Does the association between behavioral health conditions and suicide attempts persist after accounting for chronic medical comorbidities?

Background/Purpose:  Although past research has demonstrated an association between suicide attempts and behavior health (BH) conditions, many of these studies did not account for multiple comorbid chronic medical conditions, which have also been shown to be correlated to suicide attempts.The purpose of this study is to evaluate the relationship between suicide attempts and BH conditions in a population matched on number of chronic medical conditions.

Method:Individuals enrolled in a national Medicare plan with a medical claim for suicide attempt between July 2013 and June 2014 were matched on age, gender and number of chronic conditions to randomly selected controls. Conditional logistic regression was used to assess the relationship between suicide attempts and BH conditions and psychiatric service utilization.

Findings:1344 matched pairs: 59% female, mean age 60 years, mean of 2±1.7 chronic comorbidities. Those with more than 3 BH conditions were 25 times more likely to attempt suicide (OR=25.4, 95% CI: 18.0–35.8). Suicide attempters were more likely to use psychiatric services including provider visits (OR=5.4, 95% CI: 4.48-6.4), ≥5 emergency department visits (OR=18.3, 95% CI: 5.7-58.6), ≥2 inpatient visits (OR=23.0, 95% CI: 13.5-39.3), and ≥13 outpatient visits (OR=2.6, 95% CI: 2.2-2.9).  Among attempters, there was a significant relationship between suicide re-attempts and a diagnosis of depression, anxiety, serious mental illness, and bipolar depression, but not with post-traumatic stress disorder.

Implications:  This study strengthens the evidence of increased suicide attempts with behavioral health conditions, underscoring the need for earlier identification of individuals with risk factors for suicide attempts.