Surprising Number of Suicide Completers Have No Prior Diagnosis

May 16, 2015

TORONTO—Nearly 65% of people who complete suicide have no prior diagnosis of mental illness, and many who complete suicide have no record of previous attempts. Study author Nisha Ramsinghani, DO, of UCSF School of Medicine, in Fresno, California, presented these findings at the 168th meeting of the American Psychiatric Association. 

Drawing on clinical experience, Dr. Ramsinghani and coauthor Hoyle Leigh, MD, hypothesized that the number of times a patient attempts suicide differs depending on whether the patient was diagnosed with major depressive disorder, borderline personality disorder, substance use disorder, and several other psychiatric disorders. Data from the Fresno County Coroner's Office from 2010-2013 were used to test this hypothesis. 

All 206 patients who completed suicide had been treated at a community hospital. Patients’ number of prior suicide attempts; psychiatric diagnosis; and age, sex, race, and means of suicide were recorded. 

Of the patients who completed suicide, 177 had made no prior attempt, while 29 patients had attempted one or more times. Race and age were not linked with number of suicide attempts, but gender showed a statistically significant relationship with number of attempts before completion. Only 9% of male patients had attempted suicide one or more times compared with 25.8% of female patients. 

Psychiatric diagnosis, particularly borderline personality and substance use disorder, was also associated with suicide attempt prior to completion. One hundred percent of patients with borderline personality disorder had previously attempted suicide, in contrast with only 34.8% of patients without borderline personality disorder. In addition, 60.7% of patients with a substance use disorder had attempted suicide at least one time before completion.

“Surprisingly, at least 64.6% of people who committed suicide had no established prior psychiatric diagnosis,” said Dr. Ramsinghani. Although the majority of patients who completed suicide did not have a diagnosis, the remaining patients had major depressive disorder (21.8%), a substance use disorder (14.1%), general anxiety disorder (4.9%), bipolar disorder (3.9%), schizophrenia (2.4%), borderline personality disorder (1.9%), PTSD (1.9%), or another psychiatric disorder (3.9%). 

“Our results imply that better detection of mental illness and treatment of at-risk patients may prevent completed suicides, and that repeated suicide attempts is a serious indicator of eventual successful suicide,” said Dr. Ramsinghani.

However, she noted that the study had some limitations, including the scope of the data search, which was limited to one hospital and affiliated neighboring hospital, and the reliability of documentation.

Further research might involve expanding the study to include more hospitals, investigating whether hospital discharge is linked with attempted suicide, and examining whether comorbid conditions are associated with suicide attempts.

—Lauren LeBano


1. Ramsinghani N, Leigh H. Suicide: Epidemiology, Risk, Competency, and History of Prevention Techniques. Scientific and Clinical Report presented at APA 2015. 16 May 2015.