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05-10-2011 | Psychology | Article

Absolute risk for suicide remains high in mental health disorder patients


Free abstract

MedWire News: Among patients with mental health disorders, the absolute risk for suicide is greatest in men with bipolar disorder and women with schizophrenia, research shows.

The findings show that the absolute risk for suicide among patients with mental health disorders remains significantly elevated, highlighting the continued need for risk prevention strategies in such patients.

Writing in the Archives of General Psychiatry, Merete Nordentoft (Psychiatric Centre Copenhagen, Denmark) and team explain: "The absolute risk of death by suicide, often mentioned as lifetime risk of suicide after the onset of mental disorders, can be estimated as the percentage of a cohort expected to die by suicide."

They add: "Although the lifetime risk of suicide has been reported in many studies, most estimates were based on incomplete follow-up in selected samples or were based on rather short-term follow-up of patients with first-time treated mental disorders."

To address this, the researchers used the Danish Civil Registration System (DCRS) for 1955-1991 to identify 176,347 individuals, aged 15 years or older, who came into contact with secondary mental health services for the first time. These individuals were followed-up from their first contact until death, emigration, disappearance, or the end of 2006.

These participants were each matched with five individuals from the DCRS who did not have any contact with mental health services.

Using data from the Danish Registers of Causes of Death, the team found that among men, the presence of bipolar disorder was associated with the greatest absolute risk for suicide (7.77%), followed by unipolar affective disorder (6.67%), schizophrenia (6.55%), schizophrenia-like disorders (5.90%), and substance abuse treated in a psychiatric department (4.71%).

Among women, the presence of schizophrenia was associated with the greatest absolute risk for suicide (4.91%), followed by bipolar disorder (4.78%), schizophrenia-like disorder (4.07%), unipolar affective disorder (3.77%), substance abuse treated in a psychiatric department (3.34%), and anorexia (2.62%).

Comorbid substance abuse, comorbid unipolar affective disorder, and deliberate self-harm significantly increased suicide risk among individuals with mental health disorders, and the risk for suicide was highest in the first year after mental health service contact.

The absolute risk for suicide among men and women who did not have any contact with mental health services was 0.72% and 0.26%, respectively, the researchers note.

Nordentoft and team conclude: "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.

They add: "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."

By Mark Cowen

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