Conference Agenda

Introduction

Every year, more than 1,500 individuals die by suicide in Sweden (ICD-10 X60-X84 and Y10-Y34). To inform suicide prevention strategies and policy, we aim to estimate the Population Attributable Fraction (PAF) for a set of clinical target groups known to be at elevated risk. The PAF represents the proportion of suicide deaths that could potentially be prevented if the excess risk associated with a given exposure were eliminated.

Method

Using national register data, we defined exposure as diagnoses of mental and behavioral disorders (ICD-10 F10–F99) recorded in outpatient or specialized care, and the outcome as death by suicide (ICD-10 X60–X84 and Y10–Y34), with both exposure and outcome occurring in 2023. The PAF was estimated by combining relative risk (RR) estimates and exposure prevalence (Pe) for each ICD-10 diagnostic chapter. Using Monte Carlo simulation, 10.000 iterations were performed to sample Pe and RR values for each group, and PAF was computed for each iteration. This yielded a distribution of PAF values for each group, from which the mean PAF and its 95% CI were derived, providing a robust estimate of suicide risk attributable to the different diagnostic groups.

Results

Overall, mental and behavioral disorders accounted for a PAF of 41% (95% CI: 39–44). The largest PAFs were observed for anxiety-spectrum disorders (F40–F49; 23%), psychoactive substance use disorders (F10-F19; 20%) and affective disorders (F30–F39; 19%). Despite extremely high relative risk, prior intentional self-harm (X60–X84) contributed a modest but meaningful PAF of 13% due to low prevalence.

Conclusion

Although diagnosed psychiatric disorders account for a substantial proportion of suicide deaths, 44% of individuals who died by suicide had not received a mental health diagnosis in outpatient or specialized care during the year preceding death. These results therefore emphasize the need for broader public health–oriented interventions.

BACKGROUND: Mental disorders is one of the strongest predictors for suicide. Yet, a comprehensive assessment of risks remains to conducted for many specific disorders and condition. The aim of the current study was to conduct a comprehensive assessment of absolute and relative risks related to suicide suicide for individuals diagnosed with mental disorders using national linkage data spanning 44 years.

METHODS: A cohort design was applied to longitudinal data on all individuals aged 10 years and older and living in Denmark during 1980-2023. Mental disorders and other conditions were identified through hospital diagnoses recorded in hospital registers, while data on deaths by suicide were obtained from cause of death register. Standardized incidence rates, incidence rate ratios (IRRs), absolute risks, and proportional attributable risks (PAR) were calculated.

RESULTS: In a population of more than 7.5 million individuals, 11.1% had been diagnosed with a mental disorder and a 10-fold (IRR, 10.7; CI 95%: 10.4-11.1) higher suicide rate when compared to those with no mental disorders. Their absolute risk of suicide was 2.6% and the PAR was 45.9. Highest rates of suicide were found for borderline personality disorders, substance use disorders, depression, bipolar disorders and schizophrenia. Between 4-5% of those diagnosed with bipolar disorders, schizophrenia and substance use disorders die by suicide. Highest PARs were found for depression (35.6), substance use disorders (31.0), and schizophrenia (14.0).

CONCLUSION: More than 10% of the had been diagnosed with mental disorders. Risks were highest for individuals with borderline personality disorders, depression, bipolar disorders, substance use disorders, and schizophrenia were found to have the highest rates. Provided effective community-based efforts exist, major target groups would be those with any mental disorder, depression, substance use disorders, and schizophrenia. Absolute risks of suicide may have decreased over recent decades.

Introduction: Characteristics of patients with psychotic disorders who die by suicide soon after contact with mental health services are incompletely described. We aimed to characterize demographic, clinical history, and last-contact features of patients with psychotic disorders who died by suicide within one year of contact, and to compare patients with schizophrenia versus other psychotic disorders.

Methods: National case series using the Norwegian Surveillance System for Suicide in Mental Health and Substance Misuse. Sample: persons with ICD‑10 F20–F29 who died by suicide between 2018 - 2022 and had contact with mental health or substance-use last year (n = 227; schizophrenia n = 94, other psychoses n = 133). Data sources: the Cause of Death Registry, Patient Registry, and a clinician‑completed questionnaire (retrieved for 92.5%). Statistics: Fisher’s exact test and Mann–Whitney U adjusted for false discovery rate (q).

Results: The sample was predominantly male (62.1%), single (78.1%), receiving welfare benefits (68.1%), and living alone (50.0%). Clinical features included prior self‑harm (50.0%), violent behavior (30.5%), dual diagnosis (56.7%), inpatient admission last year (71.8%), and antipsychotic prescription (82.9%). Schizophrenia cases more frequently received welfare benefits, lived alone, had outpatient contact, were prescribed depot antipsychotics, and had medication non‑adherence (all q ≤ 0.01). Median time from last contact to suicide was 9 days (IQR 0–66). At last contact, 33.8% had psychotic symptoms and 13.3% suicidal ideation. 42.4 % had a crisis plan. Contact between services and relatives: 46.2%

Conclusions: Patients with psychotic disorders who die by suicide shortly after contact display social disadvantage, complex clinical histories, high treatment engagement but medication non‑adherence. Many deaths occur shortly after contact despite low prevalence of reported suicidal ideation, underscoring the need for system‑level preventive strategies. Increased use of crisis plans and contact with relatives might be possible targets to improve prevention.

