Articlebronze2011

Absolute Risk of Suicide After First Hospital Contact in Mental Disorder

689 citations0/0 files storedArchives of General Psychiatry

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Suicide and Self-Harm Studies Mental Health Treatment and Access Bipolar Disorder and Treatment

Abstract

CONTEXT: Estimates of lifetime risk of suicide in mental disorders were based on selected samples with incomplete follow-up. OBJECTIVE: To estimate, in a national cohort, the absolute risk of suicide within 36 years after the first psychiatric contact. DESIGN: Prospective study of incident cases followed up for as long as 36 years. Median follow-up was 18 years. SETTING: Individual data drawn from Danish longitudinal registers. PARTICIPANTS: A total of 176,347 persons born from January 1, 1955, through December 31, 1991, were followed up from their first contact with secondary mental health services after 15 years of age until death, emigration, disappearance, or the end of 2006. For each participant, 5 matched control individuals were included. MAIN OUTCOME MEASURES: Absolute risk of suicide in percentage of individuals up to 36 years after the first contact. RESULTS: Among men, the absolute risk of suicide (95% confidence interval [CI]) was highest for bipolar disorder, (7.77%; 6.01%-10.05%), followed by unipolar affective disorder (6.67%; 5.72%-7.78%) and schizophrenia (6.55%; 5.85%-7.34%). Among women, the highest risk was found among women with schizophrenia (4.91%; 95% CI, 4.03%-5.98%), followed by bipolar disorder (4.78%; 3.48%-6.56%). In the nonpsychiatric population, the risk was 0.72% (95% CI, 0.61%-0.86%) for men and 0.26% (0.20%-0.35%) for women. Comorbid substance abuse and comorbid unipolar affective disorder significantly increased the risk. The co-occurrence of deliberate self-harm increased the risk approximately 2-fold. Men with bipolar disorder and deliberate self-harm had the highest risk (17.08%; 95% CI, 11.19%-26.07%). CONCLUSIONS: This is the first analysis of the absolute risk of suicide in a total national cohort of individuals followed up from the first psychiatric contact, and it represents, to our knowledge, the hitherto largest sample with the longest and most complete follow-up. Our estimates are lower than those most often cited, but they are still substantial and indicate the continuous need for prevention of suicide among people with mental disorders.

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References

1997Suicide as an outcome for mental disorders 2005The Lifetime Risk of Suicide in Schizophrenia 2000Affective Disorders and Suicide Risk: A Reexamination 1970Suicide and Primary Affective Disorders 1999The Danish registers of causes of death.

Cited by

2017Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas 2013Excess Mortality, Causes of Death and Life Expectancy in 270,770 Patients with Recent Onset of Mental Disorders in Denmark, Finland and Sweden 2014A Comprehensive Nationwide Study of the Incidence Rate and Lifetime Risk for Treated Mental Disorders 2018Suicide Risk and Mental Disorders 2011The European Psychiatric Association (EPA) guidance on suicide treatment and prevention 2013Sociodemographic, psychiatric and somatic risk factors for suicide: a Swedish national cohort study 2014Suicidal Behaviour in Mood Disorders—Who, When, and Why?2015Suicide risk assessment and intervention in people with mental illness

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