ImportanceNot all people who die by suicide have a psychiatric diagnosis; yet, little is known about the percentage and demographics of individuals with lifetime suicide attempts who are apparently psychiatrically healthy. If such suicide attempts are common, there are implications for suicide risk screening, research, policy, and nosology.ObjectiveTo estimate the percentage of people with lifetime suicide attempts whose first attempt occurred prior to onset of any psychiatric disorder.Design, Setting, and ParticipantsThis cross-sectional study used data from the US National Epidemiologic Study of Addictions and Related Conditions III (NESARC-III), a cross-sectional face-to-face survey conducted with a nationally representative sample of the US civilian noninstitutionalized population, and included persons with lifetime suicide attempts who were aged 20 to 65 years at survey administration (April 2012 to June 2013). Data from the NESARC, Wave 2 survey from August 2004 to September 2005 were used for replication. Analyses were performed from April to August 2023.ExposureLifetime suicide attempts.Main Outcomes and MeasuresThe main outcome was presence or absence of a psychiatric disorder before the first lifetime suicide attempt. Among persons with lifetime suicide attempts, the percentage and 95% CI of those whose first suicide attempt occurred before the onset of any apparent psychiatric disorders was calculated, weighted by NESARC sampling and nonresponse weights. Separate analyses were performed for males, females, and 3 age groups (20 to <35, 35-50, and >50 to 65 years).ResultsIn the total sample of 36 309 respondents, 1948 persons had lifetime suicide attempts; 66.8% (95% CI, 64.1%-69.4%) were female, and 6.2% (95% CI, 4.9%-7.4%) had no apparent lifetime psychiatric diagnoses when surveyed. In addition, 13.4% (95% CI, 11.6%-15.2%) made their first suicide attempt prior to psychiatric disorder onset. Thus, an estimated 19.6% of respondents first attempted suicide without an antecedent psychiatric disorder. No significant age or sex differences were detected in the percentage of those with lifetime suicide attempts absent psychiatric disorders, although females were more likely than males to attempt suicide in the year of psychiatric disorder onset (14.9% [95% CI, 12.5%-17.3%] vs 8.6% [95% CI, 6.0%-11.2%]; P < .001), and attempts were less frequent among those older than 50 to 65 years (3.9% [95% CI, 3.5%-4.4%] vs 6.1% [95% CI, 5.4%-6.8%] for 35-50 years and 6.2% [95% CI, 5.6%-6.9%] for 20 to <35 years; P < .001).Conclusions and RelevanceIn this study, an estimated 19.6% of individuals who attempted suicide did so despite not meeting criteria for an antecedent psychiatric disorder. This finding challenges clinical notions of who is at risk for suicidal behavior and raises questions about the safety of limiting suicide risk screening to psychiatric populations.

中文翻译：

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精神健康的人终生自杀未遂

重要性 并非所有自杀身亡的人都有精神病诊断；然而，我们对终生自杀未遂但精神健康的人的百分比和人口统计数据知之甚少。如果这种自杀企图很常见，就会对自杀风险筛查、研究、政策和疾病分类学产生影响。目的估计终生自杀未遂者中首次尝试发生在任何精神疾病发作之前的百分比。设计、设置和参与者横断面研究使用了美国国家成瘾和相关病症流行病学研究 III (NESARC-III) 的数据，这是一项横断面面对面调查，对美国非机构化平民人口的全国代表性样本进行，包括个人调查管理期间（2012 年 4 月至 2013 年 6 月）年龄在 20 岁至 65 岁之间有终生自杀未遂的人。使用 2004 年 8 月至 2005 年 9 月 NESARC 第 2 波调查的数据进行复制。分析于 2023 年 4 月至 8 月进行。暴露终生自杀未遂。主要结果和措施主要结果是在第一次终生自杀未遂之前是否存在精神疾病。在终生自杀未遂的人中，计算了在任何明显的精神疾病发作之前首次自杀未遂的人的百分比和 95% CI，并通过 NESARC 抽样和无响应权重进行加权。对男性、女性和 3 个年龄组（20 至 <35 岁、35-50 岁和 >50 至 65 岁）进行单独分析。结果 在 36 309 名受访者的总样本中，1 948 人有终生寿命。自杀未遂；调查时，66.8%（95% CI，64.1%-69.4%）为女性，6.2%（95% CI，4.9%-7.4%）没有明显的终生精神病诊断。此外，13.4%（95% CI，11.6%-15.2%）在精神疾病发作前首次尝试自杀。因此，估计有 19.6% 的受访者在没有精神疾病的情况下首次尝试自杀。尽管在精神疾病发作当年女性比男性更有可能尝试自杀（14.9% [95% CI, 12.5%-17.3]），但在没有精神疾病的情况下终生自杀企图的百分比没有发现显着的年龄或性别差异。 %] vs 8.6% [95% CI, 6.0%-11.2%]；磷< .001），并且年龄超过 50 至 65 岁的人尝试的频率较低（3.9% [95% CI, 3.5%-4.4%] vs 6.1% [95% CI, 5.4%-6.8%]，持续 35-50 年） 20 至＜35 年为 6.2% [95% CI，5.6%-6.9%]；磷< .001).结论和相关性在这项研究中，估计有 19.6% 的试图自杀的人尽管不符合既往精神疾病的标准，但还是这样做了。这一发现挑战了关于谁有自杀行为风险的临床观念，并提出了将自杀风险筛查仅限于精神病人群的安全性问题。