The Real Risk for Suicide in Mental Disorders

Steven Dubovsky, MD

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In This Article

Abstract and Introduction

Abstract

New results suggest that the risk is lower than previously reported.

Introduction

Presence of a mental disorder increases the risk for suicide, but investigators typically have estimated risks in relatively brief, small studies, without adjusting for patients who are lost to follow-up or die of unclear causes. To avoid these limitations while ascertaining lifetime risks for suicide associated with specific disorders, researchers used Danish national registries to prospectively follow 176,347 people with a first psychiatric contact for a mental disorder after age 15 and 881,735 nonpsychiatric controls for up to 36 years (birth years, 1955–1991). Data included diagnoses of all treatment recipients; death from suicide or from other causes; emigration; and loss to follow-up.

Absolute risk (i.e., cumulative incidence) for suicide in nonpsychiatric controls was 0.72% in men and 0.26% in women. In patients with bipolar disorder, the risk was 7.77% in men and 4.78% in women; in those with unipolar depression, 6.67% and 3.77%; in those with schizophrenia, 6.55% and 4.91%; in those with "schizophrenia-like disorder," 5.90% and 4.07%; and in those with substance abuse treated in psychiatric settings, 4.71% and 3.34%. Suicide risk in women with anorexia nervosa was 2.62%. Independent of age at onset of the disorder, suicide risk increased the most in the early years after first psychiatric contact; cumulative incidence stabilized after 22 years. Lifetime suicide risk increased with comorbid substance abuse or unipolar depression and doubled with history of deliberate self-harm (e.g., overdose). Men with bipolar disorder and deliberate self-harm had the highest lifetime suicide risk (17.08%).

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