Absence of nonfatal suicidal behavior preceding suicide death reveals differences in clinical risks

Area of Science:

• Psychiatry
• Public Health
• Epidemiology

Background:

• Nonfatal suicidality is a strong suicide death predictor, yet most attempts do not lead to death.
• Approximately half of suicide deaths occur without a documented prior attempt, highlighting the need to identify other risk factors.

Purpose of the Study:

• To investigate clinical differences between suicide deaths with and without a history of nonfatal suicidal behavior (SI/SB).
• To identify risk factors beyond nonfatal suicidality associated with suicide death.

Main Methods:

• Analysis of population-ascertained data from 4,000 suicide deaths and 26,191 controls.
• Utilized electronic health records, including diagnostic codes and natural language processing, to identify individuals with and without prior nonfatal SI/SB.
• Compared characteristics of suicide deaths with prior SI/SB (SUI_SI/SB) to those without (SUI_None) and controls with (CTL_SI/SB) and without (CTL_None) lifetime suicidality.

Main Results:

• Suicide deaths without prior SI/SB (SUI_None) and their controls (CTL_None) were older and had fewer diagnoses compared to groups with SI/SB.
• Mental health diagnoses were less prevalent in SUI_None and CTL_None groups and less associated with suicide death than with SI/SB.
• Physical health diagnoses were more frequently associated with suicide death risk than with the presence of SI/SB.

Conclusions:

• Significant clinical distinctions exist between suicide deaths with and without a history of nonfatal SI/SB.
• Physical health conditions may represent a critical, under-recognized risk factor for suicide death in individuals without prior documented suicidal behavior.