and risk factors for short‐ and long‐term recurrence of suicidal behavior (SB) among high‐risk borderline personality disorder (BPD) patients during a 24‐month prospective follow‐up period. Methods A multicenter prospective cohort study was designed to compare data obtained from 136 patients admitted to the emergency department for current suicidal ideation (SI) or a recent suicide attempt (SA). Subjects were clinically evaluated and monitored for a new SA or suicide. Results The incidence of a new SA was 25.63 events/100 persons‐year, and one patient died by suicide. Child sexual abuse (CSA) was the only significant predictor throughout the complete follow‐up period. The absence of prior psychiatric treatment predicts the recurrence of SB in the first 6 months of follow‐up. Patient age, poor psychosocial functioning before hospitalization, age at first SA, and having multiple suicide attempts increased risk of SB recurrence at the long‐term period (24th months). In addition, there was an interaction between CSA and poor psychosocial functioning that increased risk of SB. Conclusion The risk of recurrence was higher during the first 6 months. Risk factors at 6 and 24 months vary. These findings are important for implementing suicide strategies.

Objective A suicide attempt is an established risk factor for subsequent suicide attempts and suicide. Nonetheless, the prediction of future suicidal behavior is poor. The lethality of previous suicidal behavior may be informative to better understand future suicide risk among patients hospitalized for suicidal thoughts and behavior. The current study examined whether the lethality of patients' index (most recent suicidal episode at hospitalization), first, and worst suicidal episode predicts the lethality of one's most lethal suicide attempt during a 2‐year follow‐up period. Method A total of 98 patients hospitalized at an emergency department for high suicide risk (i.e., acute suicidal ideation or a suicide attempt) were included in the study. Results Results indicated that the lethality of the index suicidal episode predicted the lethality of the worst suicide attempt during a 2‐year follow‐up period. Conclusions These findings extend a growing literature examining risk factors that influence the progression toward high lethality suicidal behavior.