Risk of suicide and all-cause death in patients with mental disorders: a nationwide cohort study

Summary & key facts

This large South Korean study followed 3,951,398 adults for an average of 11.1 years to compare deaths in people with and without recorded mental disorders. After adjusting for age, sex, health conditions, income, smoking, drinking and physical activity, people with mental disorders had higher rates of suicide and higher overall death rates than people without those diagnoses. The size of the increased risk varied a lot by diagnosis: suicide risk was highest for personality disorders, then bipolar disorder, then schizophrenia spectrum disorder. All-cause death risk was highest for intellectual disability, then schizophrenia spectrum disorder, then alcohol use disorder. The study used insuran

Key facts:

• The study included 3,951,398 adults aged 20 or older who had a health screening in 2009 and were followed until December 2021 (average follow-up 11.1 years).
• During follow-up 249,830 participants died; 12,290 of those deaths were recorded as suicide (ICD-10 codes X60–X84).
• Overall, people with any recorded mental disorder had higher risks of suicide and of dying from any cause compared with people without recorded mental disorders, after adjusting for demographic, clinical, and lifestyle factors.
• Suicide risk was highest for people with personality disorders, followed by those with bipolar disorder and those with schizophrenia spectrum disorder (study report).
• In adjusted analyses, schizophrenia spectrum disorder was associated with about a 6-fold higher risk of suicide (hazard ratio 5.91, 95% CI 5.12–6.82) compared with people without that diagnosis.
• Bipolar disorder was associated with about a 6-fold higher risk of suicide (hazard ratio 6.05, 95% CI 4.86–7.54) in adjusted analyses.
• Depressive disorder was associated with an increased suicide risk of about 3 times (adjusted hazard ratio ~2.98) compared with no depressive disorder.
• All-cause mortality was highest among people with intellectual disability, followed by those with schizophrenia spectrum disorder and those with alcohol use disorder (finding reported in the study).
• Mental disorders were identified from insurance claims using ICD-10 codes during the year before the screening date, and deaths were identified from linked national death records; this affects how diagnoses and causes of death were measured

Abstract

Mental disorders are associated with an increased risk of premature death, including suicide. This study aimed to examine the risk of suicide and all-cause death in patients with mental disorders after considering demographic, clinical, and lifestyle factors. Data from the National Health Insurance Sharing Service database and linked data from Statistics Korea were used. In total, 3,951,398 people aged ≥20 years were eligible for this study. Among the participants, 14 types of mental disorders were identified, and the subsequent incidences of suicide and all-cause death were monitored. The mean age of those with mental disorders and those without mental disorders was 56.5 (SD, 13.6) years and 46.6 (SD, 13.6) years, respectively. During an average follow-up period of 11.1 years (SD, 1.5), 249,830 participants died, of whom 12,290 died by suicide. Overall, the risk of suicide and all-cause death was higher in people with mental disorders than in controls. The risk of suicide was the highest among those with personality disorders, followed by those with bipolar disorder and schizophrenia spectrum disorder. The risk of all-cause death was the highest among those with intellectual disability, followed by those with schizophrenia spectrum disorder and alcohol use disorder. In conclusion, the risk of suicide and all-cause death increased among those with mental disorders, but there was substantial variation between the types of mental disorders for both suicide and all-cause death.

Topics

Bipolar Disorder and Treatment Mental Health Treatment and Access Suicide and Self-Harm Studies

Categories

Clinical Psychology Psychology Social Sciences

Tags

Cause of death Cohort Cohort study Disease Gerontology Human factors and ergonomics Injury prevention Internal medicine Medical emergency Medicine Mental health Occupational safety and health Pathology Poison control Psychiatry Psychology Suicide prevention