Risk factors for suicide independent of DSM–III–R Axis I disorder

BACKGROUND: The vast majority of suicides suffer from at least one mental disorder at the time of death. AIMS: To identify risk factors for suicide, particularly those independent of current DSM-III-R Axis I disorder(s). METHOD: A case-control psychological autopsy study comparing suicides with matched community controls. RESULTS: Independent risk factors for suicide included: Axis II (personality) disorder (particularly antisocial, avoidant and dependent); at least one of 12 life events (from the List of Threatening Experiences) during the previous 52 or 4 weeks (in particular, a 'serious problem with close friend, neighbour or relative'); current unemployment; previous history of deliberate self-harm; and contact with a GP within 26 weeks. Relative to individuals with no current mental disorder, the estimated risk of suicide in those with Axis I-Axis II comorbidity (OR 346.0) was significantly greater than that in those with Axis I disorder(s) only (OR 52.4). CONCLUSIONS: Suicide risk assessment may be enhanced by enquiry about the aforementioned independent risk factors, and attention to Axis I-Axis II comorbidity.