In this cross-sectional study, using data from 1,948 U.S. adults with lifetime suicide attempts from a nationally representative population survey, it is estimated that 20% reported not meeting the criteria for any psychiatric disorder before their first attempt.
The findings suggest a potential need to broaden suicide risk detection beyond psychiatric populations.
Not all people who die by suicide have a psychiatric diagnosis; however, little is known about the percentage and demographics of individuals with lifetime suicide attempts who appear psychiatrically healthy. If these suicide attempts are common, there are implications for suicide risk detection, research, policy, and nosology.
This cross-sectional study used data from the U.S. National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III), a face-to-face cross-sectional survey conducted with a nationally representative sample of the U.S. non-institutionalized civilian population, and included individuals with lifetime suicide attempts who were between 20 and 65 years old at the time of the survey administration (April 2012 to June 2013).
Data from the NESARC Wave 2 survey, conducted from August 2004 to September 2005, were used for replication. Analyses were conducted from April to August 2023.
The primary outcome was the presence or absence of a psychiatric disorder before the first lifetime suicide attempt.
Among individuals with lifetime suicide attempts, the percentage and 95% confidence interval (CI) of those whose first suicide attempt occurred before the onset of any apparent psychiatric disorder were calculated, weighted by NESARC sampling and nonresponse weights. Separate analyses were conducted for men, women, and three age groups (20 to <35, 35-50, and >50 to 65 years).
In the total sample of 36,309 respondents, 1,948 people had lifetime suicide attempts; 66.8% (95% CI, 64.1%-69.4%) were women, and 6.2% (95% CI, 4.9%-7.4%) had no apparent psychiatric diagnoses in their lifetime when surveyed.
Additionally, 13.4% (95% CI, 11.6%-15.2%) made their first suicide attempt before the onset of the psychiatric disorder. Thus, an estimated 19.6% of respondents attempted suicide for the first time without a prior psychiatric disorder.
No significant differences by age or gender were found in the percentage of individuals with lifetime suicide attempts without psychiatric disorders, although women were more likely than men to attempt suicide in the year of psychiatric disorder onset (14.9% [95% CI, 12.5%-17.3%] vs. 8.6% [95% CI, 6.0%-11.2%]; P < 0.001), and attempts were less frequent among those aged 50 to 65 years (3.9% [95% CI, 3.5%-4.4%] vs. 6.1% [95% CI, 5.4%-6.8%] for ages 35-50 and 6.2% [95% CI, 5.6%-6.9%] for ages 20 to <35; P < 0.001).
In this study, an estimated 19.6% of individuals who attempted suicide did so despite not meeting the criteria for a prior psychiatric disorder.
This finding challenges clinical notions about who is at risk for suicidal behavior and raises concerns about the safety of limiting suicide risk detection to psychiatric populations.
