Demographic, behavioral, and psychiatric risk factors for suicide: A 25-year longitudinal cohort study

Background: There have been very few prospective studies of death by suicide in the general population. Rather, studies of suicide have generally used psychological autopsies, a method that has the potential weakness of recall bias. Aims: To examine correlates of death by suicide among a community-based nonclinical sample prospectively assessed years before death by suicide. Method: We analyzed data from an epidemiological study of a 10-year birth cohort (n = 4,914) conducted in Israel in the 1980s, with follow-up mortality data over 25 years. Results: Eight participants died by suicide during follow-up (6/100,000 per year; mean follow-up to suicide = 18.3 ± 2.0 years), the majority of whom were rated as functioning relatively well at baseline. Male sex, psychiatric hospitalizations, major depressive disorder, and previous suicide attempts were associated with later suicide. Conclusion: In this nonclinical sample of persons assessed between ages 25 and 34, several correlates of suicide were identified, but the majority of persons who died by suicide were relatively high functioning at baseline. Major precursors of suicide may be more proximal factors of acute or chronic negative changes in life circumstances.