Suicide Mortality among Psychiatric Patients in Northeast Italy. A 10-year Cohort Study

Aims. The present study investigated the relationship between suicidemortality and contact with a community mental health center (CMHC)among the adult population in the Veneto Region (northeast Italy,population 4.9 million). Specifically, it estimated the effects of age,gender, time elapsed since the first contact with a CMHC, calendar yearof diagnosis, and diagnostic category on suicide mortality and modality.Methods. The regional mortality archive was linked to electronic medicalrecords for all residents aged 18–84 years who had been admitted to aCMHC in the Veneto Region in 2008. In total, 54,350 subjects diagnosedwith a mental disorder were included in the cohort and followed up for aperiod of 10 years, ending in 2018. Years of life lost (YLL) werecomputed and suicide mortality was estimated as a mortality rate ratio(MRR). Results. During the follow-up period, 4.4% of all registereddeaths were from suicide, but, given the premature age of death (mean52.2 years), suicide death accounted for 8.7% of YLL; this percentagewas particularly high among patients with borderline personality disorder(27.2%), substance use disorder (12.1%), and bipolar disorder (11.5%)who also presented the highest suicide mortality rates. Suicide mortalityrates were halved in female patients (MRR: 0.45 95 CI: 0.37–0.55),highest in patients aged 45–54 years (MRR: 1.56 95 CI: 1.09–2.23), andparticularly elevated in the 2 months following first contact with CMHCs(MRR: 10.4 95 CI: 5.30–20.3). A sensitivity analysis restricted topatients first diagnosed in 2008 confirmed the results. The most commonmodalities of suicide were hanging (47%), jumping (18%), poisoning(13%), and drowning (10%), whereas suicide from firearm was rare(4%). Gender, age at death, and time since first contact with CMHCsinfluenced suicide modality. Conclusions. Suicide prevention strategiesmust be promptly initiated after patients’ first contact with CMHCs.Patients diagnosed with borderline personality disorder, substance usedisorder, and bipolar disorder may be at particularly high risk for suicide.