The association between mental disorders and suicide: A systematic review and meta-analysis of record linkage studies

Background: There has long been debate about the extent to which mental disorders contribute to suicide. We aimed to examine the evidence on the contribution of mental disorders to suicide among record linkage studies. Methods: We performed a systematic search using eight major health databases for English-language studies published between 1 January 2000 and 11 June 2018 that linked collected data on mental disorders and suicide. We then conducted a meta-analysis to assess risk of suicide conferred by mental disorders. Results: Our search identified 20 articles representing 13 unique studies. The pooled rate ratio (RR) was 13.2 (95% CI 8.6-20.3) for psychotic disorders, 12.3 (95% CI 8.9-17.1) for mood disorders, 8.1 (95% CI 4.6-14.2) for personality disorders, 4.4 (95% CI 2.9-6.8) for substance use disorders, and 4.1 (95% CI 2.4-6.9) for anxiety disorders in the general population. The overall pooled RR for these mental disorders was 7.5 (95% CI 6.6-8.6). The population attributable risk of mental disorders was up to 21%. Limitations: The overall heterogeneity between studies was very high. Conclusions: Our findings underline the important role of mental disorders in suicide. This suggests that ongoing efforts are required to improve access to and quality of mental health care to prevent suicide by people with mental disorders.