SUICIDE MORTALITY IN NON-AFFECTIVE PSYCHOTIC DISORDERS: NATIONWIDE EVIDENCE ON RISK FACTORS AND TEMPORAL PATTERNS

ABSTRACT Individuals with non-affective psychotic disorders experience substantially higher suicide mortality than the general population, particularly during the early stages of illness. Despite relatively stable suicide rates in the general population in recent years, evidence on temporal trends and the evolution of suicide risk among people with non-affective psychoses remains limited. We examined suicide mortality among individuals with non-affective psychoses by identifying demographic and clinical risk factors, assessing temporal and regional variation and modelling suicide hazard trajectories from first diagnosis. Using nationwide Finnish register data, we followed individuals with non-affective psychotic disorders between 2012 and 2024. Risk factors were examined using survival analysis with time-varying covariates, and suicide hazard trajectories following first diagnosis were estimated among incident cases. During 2012–2024, 1 129 individuals with non-affective psychotic disorders died by suicide. Suicide mortality was substantially higher among men than women and remained largely stable over time, with no clear temporal trend and no statistically significant regional variation. In survival analyses, male sex, younger adult age, acute and transient psychotic disorders, unspecified psychoses, comorbid substance use disorders and depressive disorders were associated with increased suicide risk, whereas the use of residential social care services was associated with a markedly reduced risk. Suicide hazard peaked immediately after first diagnosis, especially among men, and declined sharply during the first two years, continuing to decrease gradually thereafter. Taken together, suicide mortality remained largely stable over time; however, suicide risk among individuals with non-affective psychotic disorders was high and concentrated in identifiable highrisk periods and clinical contexts, indicating substantial potential for prevention. Suicide prevention strategies for people with non-affective psychotic disorders should prioritize early illness phases, timely care during high-risk periods and integrated treatment of substance use disorders. Further research is warranted to better understand factors underlying the potentially protective role of residential social care services.