One-fifth of people attempting suicide have no prior mental disorders

One in five individuals who attempt suicide do not have a history of psychiatric disorders, a cross-sectional study has shown.

“Not all people who die by suicide have a psychiatric disorder,” wrote the researchers. “Yet, little is known about lifetime suicide attempts among ostensibly psychiatrically healthy people.” [JAMA Psychiatry 2024;81:572-578]

Therefore, the researchers used data from the NESARC-III study, a cross-sectional face-to-face survey conducted with a nationally representative sample of the US population, to estimate the percentage of individuals with lifetime suicide attempts whose first attempt occurred before the onset of any psychiatric disorder. Data analyses were performed for males, females, and three age groups between April and August 2023.

In the total sample of 36,309 respondents, 1,948 individuals (5.36 percent) had lifetime suicide attempts. “Of them, 128 [6.2 percent] did not have apparent antecedent psychiatric diagnoses and an additional 261 [13.4 percent] made a first suicide attempt prior to psychiatric disorder [diagnoses],” reported the researchers. “Thus, an estimated 19.6 percent of respondents reported a lifetime suicide attempt with no evidence of a psychiatric disorder.”

Older adults aged >50 years were significantly less likely to have made a suicide attempt than those aged 20–<35 or 35–50 years (3.9 percent vs 6.1 and 6.2 percent, respectively; both p<0.001). Compared with males, females were nearly twice as likely to report a lifetime suicide attempt (3.6 vs 6.7 percent; p<0.001) and were more likely to make a suicide attempt in the same year of onset of their first psychiatric disorder (8.6 vs 14.9 percent; p<0.001).

These results indicate that screening for suicide risk solely among those with known psychiatric conditions could fail to recognize one-fifth of those who are at risk, suggesting a need to broaden suicide risk screening beyond psychiatric populations.

In a separate cross-sectional study published in the same issue of JAMA Psychiatry, researchers analyzed profiles of 306,800 suicide decedents (mean age, 46.3 years; males, 78.1 percent) using data from the 2003–2020 National Violent Death Reporting System Restricted Assess Database. [JAMA Psychiatry 2024;81:595-605]

They identified five distinct suicide profiles, including physical health challenges (31.7 percent), polysubstance problems (19.2 percent), crisis, alcohol-related and intimate partner problems (18.0 percent), mental health problems (17.6 percent), and comorbid mental health and substance use disorders (13.5 percent), revealing that mental health problems were not the major cause for suicide deaths.

However, individuals with comorbid mental health and substance use disorders and those with mental health problems showed the highest rates of suicide intent disclosure (29.4 percent and 29.1 percent, respectively), whereas those with physical health challenges had the lowest (14.4 percent).

“These findings highlight the need for tailored suicide prevention strategies that address the specific needs of each profile to the extent they are identifiable, or prevent impulsive thoughts from being acted on, moving away from a one-size-fits-all approach,” commented the researchers. “Improving detection and treatment of coexisting mental health conditions, substance and alcohol use disorders, and physical illnesses is paramount.”