RESEARCH WEEKLY: People with SMI Disproportionately Impacted by Suicide
By Elizabeth Hancq
Research consistently indicates that people with serious mental illness, including schizophrenia and bipolar disorder, are at significantly increased risk of death by suicide compared to the general population. In the United States, suicide is the leading cause of death among individuals with schizophrenia between 15 and 44 years old.
Until now, little research has examined suicide risk among people with serious mental illness compared to other psychiatric illnesses. This question is especially relevant given the increased attention to suicide prevention policies in the United States and newfound examination of psychiatric crisis call center systems with the rollout of 988, the new nationwide three-digit mental health crisis hotline planned for a July 2022 implementation.
A new study published in Schizophrenia Research by researchers from Yale School of Medicine Department of Psychiatry addresses this knowledge gap and concludes that people with serious mental illness are significantly overrepresented in deaths by suicide, even compared to individuals with other psychiatric diagnoses. Despite making up around 4% of the population of the United States, people with serious mental illness accounted for more than twice (8.7%) those deaths by suicide, according to their results.
The authors analyzed 2003–2017 data from the National Violent Death Reporting System, a database maintained by the Centers for Disease Control and Prevention (CDC) that includes death information from 37 U.S. States. They examined 174,001 deaths by suicide by adults over that fifteen-year time period, examining psychiatric diagnoses, sociodemographic and clinical characteristics, and precipitating circumstances of the individuals who died.
Characteristics of individuals with SMI who died by suicide
The vast majority of people with serious mental illness who died by suicide are those with bipolar disorder, according to the study results. Compared to people with other mental illnesses who died by suicide, people with serious mental illness were more likely to be never married or single, have substance use problems and be homeless. People with serious mental illness who died by suicide were much more likely to be female, despite more than three-fourths of all individuals who die by suicide being male. In addition, compared to individuals who died by suicide with other psychiatric diagnoses, disproportionately more people with serious mental illness were Black.
Most people with serious mental illness who died by suicide were currently receiving mental health treatment and people with serious mental illness were much more likely to have had a previous suicide attempt compared to people with other or no mental illness. People with serious mental illness were much less likely to use firearms as their method of suicide compared to the general population, which the authors suggest could be due to federal and state laws that prohibit firearm possession among people who have been hospitalized or adjudicated for mental illness.
According to post-mortem toxicology results of the individuals with serious mental illness who died by suicide, only 30% of males and 41% of females had detectable levels of antipsychotic medications. The results indicate that medication nonadherence among individuals with serious mental illness is a major barrier to suicide prevention in this population, as antipsychotic medication use reduces risk of suicide and all-cause mortality among individuals with serious mental illness.
Implications of the results for suicide prevention policy
Overall, the results indicate the disproportionate impact of suicide on individuals with serious mental illness and point to the urgent necessity to tailor suicide prevention policies to address the unique needs of this vulnerable population. This may include interventions to improve medication adherence, especially among individuals with a history of a previous suicide attempt. Suicide prevention programs specifically designed for individuals with serious mental illness who are disproportionately impacted by suicide, including Black Americans and women, are needed to prevent further disparities among these populations.
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Crisis Text Line also provides free, 24/7, confidential support via text message to people in crisis when they dial 741741.
