Risk factors for suicide independent of DSM–III–R Axis I disorder

Abstract

Background: The vast majority of suicides suffer from at least one mental disorder at the time of death.Aims: To identify risk factors for suicide, particularly those independent of current DSM–III–R Axis I disorder(s)Method: A case–control psychological autopsy study comparing suicides with matched community controls.Results: Independent risk factors for suicide included: Axis II (personality) disorder (particularly antisocial, avoidant and dependent); at least one of 12 life events (from the List of Threatening Experiences) during the previous 52 or 4 weeks (in particular, a ‘serious problem with close friend, neighbour or relative’); current unemployment; previous history of deliberate self-harm; and contact with a GP within 26 weeks. Relative to individuals with no current mental disorder, the estimated risk of suicide in those with Axis I–Axis II comorbidity (OR 346.0) was significantly greater than that in those with Axis I disorder(s) only (OR 52.4)Conclusions: Suicide risk assessment may be enhanced by enquiry about the aforementioned independent risk factors, and attention to Axis I–Axis II comorbidity.