Purpose: This study aims to characterize the demographic, clinical and suicide-specific characteristics of individuals who die by suicide with no mental health diagnosis (NMHD) compared to those with a mental health diagnosis (MHD).
Methods: Suicide deaths in Toronto were identified from the coroner’s records (1998-2020). All deaths were classified into NMHD and MHD groups. Chi-squared tests were performed to examine the differences in demographic, clinical and suicide characteristics of individuals between the two groups. A post-hoc binary logistic regression was also conducted. Latent class analysis was performed to understand the subgroups within the NMHD group.
Results: Of 5,288 suicide decedents, 1,371 (25.9%) were classified as NMHD and 3,917 (74.7%) as MHD. Logistic regression showed that NMHD decedents were more likely to be male (78.4% vs 67.2%; OR=1.42, 95% CI=1.22-1.66), live alone (48.3% vs. 42.4%; OR=1.27, 95% CI=1.11-1.44), have a medical/health stressor (15.4% vs 10.2%; OR=1.57, 95% CI=1.29-1.91), participate in a murder-suicide or pact (2.7% vs 0.9%; OR=2.34, 95% CI=1.43-3.83), die by asphyxia (9.3% vs 6.6%; OR=1.37, 95% CI=1.08-1.74). NMHD decedents were less likely to die at home (60% vs 67.9%; OR=0.74, 95% CI=0.64-0.86), have had an academic, employment or financial stressor (15% vs 19%; OR=0.66, 95% CI=0.55-0.79), past suicide attempts (7.7% vs 32.8%; OR=0.21, 95% CI=0.17-0.26), emergency room visits in the last week (1.5% vs 9.2%; OR=0.17, 95% CI=0.11-0.27) and die by self-poisoning (9.1% vs 19.8%; OR=0.55, 95% CI=0.44-0.69). Our latent class analysis demonstrated the best fit for a 4-class model, mostly differentiating in stressors, mode of death, sex and physical health.
Conclusion/Implications: Suicide is mainly conceptualized as an event occurring in people with mental disorders. However, this study confirms that a large proportion of suicide deaths occur in those with no identified mental disorder and that this group has a somewhat distinct profile. Suicide prevention strategies should account for people with NMHD.