Absence of nonfatal suicidal behavior preceding suicide death reveals differences in clinical risks

Abstract

Nonfatal suicidality is the most robust predictor of suicide death. However, only ~10% of those who survive an attempt go on to die by suicide. Moreover, ~50% of suicide deaths occur in the absence of prior known attempts, suggesting risks other than nonfatal suicide attempt need to be identified. We studied data from 4,000 population-ascertained suicide deaths and 26,191 population controls to improve understanding of risks leading to suicide death. This study included 2,253 suicide deaths and 3,375 controls with evidence of nonfatal suicidality (SUI_SI/SB and CTL_SI/SB) from diagnostic codes and natural language processing of electronic health records notes. Characteristics of these groups were compared to 1,669 suicides with no prior nonfatal SI/SB (SUI_None) and 22,816 controls with no lifetime suicidality (CTL_None). The SUI_None and CTL_None groups had fewer diagnoses and were older than SUI_SI/SB and CTL_SI/SB. Mental health diagnoses were far less common in both the SUI_None and CTL_None groups; mental health problems were less associated with suicide death than with presence of SI/SB. Physical health diagnoses were conversely more often associated with risk of suicide death than with presence of SI/SB. Pending replication, results indicate highly significant clinical differences among suicide deaths with versus without prior nonfatal SI/SB.

Keywords: chronic pain; electronic health records; suicidal behaviors; suicidal ideation.

Figure 1.

Standardized marginal effects of logistic regressions of presence/absence of mental health PheCodes on case-control status (blue: suicide death effect) and also on presence/absence of SI/SB (red: have SI/SB effect). Note. Standardized marginal effects were derived from logistic regressions. Each binary presence/absence PheCode was regressed on case-control status (blue: suicide death effect) and on presence/absence of SI/SB (red: have SI/SB effect), adjusting for age, sex, and transformed overall number of PheCodes.

2.

Standardized marginal effects of logistic regressions of presence/absence of physical health PheCodes on case-control status (blue: suicide death effect) and also on presence/absence of SI/SB (red: have SI/SB effect). Note. Standardized marginal effects were derived from logistic regressions. Each binary presence/absence PheCode was regressed on case-control status (blue: suicide death effect) and on presence/absence of SI/SB (red: have SI/SB effect), adjusting for age, sex, and transformed overall number of PheCodes.