Suicide and Medical Illness: A Latent Class Analysis of Coroner Records in Toronto

OBJECTIVE: People with chronic illnesses are at elevated risk of suicide. Prior research has focused on risk with specific diagnoses and/or comparisons with living controls; the profiles of medically ill people who die by suicide remain largely unknown. This study aims to identify characteristics and subgroups among suicide decedents with medical illnesses. METHODS: We conducted a retrospective chart review of 5288 suicide deaths in Toronto, Canada (1998-2020) using coroner records. Bivariate and logistic regression compared decedents with and without reported medical illness across demographics, stressors, psychiatric history, and suicide-related characteristics. Latent class analysis (LCA) identified subgroups based on patterns of medical illness and sociodemographic characteristics. Post-hoc comparisons assessed additional differences across classes. RESULTS: Among suicide decedents, 33.6% had a reported medical illness. Compared to other suicide decedents, they were older, more likely to die at home, experience depression, and use self-poisoning. Latent class analysis identified four distinct profiles defined by medical and sociodemographic characteristics: (1) older men with cardiovascular disease and/or diabetes; (2) middle-aged individuals with pain, neurological, and/or musculoskeletal conditions and a balanced sex distribution; (3) younger-to-middle-aged men with mixed medical conditions, including HIV/AIDS and respiratory illness; and (4) older men with reported malignancy. Exploratory post-hoc comparisons suggested additional differences across psychiatric, psychosocial, and suicide-related characteristics, including depression, substance misuse/use disorder, and suicide methods. CONCLUSIONS: Our results indicate that the characteristics of suicide among medically ill populations are heterogeneous. Tailored, integrated prevention strategies that address both medical illness and psychosocial context are important elements for addressing suicide in this group.