The association between self-reported mental health, medication record and suicide risk: A population wide study

Abstract

Suicide mortality and mental ill health are increasing globally. Mental ill health can be measured in multiple ways. It is unclear which measure is most associated with suicide risk. This study explored the association between self-rated mental health and medication record and death by suicide. The 2011 Northern Ireland Census records of adults aged 18-74 years (n=1,098,967) were linked to a centralised database of dispensed prescription medication and death registrations until the end of 2015. Mental health status was ascertained through both a single-item self-reported question in the Census and receipt of psychotropic medication. Logistic regression models examined the association between indicators of mental ill health and likelihood of suicide mortality. Of the 1,098,967 cohort members, 857 died by suicide during the study period. Just over half of these deaths (n=429, 50.1%) occurred in individuals with neither indicator of mental ill health. Cohort members with both self-reported mental ill health and receipt of psychotropic medication had the highest risk of suicide (OR=6.13, 95%CI: 4.94–7.61), followed by those with psychotropic medication record only (OR=4.00, 95%CI: 3.28–4.88) and self-report only (OR=2.88, 95%CI: 2.16–3.84). Individuals who report mental ill health and have a history of psychotropic medication use are at a high risk of suicide mortality. However, neither measure is particularly sensitive, as both failed to signal over half of subsequent suicides. Some individuals who report poor mental health but are not in receipt of psychotropic medication are at increased risk of suicide, indicating possible unmet treatment need. The combination of the two indicators offers more precision for identifying those most at risk for targeted interventions.

Parental mental health and risk of poor mental health and death by suicide in offspring: a population-wide data-linkage study

“…Furthermore, a self-report measure, while democratising the identification process, is subject to reporting bias especially related to the continuing stigma surrounding mental illness. However, this indicator has face validity based on its demographic distribution which mirrors known associations with MH, correlational validity as it is associated with receipt of psychotropic medication, and predictive validity as it is a strong predictor of death by suicide (Tseliou et al ., 2015; Rosato et al ., 2019; Onyeka et al ., 2021).…”

“…Those who identified as having ‘ An emotional, psychological or MH condition (such as depression or schizophrenia) ’ were defined as having poor MH. This indicator has face validity based on its demographic distribution which mirrors known associations with MH, correlational validity as it is associated with receipt of psychotropic medication, and predictive validity as it is a strong predictor of death by suicide (Tseliou et al ., 2015; Rosato et al ., 2019; Onyeka et al ., 2021).…”

A Markov Chain Model for Mental Health Interventions

“…An additional problem is the reluctance of people to seek help when they start experiencing emotional distress, anxiety, or depression [ 7 , 8 , 9 , 10 , 11 ]. Psychiatric intervention for individuals with worsening mental health is critical to treating depression and anxiety and preventing suicide [ 12 , 13 , 14 ].…”

“…In response to the disparities in access to care, recent studies have focused on mental health prevention and treatment programs [ 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. Researchers have used Markov chain models to analyze and evaluate mental health programs in the past, including suicide prevention models.…”