Suicide is strongly associated with mental disorders, especially depression. However, it has been found that a minority of individuals affected by depression receive adequate treatment. Co-morbidity with other psychiatric disorders, especially with self-harm, increases the risk of suicide.

To investigate the main risk factors of suicide and the use of antidepressant treatment in the Italian Region of Friuli Venezia Giulia (FVG).

To determinate the prevalence of psychiatric disorders and self-harm in suicides and population controls. To investigate the use of antidepressants among suicides. To determinate to which extent suicides had previous contacts with health care.

Individual based data on self-harm, diagnoses and antidepressant prescriptions in FVG from 2002 to 2008 were obtained from the Regional Health Information System. All suicides occurred during the study period (N = 766) were included as cases. Each case was matched with regard to age and sex with 10 controls from the general population.

Previous self-harm and a psychiatric diagnosis increases the suicide risk by 124 and 31 fold respectively. Only 48% of cases with a previous diagnosis of unipolar depression received a prescription of antidepressants in the last 90 days prior to death. Among all suicides 20% had received an antidepressant prescription during the last 90 days. Twenty-two percent of the cases had never received any prescriptions or diagnosis.

The main risk factors of suicide are self-harm and psychiatric illness. Depression appears undertreated among suicides. A substantial number of people who will kill themselves are unknown by health care.