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Absolute Risk of Suicide After First Hospital Contact in Mental Disorder
Open accessAbstract
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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“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]
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“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]
In the citing paper
“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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“, 2001), while several other studies showed the opposite result of higher rates in BD among large outpatient, inpatient or broad clinical samples (Ilgen et al., 2010; Nordentoft et al., 2011; Sani et al., 2011; Singhal et al., 2014; Tondo et al., 2007).”
InfluentialSerra, P. R., Navarra‐Ventura, G., Castro, A., Gili, M., Salazar-Cedillo, A., Ricci‐Cabello, I., Roldán-Espínola, L., Coronado-Simsic, V., García-Toro, M., Gómez-Juanes, R., et al. (2023) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-023-01716-5 · Cited by 216
“Patients with depressive disorders are especially vulnerable to suicide [4] and suicidal behaviour [5–7].”
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“…(e.g. schizophrenia) experience high rates of suicidal phenomenon, including completed suicide (lifetime prevalence 4.9–6.6%; Palmer et al. 2005; Nordentoft et al. 2011), suicide attempt (lifetime prevalence 30.2%; Radomsky et al. 1999; Baca-Garcia et al. 2005) and ideation (15-day prevalence…”
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MethodLong-term Risk of Dementia in Persons With Schizophrenia
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“In the fi rst analysis of the absolute risk of suicide in a total national cohort of individuals followed up from the fi rst psychiatric contact, Nordentoft et al. (2011) reported that schizophrenia was the fi rst psychiatric disorder responsible of completed suicide in women (cumulative incidence…”
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“First, schizophrenia patients could be a proxy variable for several chronic conditions, including cerebrovascular disease, 63 substance abuse, 64 atrial fibrillation or flutter, 65,66 peripheral vascular disease, 63,67 diabetes mellitus, 68 ischemic heart disease, 63,67,69 and congestive heart…”
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“…this is true for all mental illnesses, suicide risk appears to be especially elevated among individuals who had been diagnosed with a bipolar disorder and with disorders in the schizophrenia spectrum (Large et al., 2009; Nordentoft et al., 2004; Nordentoft et al., 2011; Nordentoft et al., 2013b).”
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“The estimated lifetime risk of suicide among patients with major depression is 3.7% for women and 6.7% for men (Nordentoft et al. 2011).”
InfluentialNeuroprogression and illness trajectories in bipolar disorder
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“Bipolar patients present acute affective episodes that can potentially lead to self-deleterious behaviors such as drug abuse, self-harm, and suicide [2].”
BackgroundSuicide Risk After Nonfatal Self-Harm
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Sex, Gender, and Suicidal Behavior
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“Median (range) 3 (1-153) 6 (1-134) 1 (1-24) 1 (1-12)”
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Self-citationArtificial intelligence and suicide prevention: A systematic review
Lejeune, A., Glaz, A. L., Perron, P.-A., Sebti, J., Baca‐García, E., Walter, M., Lemey, C., & Berrouiguet, S. (2022) · European Psychiatry · doi:10.1192/j.eurpsy.2022.8 · Cited by 130
“Patients with severe mental illness, in particular mood disorder, borderline personality disorder, and anorexia nervosa, are more likely to attempt suicide [3,4].”
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Meta-analysis of suicide rates among psychiatric in-patients
Walsh, G., Sara, G., Ryan, C. J., & Large, M. (2015) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12383 · Cited by 110
“Psychiatric disorders are strongly associated with suicide (1, 2), and patients living with mental illness are often hospitalized because of perceived suicide risk (3, 4).”
BackgroundKawanishi, C., Aruga, T., Ishizuka, N., Yonemoto, N., Otsuka, K., Kamijo, Y., Okubo, Y., Ikeshita, K., Sakai, A., Miyaoka, H., et al. (2014) · The Lancet Psychiatry · doi:10.1016/s2215-0366(14)70259-7 · Cited by 105
From research to practice: how OPUS treatment was accepted and implemented throughout D enmark
Nordentoft, M., Melau, M., Iversen, T., Petersen, L., Jeppesen, P., Thorup, A. A. E., Bertelsen, M., Hjorthøj, C. R., Hastrup, L. H., & Jørgensen, P. (2013) · Early Intervention in Psychiatry · doi:10.1111/eip.12108 · Cited by 104
Self-citationArnone, D., Karmegam, S. R., Östlundh, L., Alkhyeli, F., Alhammadi, L., Alhammadi, S., Alkhoori, A., & Selvaraj, S. (2024) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105594 · Cited by 126
“…et al., 1994; Chang et al., 2012; Knudsen et al., 2022; Laan et al., 2011; Laursen et al., 2016; Leadholm et al., 2014; Musliner et al., 2016; Nordentoft et al., 2011; Osby et al., 2001; Palj ¨ arvi et al., 2023; Reutfors et al., 2017; Tidemalm et al., 2008; Valuck et al., 2004; Wang et al.,…”
Roaldset, J. O., Linaker, O. M., & Bjørkly, S. K. (2012) · Archives of Suicide Research · doi:10.1080/13811118.2013.722052 · Cited by 108
“Depressive disorders and psychotic disorders, which are known to be salient risk factors for suicidal behavior (Hawton & van Heeringen, 2009; Nordentoft et al., 2011), were not significant risk factors in our investigation.”
