Estimating the association between mental health disorders and suicide: a review of common sources of bias and challenges and opportunities for US-based research

Abstract

Purpose of review: The purpose of this review is to 1) illuminate prevalent methodological approaches and estimates of association between mental health diagnoses and suicide from the meta-analytic literature; 2) discuss key internal and external validity concerns with these estimates; and 3) highlight some of the unique attributes and challenges in US-based suicide research and opportunities to move the evidence base forward.

Recent findings: Globally, there is considerable variability in measures of association between mental health disorders and suicide and a growing debate over methodological approaches to this research. A high suicide incidence makes the US an outlier, and the decentralized nature of US administrative data poses a unique challenge to data linkage that could otherwise advance this research.

Summary: We offer methodological considerations for future research and discuss opportunities made possible by the recent expansion of the US National Violent Death Reporting System to a nationwide registry.

Keywords: generalizability; mental health disorder; suicide; validity.

Figure 1.

Example Directed Acyclic Graph (DAG) depicting potential causal and biasing pathways between mental health and substance use disorders and suicide ACEs=Adverse Childhood Experiences; MHD=Mental Health Disorder; SUD=Substance Use Diagnosis