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Cited by 689Suicide and Self-Harm StudiesMental Health Treatment and AccessBipolar Disorder and Treatment

Absolute Risk of Suicide After First Hospital Contact in Mental Disorder

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Nordentoft, Merete·2011·Archives of General Psychiatry
DOI 10.1001/archgenpsychiatry.2011.113
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Abstract

CONTEXT: Estimates of lifetime risk of suicide in mental disorders were based on selected samples with incomplete follow-up. OBJECTIVE: To estimate, in a national cohort, the absolute risk of suicide within 36 years after the first psychiatric contact. DESIGN: Prospective study of incident cases followed up for as long as 36 years. Median follow-up was 18 years. SETTING: Individual data drawn from Danish longitudinal registers. PARTICIPANTS: A total of 176,347 persons born from January 1, 1955, through December 31, 1991, were followed up from their first contact with secondary mental health services after 15 years of age until death, emigration, disappearance, or the end of 2006. For each participant, 5 matched control individuals were included. MAIN OUTCOME MEASURES: Absolute risk of suicide in percentage of individuals up to 36 years after the first contact. RESULTS: Among men, the absolute risk of suicide (95% confidence interval [CI]) was highest for bipolar disorder, (7.77%; 6.01%-10.05%), followed by unipolar affective disorder (6.67%; 5.72%-7.78%) and schizophrenia (6.55%; 5.85%-7.34%). Among women, the highest risk was found among women with schizophrenia (4.91%; 95% CI, 4.03%-5.98%), followed by bipolar disorder (4.78%; 3.48%-6.56%). In the nonpsychiatric population, the risk was 0.72% (95% CI, 0.61%-0.86%) for men and 0.26% (0.20%-0.35%) for women. Comorbid substance abuse and comorbid unipolar affective disorder significantly increased the risk. The co-occurrence of deliberate self-harm increased the risk approximately 2-fold. Men with bipolar disorder and deliberate self-harm had the highest risk (17.08%; 95% CI, 11.19%-26.07%). CONCLUSIONS: 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. 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.

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  • Suicidal behavior appears in many psychiatric disorders, not only in mood disorders and borderline personality disorder.

    “First, suicidal behavior is found in many psychiatric disorders and not just in mood disorders and borderline personality disorder, where it is part of the diagnostic symptom list.”

    From A brain-centric model of suicidal behavior (2020) · cites this paper as [12]

  • Only a minority of psychiatric patients make suicide attempts.

    “Second, only a minority of psychiatric patients make suicide attempts, and the presence or absence of suicidal behavior is not simply determined by the presence of a psychiatric illness or the overall severity of illness (12-14).”

    From A brain-centric model of suicidal behavior (2020) · cites this paper as [12]

  • The presence or absence of suicidal behavior is not simply determined by the presence or overall severity of a psychiatric illness.

    “Second, only a minority of psychiatric patients make suicide attempts, and the presence or absence of suicidal behavior is not simply determined by the presence of a psychiatric illness or the overall severity of illness (12-14).”

    From A brain-centric model of suicidal behavior (2020) · cites this paper as [12]

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Research works printed but not linked: 1

  1. World Health Organization. Classification of Diseases: Extended Danish-Latin Ver- ARCH GEN PSYCHIATRY/ VOL 68 (NO. 10), OCT 2011 WWW.ARCHGENPSYCHIATRY.COM 1063 ©2011 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 08/20/2023 sion of the World Health Organization International Classification of Diseases, 8th Revision. Copenhagen: Danish National Board of Health; 1971.

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Authors
Nordentoft, M.
Affiliations
Mental Health Services (DK)
Corresponding author
Nordentoft, Merete
ORCID
Nordentoft, Merete
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2011-10-01
Volume
68
Issue
10
Pages
1058
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archgenpsychiatry.2011.113
OpenAlex
W2033648797
Cited by
689
References
35
Citations by year
2026: 25 · 2025: 33 · 2024: 40 · 2023: 52 · 2022: 35 · 2021: 67 · 2020: 68 · 2019: 65 · 2018: 64 · 2017: 44 · 2016: 53 · 2015: 52 · 2014: 46 · 2013: 29 · 2012: 14
FWCI
30.99
Type
journal article
Language
en
Open access
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
suicide risk, mental illness, bipolar disorder, schizophrenia, unipolar affective disorder, substance use comorbidity, self-harm, sex differences, lifetime risk, psychiatric hospitalization, national cohort, Denmark, suicide prevention, suicide risk factors, suicide prevention research funding, suicide prevention workforce
MeSH terms
Adolescent, Adult, Mental Disorders, Bipolar Disorder, Denmark, Female, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Schizophrenia, Schizophrenic Psychology, Sex Factors, Suicide, Comorbidity, Incidence, Mood Disorders, Substance-Related Disorders, Young Adult

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