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Psychiatr Serv. 2019 Sep 1;70(9):750-757. doi: 10.1176/ Epub 2019 Jun 12.

Diagnosed Mental Health Conditions and Risk of Suicide Mortality.

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Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder).



Although mental health conditions are risk factors for suicide, limited data are available on suicide mortality associated with specific mental health conditions in the U.S. population. This study aimed to fill this gap.


This study used a case-control design. Patients in the case group were those who died by suicide between 2000 and 2013 and who were patients in eight health care systems in the Mental Health Research Network (N=2,674). Each was matched with 100 general population patients from the same system (N=267,400). Diagnostic codes for five mental health conditions in the year before death were obtained from medical records: anxiety disorders, attention deficit-hyperactivity disorder (ADHD), bipolar disorder, depressive disorders, and schizophrenia spectrum disorder.


Among patients in the case group, 51.3% had a recorded psychiatric diagnosis in the year before death, compared with 12.7% of control group patients. Risk of suicide mortality was highest among those with schizophrenia spectrum disorder, after adjustment for age and sociodemographic characteristics (adjusted odds ratio [AOR]=15.0) followed by bipolar disorder (AOR=13.2), depressive disorders (AOR=7.2), anxiety disorders (AOR=5.8), and ADHD (AOR=2.4). The risk of suicide death among those with a diagnosed bipolar disorder was higher in women than men.


Half of those who died by suicide had at least one diagnosed mental health condition in the year before death, and most mental health conditions were associated with an increased risk of suicide. Findings suggest the importance of suicide screening and providing an approach to improve awareness of mental health conditions.


Diagnosis; Health care; Mental health; Prevention; Suicide and self-harm

[Available on 2020-09-01]

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