BackgroundNazarzadeh, M., Bidel, Z., Ayubi, E., Asadollahi, K., Carson‐Chahhoud, K., & Sayehmiri, K. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-4 · Cited by 103
Rapid Mood-Elevating Effects of Low Field Magnetic Stimulation in Depression
Rohan, M. L., Yamamoto, R. T., Ravichandran, C. T., Cayetano, K. R., Morales, O. G., Olson, D. P., Vitaliano, G., Paul, S. M., & Cohen, B. M. (2014) · Biological Psychiatry · doi:10.1016/j.biopsych.2013.10.024 · Cited by 97
“This time lag to clinical response leaves patients vulnerable to the often disabling symptoms of depression, including a high risk of suicidal behavior during the first weeks of treatment (21).”
Suicide attempts in major depressive episode: evidence from the BRIDGE ‐ II ‐Mix study
Popović, D., Vieta, E., Azorin, J., Angst, J., Bowden, C. L., Mosolov, S. N., Young, A. H., & Perugi, G. (2015) · Bipolar Disorders · doi:10.1111/bdi.12338 · Cited by 101
“Extensive evidence suggests the predictive significance of previous suicide attempts to new attempts or completed suicide (5, 9).”
BackgroundPreventing Suicide among Inpatients
Sakinofsky, I. (2014) · The Canadian Journal of Psychiatry · doi:10.1177/070674371405900304 · Cited by 107
Passos, I. C., Ballester, P. L., Barros, R. C., Librenza‐Garcia, D., Mwangi, B., Birmaher, B. B., Brietzke, E. M., Hájek, T., López‐Jaramillo, C., Mansur, R. B., et al. (2019) · Bipolar Disorders · doi:10.1111/bdi.12828 · Cited by 103
The role of prediction in suicide prevention
Large, M. M. B. (2018) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2018.20.3/mlarge · Cited by 112
Aaltonen, K. I., Isometsä, E. T., Sund, R., & Pirkola, S. P. (2018) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12990 · Cited by 98
“The high suicide risk of first-hospitalized patients with preceding suicide attempts, highlighted particularly in men, is understandable as a proxy for several important risk indicators for suicide, that is, preceding suicide attempts (9), psychiatric hospitalizations (2), highrisk postdischarge periods (33), and earl…”
BackgroundResultInfluentialLiang, C., Chung, C., Ho, P., Tsai, C., & Chien, W. (2017) · Bipolar Disorders · doi:10.1111/bdi.12589 · Cited by 102
Prevalence of mental disorders and mental health service use in Japan
Nishi, D., Ishikawa, H., & Kawakami, N. (2019) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.12894 · Cited by 102
Rihmer, Z., & Döme, P. (2016) · Milestones in drug therapy · doi:10.1007/978-3-319-31689-5_4 · Cited by 94
Fazel, S., Wolf, A., Larsson, H., Mallett, S., & Fanshawe, T. R. (2019) · Translational Psychiatry · doi:10.1038/s41398-019-0428-3 · Cited by 96
Aas, M., Andreassen, O. A., Aminoff, S. R., Færden, A., Romm, K. L., Nesvåg, R., Berg, A. O., Simonsen, C., Agartz, I., & Melle, I. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0827-4 · Cited by 88
“Depression is common in first-episode psychosis [27], with an increased risk of suicide during the early phases of psychotic illness, in addition to a reduced quality of life [28, 29].”
BackgroundKeepers, G. A., Fochtmann, L. J., Anzia, J. M., Benjamin, S., Lyness, J. M., Mojtabai, R., Servis, M. E., Walaszek, A., Buckley, P. F., Lenzenweger, M. F., et al. (2020) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.18402 · Cited by 89
Viguera, A. C., Milano, N. J., Ralston, L., Thompson, N. R., Griffith, S. D., Baldessarini, R. J., & Katzan, I. L. (2015) · Psychosomatics · doi:10.1016/j.psym.2015.04.005 · Cited by 85
Guldin, M., Kjaersgaard, M. I. S., Fenger‐Grøn, M., Parner, E. T., Li, J., Prior, A., & Vestergaard, M. (2017) · World Psychiatry · doi:10.1002/wps.20422 · Cited by 89
Method of assessment determines prevalence of suicidal ideation among patients with depression
Vuorilehto, M. S., Valtonen, H. M., Melartin, T. K., Sokero, P., Suominen, K. H., & Isometsä, E. T. (2013) · European Psychiatry · doi:10.1016/j.eurpsy.2013.08.005 · Cited by 82
“Previous attempts are a robust indicator of risk [19]; however, about half of suicide completers die in their first suicide attempt [11].”
