Suicide risk in first- and second-generation young migrants: a 12-month cohort study

Evidence on the impact of migration on suicidal behavior among adolescents remains limited. Particularly, there is scarce knowledge concerning clinical populations and second generations of migrants. This cohort study examined differences in clinical, psychosocial and behavioral profiles associated with suicidal behavior among non-migrant, first-generation and second-generation migrant adolescents presenting to a Child and Adolescent Psychiatry Emergency Department (ED) in Madrid.

Adolescents aged 8-17 years (N = 1,281) presenting with suicidal ideation or behavior were identified at an index ED visit, and their electronic medical records were retrospectively reviewed over a 12-month follow-up period. Sociodemographic, clinical and psychosocial risk factors-including socioeconomic adversity, family psychiatric history, maltreatment, family conflict, victim of bullying and eating problems-were systematically recorded. Reasons for consultation, methods and severity of suicidal behavior were compared across migration groups. Cox proportional hazards regression models, including age- and sex-adjusted and two multivariable models, examined whether migration status independently predicted time to repeat suicidal behavior during follow-up.

Migrant adolescents-both first- and second-generation-presented with a higher burden of psychosocial adversity and more severe self-harm methods at index ED visit compared to non-migrants. Migrant adolescents, particularly first-generation, were less likely to have had prior outpatient mental health follow-up. In fully adjusted multivariable models accounting for sociodemographic, psychosocial and clinical covariates, including previous suicidal behavior, second-generation migrant background remained an independent predictor of repeat suicidal behavior, whereas first-generation background did not show a statistically significant effect.

Second‑generation migrant background was associated with a more severe clinical presentation and repeat suicidal behavior, even after adjusting for psychosocial and clinical covariates. These findings suggest that generational migration status is a relevant factor to consider when assessing and following up on suicide risk for adolescents of migrant origin, particularly those from a second-generation background.