Research article

Suicide and no axis I psychopathology

Carl Ernst¹ , Aleksandra Lalovic¹ , Alain Lesage^1,2 , Monique Seguin^1,3 , Michel Tousignant^1,3 and Gustavo Turecki¹

¹McGill Group for Suicide Studies, Douglas Hospital Research Centre, McGill University, Montreal, Canada

²Department of Psychiatry, University of Montreal, Montreal, Canada

³University of Quebec, Montreal, Canada

author email corresponding author email

BMC Psychiatry 2004, 4:7doi:10.1186/1471-244X-4-7

Published:	30 March 2004

Abstract

Background

It is unclear why approximately 10% of suicide completers seem to be psychiatrically normal. To better understand this issue, we studied suicide completers without an axis I diagnosis and compared them, on measures of psychopathology other than axis I, to normal controls and suicide cases with axis I psychopathology.

Methods

168 suicide cases were examined by way of a psychological autopsy with the best possible informant. Sixteen cases did not meet criteria for an axis I diagnosis; each of these cases was then age and gender matched to 52 suicide completers with an axis I disorder and 110 normal controls.

Results

Fourteen of sixteen suicide cases without an axis I diagnosis had detectable abnormalities that were more similar to the axis I diagnosed suicide group than to a living group. Both suicide groups were similar in the total number of past suicide attempts, the total number of individuals with an axis II disorder, and similar scores on measures of impulsive-aggressive behaviors.

Conclusions

These findings suggest that most of the individuals who committed suicide and appeared psychiatrically normal after a psychological autopsy may probably have an underlying psychiatric process that the psychological autopsy method, as commonly carried out, failed to detect.