BackgroundRandall, J. R., Walld, R., Finlayson, G., Sareen, J., Martens, P. J., & Bolton, J. M. (2014) · The Canadian Journal of Psychiatry · doi:10.1177/070674371405901006 · Cited by 81
Randall, J. R., Roos, L. L., Lix, L. M., Katz, L. Y., & Bolton, J. M. (2017) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1559 · Cited by 80
Attempted Suicide in Bipolar Disorder: Risk Factors in a Cohort of 6086 Patients
Tidemalm, D., Haglund, A., Karanti, A., Landén, M., & Runeson, B. (2014) · PLoS ONE · doi:10.1371/journal.pone.0094097 · Cited by 80
“The Danish study found 5% suicides among the women and 8% among the men in those with bipolar disorder in a long-term follow-up of patients after psychiatric contact [13].”
BackgroundResultGenetic contributions to suicidal thoughts and behaviors
DiBlasi, E., Kang, J., & Docherty, A. R. (2021) · Psychological Medicine · doi:10.1017/s0033291721001720 · Cited by 83
Hink, A. B., Bonne, S. L., Levy, M. S., Kuhls, D. A., Allee, L. C., Burke, P., Sakran, J. V., Bulger, E. M., & Stewart, R. M. (2019) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0000000000002330 · Cited by 79
Granfeldt, A., Wissenberg, M., Hansen, S. M., Lippert, F. K., Lang-Jensen, T., Hendriksen, O. M., Torp-Pedersen, C. T., Christensen, E. F., & Christiansen, C. F. (2016) · Resuscitation · doi:10.1016/j.resuscitation.2016.08.024 · Cited by 78
Weitoft, G. R., Berglund, M., Lindström, E., Nilsson, M., Salmi, P., & Rosén, M. (2014) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.3567 · Cited by 80
Long‐term suicide risk in no, one or more mental disorders: the Lundby Study 1947–1997
Holmstrand, C., Bogren, M., Mattisson, C., & Brådvik, L. (2015) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12506 · Cited by 78
“(10) showed that, in all diagnostic groups, comorbidity with substance abuse disorder increased the cumulative incidence of suicide, except among men with schizophrenia.”
BackgroundRakofsky, J. J., & Rapaport, M. H. (2018) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/con.0000000000000604 · Cited by 88
Discovery of serum protein biomarkers in drug-free patients with major depressive disorder
Lee, M. Y., Kim, E. Y., Kim, S. H., Cho, K.-C., Ha, K., Kim, K. P., & Ahn, Y. M. (2016) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2016.04.009 · Cited by 75
“…associated with debilitating comorbidities such as general ill health and substance plied Chemistry, Kyung Hee ea. hiatry and Behavioral Science, University College of Medicine, f Korea. nu.ac.kr (Y.M. Ahn). abuse and suicide (Blair-West et al., 1997; Inskip et al., 1998;Nordentoft et al., 2011).”
Suicide in first episode psychosis: A nationwide cohort study
Björkenstam, C., Björkenstam, E., Hjern, A., Bodén, R., & Reutfors, J. (2014) · Schizophrenia Research · doi:10.1016/j.schres.2014.05.010 · Cited by 73
“1%, respectively, in women (Nordentoft et al., 2011).”
Suicide attempts and markers of immune response in individuals with serious mental illness
Dickerson, F., Wilcox, H. C., Adamos, M. B., Katsafanas, E., Khushalani, S., Origoni, A. E., Savage, C. L. G., Schweinfurth, L. A. B., Stallings, C. R., Sweeney, K., et al. (2016) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2016.11.011 · Cited by 73
Hall, L. S., Medway, C. W., Pain, O., Pardiñas, A. F., Rees, E., Escott‐Price, V., Pocklington, A. J., Bray, N. J., Holmans, P., Walters, J., et al. (2019) · Human Molecular Genetics · doi:10.1093/hmg/ddz253 · Cited by 72
Suicidality in Bipolar Disorder: The Role of Emotion‐Triggered Impulsivity
Johnson, S. L., Carver, C. S., & Tharp, J. A. (2016) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12274 · Cited by 76
“In the national cohort study, 8% of men and 5% of women diagnosed with bipolar disorder died from suicide (Nordentoft et al., 2011).”
Walter, F., Carr, M., Mok, P. L. H., Antonsen, S., Pedersen, C. B., Appleby, L., Fazel, S., Shaw, J. J., & Webb, R. T. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30180-4 · Cited by 78
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Metadata
- 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)
- 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
- bronze
- doi.org
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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