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

Area of Science:

• Psychiatry
• Public Health
• Epidemiology

Background:

• Nonfatal suicidal behavior is a strong predictor of suicide death, but only a small percentage of attempters die by suicide.
• Approximately 50% of suicide deaths occur without a documented history of prior nonfatal attempts, highlighting the need to identify other risk factors.

Purpose of the Study:

• To investigate the clinical characteristics of suicide deaths that occur in the absence of prior nonfatal suicidal ideation or behavior (SI/SB).
• To compare individuals who died by suicide with and without a history of SI/SB, and their respective control groups.

Main Methods:

• Analysis of population-ascertained data from 4,000 suicide deaths and 26,191 population controls.
• Utilized diagnostic codes and natural language processing of electronic health records to identify individuals with and without evidence of SI/SB.

Main Results:

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

Conclusions:

• Significant clinical differences exist between suicide deaths with and without prior SI/SB.
• For a substantial number of individuals at risk for suicide mortality, a history of SI/SB may not be a sufficient clinical marker for risk assessment.