Psychiatric diagnoses and suicide: revisiting the evidence.
BACKGROUND
The key role of prevention and treatment of mental disorders in the prevention of suicide is widely acknowledged. Which specific disorders need to be targeted remains to be conclusively demonstrated.


OBJECTIVE
To re-examine the presence of psychiatric diagnosis in cases of completed suicide from a global perspective.


METHODS
A review of studies reporting diagnoses of mental disorders in cases of completed suicide with or without history of admission to mental hospitals.


RESULTS
Most cases were from Europe and North America (82.2%). The majority (98%) of these had a diagnosis of at least one mental disorder. Among all diagnoses, mood disorders accounted for 30.2%, followed by substance-use related disorders (17.6%), schizophrenia (14.1%), and personality disorders (13.0%).


CONCLUSIONS
The mental health paradigm in suicide prevention covers just a part of the problem. Antisuicide strategies focusing exclusively on the identification and treatment of depression need to be reconsidered. In addition to this, other mental disorders should be targeted, in particular alcohol-use disorders and schizophrenia. More emphasis should also be placed on psychosocial and environmental interventions diminishing and counteracting stress.
Bertolote
José Manoel
JM
Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland. bertolotej@who.int
Fleischmann
Alexandra
A
De Leo
Diego
D
Wasserman
Danuta
D
D005060:Europe / Q000453:epidemiology; D006801:Humans; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy; D009656:North America / Q000453:epidemiology; D011634:Public Health / Q000639:trends; D012106:Research / Q000639:trends; D012559:Schizophrenia / Q000150:complications; D012565:Schizophrenic Psychology; D019966:Substance-Related Disorders / Q000150:complications; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D000092864:Suicide Prevention