Suicide mortality among psychiatric patients in Northeast Italy: a 10-year cohort study

Abstract

Aims The present study investigated the relationship between suicide mortality and contact with a community mental health centre (CMHC) among the adult population in the Veneto Region (northeast Italy, population 4.9 million). Specifically, it estimated the effects of age, gender, time elapsed since the first contact with a CMHC, calendar year of diagnosis and diagnostic category on suicide mortality and modality. Methods The regional mortality archive was linked to electronic medical records for all residents aged 18–84 years who had been admitted to a CMHC in the Veneto Region in 2008. In total, 54 350 subjects diagnosed with a mental disorder were included in the cohort and followed up for a period of 10 years, ending in 2018. Years of life lost (YLL) were computed and suicide mortality was estimated as a mortality rate ratio (MRR). Results During the follow-up period, 4.4% of all registered deaths were from suicide, but, given the premature age of death (mean 52.2 years), suicide death accounted for 8.7% of YLL; this percentage was particularly high among patients with borderline personality disorder (27.2%), substance use disorder (12.1%) and bipolar disorder (11.5%) who also presented the highest suicide mortality rates. Suicide mortality rates were halved in female patients (MRR 0.45; 95% CI 0.37–0.55), highest in patients aged 45–54 years (MRR 1.56; 95% CI 1.09–2.23), and particularly elevated in the 2 months following first contact with CMHCs (MRR 10.4; 95% CI 5.30–20.3). A sensitivity analysis restricted to patients first diagnosed in 2008 confirmed the results. The most common modalities of suicide were hanging (47%), jumping (18%), poisoning (13%) and drowning (10%), whereas suicide from firearm was rare (4%). Gender, age at death and time since first contact with CMHCs influenced suicide modality. Conclusions Suicide prevention strategies must be promptly initiated after patients’ first contact with CMHCs. Patients diagnosed with borderline personality disorder, substance use disorder and bipolar disorder may be at particularly high risk for suicide.

Suicide Risk in Personality Disorders: A Systematic Review

“…There was no discernible trend to distinguish between studies which did or did not report a significant association. Four studies measured suicide death as an outcome, with three reporting a significant association with PD [ 30 , 32 , 34 , 41 ]. Only Sumlin et al (2020) reported no association between PD and suicide death; however, the sample size of this study was considerably smaller ( N = 162) than that of the other three studies (range: from 14,103 to 54,350 participants).…”

Suicide warning signs that are challenging to recognize: a psychological autopsy study of Korean adolescents

“…Most studies [11,80,[86][87][88][89] have focused on identifying risk factors for suicide attempters, not suicide completers. Some studies targeting people who died by suicide have shown inconsistent results regarding personality traits [11,[91][92][93]. One study reported that suicide was related to comorbid conditions rather than personality disorders, while other studies indicated that it was related to borderline or other personality disorders [91][92][93].…”

“…Some studies targeting people who died by suicide have shown inconsistent results regarding personality traits [11,[91][92][93]. One study reported that suicide was related to comorbid conditions rather than personality disorders, while other studies indicated that it was related to borderline or other personality disorders [91][92][93]. However, some studies also mention that avoidant traits are related to suicide completers [87,90].…”