Characterization of Rare Genetic Variants Involved in Risk of Death by Suicide

Suicide prevention often relies on known warning signs, including prior suicidal thoughts or nonfatal suicide attempts. These markers are important, but at the same time, many people who die by suicide may never disclose suicidal thoughts, seek mental health care, or have suicidal thoughts and behaviors (STB) documented in their medical record before their death. This presents a major challenge for prevention and risk detection, particularly in healthcare settings that rely heavily on known suicidal ideation or behavior to guide intervention. Understanding how people who die by suicide without prior documented STB differ from those with known suicidal thoughts or behaviors may help broaden how suicide risk is recognized across clinical settings.

With her AFSP-funded work, Dr. Emily DiBlasi analyzed electronic health record data from 4,000 suicide deaths and more than 26,000 living population controls in Utah matched by sex and birth year using diagnostic data and natural language processing of clinical notes to identify prior suicidal ideation or behavior. Dr. DiBlasi found that approximately 56% of people who died by suicide had evidence of prior nonfatal suicidal ideation or behavior documented in their medical records, while about 44% did not. Individuals without prior documented STB tended to be older and had fewer overall psychiatric and medical diagnoses than those with documented suicidal thoughts or behaviors. Mental health diagnoses were much more strongly associated with documented STB itself than with suicide death alone, while several physical health conditions, including chronic pain, injury-related conditions, neurological disorders, and disability-related conditions, showed stronger associations with suicide mortality. Overall, the findings suggest that suicide risk may emerge through multiple clinical pathways, and that many individuals who die by suicide may not present just by suicidal ideation and behavior alone, but do show established contributors to risk such as chronic health problems, pain, and disability. The study also highlights the importance of approaches that consider both mental and physical health patterns when identifying suicide risk.

Citation: Coon, H., Shabalin, A. A., DiBlasi, E., Monson, E. T., Han, S., Kaufman, E. A., Chen, D., Kious, B., Molina, N., Yu, Z., Staley, M. J., Crockett, D. K., Colbert, S. M., Mullins, N., Bakian, A. V., Docherty, A. R., & Keeshin, B. R. (2025). Absence of nonfatal suicidal behavior preceding suicide death reveals differences in clinical risks. Psychiatry research, 347, 116391. https://doi.org/10.1016/j.psychres.2025.116391