Beyond risk factors: a mixed-methods study of interpersonal dynamics in suicide attempts and reattempts from police narratives

Abstract

Abstract Background Each year, approximately 1.5 million Americans attempt suicide, and repeated attempts pose heightened risks for individuals, families, and communities. These attempts can result in long-lasting injuries, isolation, and psychological distress. Research relies heavily on structured quantitative data, limiting insight into interpersonal and situational dynamics. Although mental health concerns are well-established risk factors for suicidal behavior, it remains unclear which concerns predict reattempts. We address these gaps using four years (2018–2021) of police service-call data ( N = 2,659 incidents) from one Midwestern city. Using a mixed-methods design, we conduct thematic analysis of officer narratives to explore the situational context of suicide attempts and estimate logistic regression models to examine whether mental health concerns are associated with repeated attempts. Results Qualitatively, seven themes, including relationship conflict, health issues, and general life stressors, are identified, reflecting interpersonal dynamics consistent with the Interpersonal Theory of Suicide. Quantitatively, however, police-documented mental health concerns are not significantly associated with repeated attempts. These null findings should be interpreted cautiously, as they may reflect limitations in police documentation. Conclusions Together, these findings highlight the value of mixed-methods approaches for police data research, the need for standardized crisis documentation practices, and the importance of improving officer training and integrating mental health professionals into crisis response. They also underscore the importance of understanding the interpersonal context to aid suicide prevention and intervention efforts.