Keypoint: About 6% of individuals with a suicide attempt have never been diagnosed with a psychiatric disorder.
Approximately 20% of adults with lifetime suicide attempts did not meet the criteria for a psychiatric disorder diagnosis before their first attempt, according to new research published in JAMA Psychiatry.
Although suicidality is commonly associated with pre-existing psychiatric disorders or distress, not all individuals who die by suicide have an antecedent psychiatric disorder. The current study sought to explore lifetime suicide attempts among psychiatrically healthy individuals by investigating the prevalence of lifetime suicide attempts in healthy volunteers, examining the timing of such attempts relative to the onset of psychiatric conditions, and comparing rates across different demographics.
Researchers leveraged data for this cross-sectional study from the National Epidemiologic Study of Addictions and Related Conditions III (NESARC-III), which assessed diagnoses from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and surveyed respondents on suicidal behavior. Among those reporting a lifetime suicide attempt, the researchers calculated attempt frequencies for both healthy volunteers and persons with lifetime psychiatric disorders.
Of the 36,309 NESARC-III respondents, 66.8% (95% CI, 64.1%-69.4%) were women and 1948 (5.2%; 95% CI, 4.8%-5.6%) reported lifetime suicide attempts. For those with a history of suicide attempts, 128 (6.2%; 95% CI, 4.9%-7.4%) were healthy volunteers without a prior psychiatric diagnosis and 261 (13.4%; 95% CI, 11.6%-15.2%) made a first suicide attempt before the onset of a psychiatric disorder. As such, an estimated 19.6% of respondents reported a lifetime suicide attempt with no evidence of a psychiatric disorder prior to their attempt.
While women were approximately twice as likely as men to report a lifetime suicide attempt (P <.001), the percentage of individuals with lifetime suicide attempts who were healthy volunteers or lacked a psychiatric disorder prior to attempts did not significantly vary by sex. However, women were significantly more likely than men to make a suicide attempt in the same year as the onset of a psychiatric disorder (P <.001), while men were more likely to experience an attempt following the onset of a psychiatric disorder (P <.001).
These study findings indicate that an estimated 6.2% of individuals in the United States who attempted suicide were healthy volunteers, and this percentage increased to 19.6% when including those whose suicide attempts occurred before the onset of a psychiatric disorder diagnosis. Study authors concluded, “This finding challenges clinical notions of who is at risk for suicidal behavior and raises questions about the safety of limiting suicide risk screening to psychiatric populations.”
Study limitations include the reliance on self-reported information and a lack of data on psychiatric diagnoses that were not assessed in the NESARC-III survey.
Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of author disclosures.
This article originally appeared on Psychiatry Advisor