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

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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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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: 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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