Comorbidity of psychiatric and personality disorders in first suicide attempters: A case-control study

Objectives: Comorbid psychiatric and personality disorders in suicide attempters pose greater estimated risk of suicide than psychiatric disorders alone. The current study aimed to evaluate prevalence and pattern of psychiatric and/or personality morbidity and comorbidity in first-time suicide attempters in comparison to the age and sex matched community sample. Methods: Socio-demographic variables, family background, psychiatric morbidity and comorbidity in survivors of first suicide attempt were compared to age and sex matched community controls. Structured (Mini International Neuropsychiatric Interview plus) and semi-structured (International Personality Disorder Examination) clinical interviews were utilized to evaluate for axis-I and axis-II (personality) diagnosis. Risk-rescue rating was administered to assess medical seriousness of suicide attempt. Results: Individuals who made a first suicide attempt showed significantly lower educational achievement (P < 0.0001; OR 1.56; 95% CI 0.89-2.74), but no significant difference in other sociodemographic variables compared to the controls. Cases had high family history of psychiatric illnesses (31% vs. 7%; P < 0.0001; OR 5.97; 95% CI 2.48-14.35); high prevalence of psychiatric disorders (89% vs. 25%; P < 0.0001; OR 24.27 95% CI 11.21-52.57), personality disorders (52% vs. 24%; P < 0.0001; OR 3.43; 95% CI 1.88-6.28), comorbidity of psychiatric and personality disorders (51.6% vs. 19.5%; P = 0.022; OR 3.01; 95% CI 1.14-7.92), and high overall prevalence of any axis-I and/or axis-II (personality) morbidity (93% vs. 41%; P < 0.0001; OR 19.12; 95% CI 8.05-45.43), compared to controls. Conclusion: Survivors of first suicide attempt are at nineteen times increased odds of having psychiatric morbidity and/or comorbidity, especially with personality disorders. Personality evaluation and management in such individuals may result in better comprehensive approach to health care. (C) 2013 Elsevier B.V. All rights reserved.