Introduction
Suicidality in Major Depressive Disorder (MDD) constitutes a major clinical and public health concern. Although depressive severity is a well-established risk factor, the contribution of specific anxiety symptom dimensions and anxiety disorders to suicidality remains insufficiently understood. Prior research has relied on anxiety measures, limiting insight into differential anxiety-related pathways to suicidal ideation and behaviour. In line with the theme Rethinking Suicide Research and Prevention, this study aims to refine suicide risk assessment in psychiatric settings.

Methods
This ongoing prospective cohort study includes 120 inpatients hospitalized for a Major Depressive Episode at a university psychiatric hospital in Athens. Suicidality is assessed using the Suicidal Ideation Attributes Scale and the Suicide Intention Scale. Anxiety disorders are diagnosed through structured clinical interviews (DSM-5, MINI), while anxiety symptom severity is evaluated using disorder-specific instruments assessing generalized anxiety, worry, panic disorder, agoraphobia, and social anxiety. Depressive severity is measured with the Montgomery–Åsberg Depression Rating Scale and anhedonia with the Snaith–Hamilton Pleasure Scale. Assessments are conducted at three time points: admission, discharge, and one month post-discharge. Planned analyses include correlation and multiple regression models examining associations between anxiety dimensions, anhedonia, depressive severity, and suicidality.

Results
Data collection and analyses are ongoing. Preliminary analyses suggest that worry represents the primary dimension of generalized anxiety associated with suicidality. In addition, social anxiety, encompassing both affective and behavioral components, shows positive associations with suicidality. As expected, depressive severity and anhedonia are positively associated with suicidality. No independent effects of anxiety variables on suicidality have been observed in the preliminary models.

Conclusions
These preliminary findings indicate that anxiety is not a uniform risk factor for suicidality in MDD. Distinguishing anxiety dimensions alongside anhedonia may enhance the precision of suicide risk assessment and inform prevention strategies in psychiatric care.

Background: Youth with mental and physical health disorders face elevated risks of premature mortality, including suicide. However, the relative contributions of mental health disorders, physical health disorders, and their co-occurrence to cause-specific mortality remain unclear. We used nationwide longitudinal register data to examine associations with suicide and suicide-unrelated mortality.

Methods: Over 2.7 million individuals born in Denmark were followed from ages 5 years to 46 years. Hazard ratios (HRs) were used to quantify risks of suicide, suicide-unrelated mortality, and mortality by accidental causes in adulthood for individuals who received diagnoses of mental health only, physical health only, or comorbid disorders at age 5-18 years vs those who did not, adjusting for sex, age, parental socioeconomic status, and parental psychiatric diagnoses.

Results: All diagnostic groups showed elevated mortality risks all examined causes. Risk of suicide mortality was highest among individuals with mental health (HR=3.00, 95% CI 2.48–3.64) and comorbid (HR=3.33, 95% CI 2.78–4.00) disorders, while a smaller but significant increase in suicide risk was observed among those with physical health diagnoses only (HR=1.18, 95% CI 1.07–1.31), in fully adjusted models. Suicide-unrelated mortality risk had a graded increase from physical health only (HR=2.26, 95% CI 2.16-2.35), mental health only (HR=3.07, 95% CI 2.72-3.46), to comorbid diagnoses (HR=4.72, 95% CI 4.28-5.20). However, this pattern disappeared in fully adjusted model to show similar risk for physical health only (HR=1.72, 95% CI 1.65–1.80) to mental health only (HR=1.64, 95% CI 1.45–1.86) and highest for comorbid diagnoses (HR=2.54, 95% CI 2.30–2.81).

Conclusions: Our findings show that childhood mental health disorders, alone and co-occurring with physical health conditions, may contribute to cause-specific premature mortality, particularly suicide, underscoring the need for integrated, life-course prevention and care strategies for youth with mental and physical health disorders.

Suicidality is a core component of Borderline Personality Disorder (BPD, or Emotionally Unstable Personality Disorder – EUPD) diagnosis (Mind, 2022). The stigmatising nature of these diagnoses is well-established, and has been associated with exclusion from mental health care. BPD/EUPD diagnoses are socially patterned, particularly by gender and neurodiversity (Broughton, 2024). In this paper, we centre lived experiences with suicide of people diagnosed with BPD/EUPD, revealing marginalisation and exile from services based on the intersection of diagnosis and identity.

Drawing from the Suicide Cultures: Reimagining Suicide Research dataset of 61 in-depth interviews, long-term ethnographies of 13 fieldsites, and 236 suicide death reviews, we conducted an abductive, critical phenomenological analysis of the experiences of people who had attempted suicide who reported having a diagnosis of BPD/EUPD, as well as broader mentions of BPD/EUPD by study participants.

Participants shared experiences of stigmatisation associated with BPD diagnosis as a primary factor in exclusion from and/or poor mental healthcare. Participants who were able to access services noted that this was often 'dismissive' and failed to look beyond their BPD diagnosis and its association with ‘bad behaviour’ as an explanatory framework for their suicidality. This led to participants self-excluding from further engagement with services due to past treatment, and highlights the lack of ‘care’ embedded within services. Particularly stark were the experiences of changing diagnoses over time, and the resulting shift in quality of interactions with healthcare providers, despite long-established relationships with services. Entangled with these experiences are the gendered associations of BPD, and the ways this impacted both women and men in our data struggling with and against the intersectional stereotypes entangled with this diagnosis. These stories have implications for the design and implementation of care, marginalisation and exclusion of particular groups within healthcare systems, and cultural attitudes’ impact on marginalised communities’ experiences of suicide.