The discussion about the association between personality disorder and suicide is important.Reference Liu¹ First, I want to present some information on the risk of suicide in patients with personality disorder with special reference to the subtype of personality disorder.

Coleman et al. conducted a cross-sectional study to understand the relationship between narcissistic personality disorder (NPD) and suicidal behaviour in 657 patients with mood disorders.Reference Coleman, Lawrence, Parekh, Galfalvy, Blasco-Fontecilla and Brent² The adjusted odds ratio for suicide attempt in the participants with NPD was 0.41 (95% CI 0.19–0.88). In addition, being male, substance use disorder, aggression and hostility also presented a significant increase in odds ratio for suicide attempt. In contrast, the adjusted odds ratio for suicide attempt in those participants with borderline personality disorder (BPD) was 4.96 (95% CI 3.25–7.58). NPD in patients with mood disorders showed a protective effect for suicidal behaviour, which was different from that in participants with BPD. Sher reports that patients with NPD have a risk of suicide behaviour,Reference Sher³ and I recommend stratified analysis by subtype of personality disorder for risk assessment of suicide.

Second, there is a difference between suicidal ideation and attempt.Reference Lewitzka, Spirling, Ritter, Smolka, Goodday and Bauer⁴ In addition, mood disorder is a risk factor for suicidal behaviour.Reference Vilaplana, Richard-Devantoy, Turecki, Jaafari and Jollant⁵ Wang et al. conducted a prospective study to investigate the effect of stressful life events on subsequent suicidal behaviour in patients with major depressive disorder.Reference Wang, Sareen, Afifi, Bolton, Johnson and Bolton⁶ They clarified that financial stress was a strong predictor for suicide attempts after adjusting for sociodemographic variables, anxiety, substance use and personality disorder. As Liu also pointed out, comprehensive analysis is recommended for risk assessment of suicide.