title: Absolute risk of suicide after first hospital contact in mental disorder.
abstract: BACKGROUND
  Estimates of lifetime risk of suicide in mental disorders were based on selected samples with incomplete follow-up.
  
  
  OBJECTIVE
  To estimate, in a national cohort, the absolute risk of suicide within 36 years after the first psychiatric contact.
  
  
  METHODS
  Prospective study of incident cases followed up for as long as 36 years. Median follow-up was 18 years.
  
  
  METHODS
  Individual data drawn from Danish longitudinal registers.
  
  
  METHODS
  A total of 176,347 persons born from January 1, 1955, through December 31, 1991, were followed up from their first contact with secondary mental health services after 15 years of age until death, emigration, disappearance, or the end of 2006. For each participant, 5 matched control individuals were included.
  
  
  METHODS
  Absolute risk of suicide in percentage of individuals up to 36 years after the first contact.
  
  
  RESULTS
  Among men, the absolute risk of suicide (95% confidence interval [CI]) was highest for bipolar disorder, (7.77%; 6.01%-10.05%), followed by unipolar affective disorder (6.67%; 5.72%-7.78%) and schizophrenia (6.55%; 5.85%-7.34%). Among women, the highest risk was found among women with schizophrenia (4.91%; 95% CI, 4.03%-5.98%), followed by bipolar disorder (4.78%; 3.48%-6.56%). In the nonpsychiatric population, the risk was 0.72% (95% CI, 0.61%-0.86%) for men and 0.26% (0.20%-0.35%) for women. Comorbid substance abuse and comorbid unipolar affective disorder significantly increased the risk. The co-occurrence of deliberate self-harm increased the risk approximately 2-fold. Men with bipolar disorder and deliberate self-harm had the highest risk (17.08%; 95% CI, 11.19%-26.07%).
  
  
  CONCLUSIONS
  This is the first analysis of the absolute risk of suicide in a total national cohort of individuals followed up from the first psychiatric contact, and it represents, to our knowledge, the hitherto largest sample with the longest and most complete follow-up. Our estimates are lower than those most often cited, but they are still substantial and indicate the continuous need for prevention of suicide among people with mental disorders.
authors.affiliation: Psychiatric Centre Copenhagen, Denmark. mn@dadlnet.dk
authors.forename: Merete
authors.initials: M
authors.lastname: Nordentoft
authors.forename: Preben Bo
authors.initials: PB
authors.lastname: Mortensen
authors.forename: Carsten Bøcker
authors.initials: CB
authors.lastname: Pedersen
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology / Q000523:psychology; D011446:Prospective Studies; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology; D012565:Schizophrenic Psychology; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult