Suicide!

TORONTO ― Most people who die by suicide have no previous psychiatric diagnosis, new research shows.

A single-center study from California found that nearly two thirds of persons who completed suicide during a 3-year period had no established psychiatric diagnosis.
These findings suggest that "better detection of mental illness and treatment of at-risk patients may prevent completed suicides," said Nisha Ramsinghani, DO, from the Community Regional Medical Center, Fresno, California.
The findings also suggest that repeated suicide attempts are a "serious indicator of eventual successful suicide," she reported here at the American Psychiatric Association (APA) 2015 Annual Meeting.

"Our clinical observations suggested that the number of suicide attempts vary depending on the psychiatric diagnoses. We hypothesized that the number of previous attempts in completed suicides will also vary among different diagnoses," Dr Ramsinghani and her coauthors note in meeting materials.
To investigate, they analyzed the records of 205 people cared for at the Community Regional Medical Center in Fresno who died by suicide between 2010 and 2013.
Most of these individuals (n = 177, 85.9%) had no prior suicide attempt, and only 29 (14.1%) had one or more prior attempts. Women were more apt to have at least one prior attempt than men (26% vs 9%; P = .004). The mean age of the persons who completed suicide was 46.4 years.
Major depressive disorder was the most frequent diagnosis among those who completed suicide (21.8%), followed by substance use disorder (SUD) (14.1%), generalized anxiety disorder (4.9%), bipolar disorder (3.9%), schizophrenia (2.4%), borderline personality disorder (BPD) (1.9%), and posttraumatic stress disorder (1.9%).
It is noteworthy, Dr Ramsinghani said, that every person who completed suicide who had a diagnosis of BPD had at least one previous suicide attempt. Nearly two thirds of those who completed suicide and who had SUD also made at least one attempt before dying by suicide.
Interpret Cautiously
"Surprisingly," she said, in this cohort, 64.6% of persons who completed suicides had no prior (established) psychiatric diagnosis.
In an interview with Medscape Medical News, Mark Sinyor, MD, FRCPC, assistant professor, University of Toronto, and psychiatrist, Sunnybrook Health Sciences Centre, who was not involved in the study, cautioned that this was a single-center study, "and if you look at psychological autopsies that are done on suicides, more than 90% have a clear psychiatric diagnosis in retrospect."

"One of the issues is that even those people who can be identified as having a mental illness, not all of them have had recent contact with a healthcare provider or psychiatrist. I would hope that for everyone in the psychiatric community, suicide is top of mind," Dr Sinyor said.
It is also important to note that most people who die by suicide have high rates of other medical illnesses, "so all our colleagues in family medicine and other areas of medicine need heightened awareness of suicide as well and help make sure that people who show signs of being at risk get the appropriate care," Dr Sinyor said.
In addition, "as a society, we need to realize that many people have these thoughts, and people need to come get help. We need to educate the public and send the message that we have effective treatments for mental illness, life stressors, and trouble coping," Dr Sinyor said.