A New Lens: Research Domain Criteria
Researchers from UCLA took a different approach. Rather than relying solely on clinical diagnoses in the NVDRS, they used the Research Domain Criteria (RDoC) framework. Developed by the National Institute of Mental Health, RDoC looks at psychological functioning across six broad domains:
- Negative valence (distress, hopelessness, anxiety)
- Positive valence (motivation, reward, substance use patterns)
- Social processes (relationships, belonging)
- Arousal processes (agitation, sleep disturbance)
- Cognitive systems (attention, memory, decision-making)
- Sensorimotor systems
Rather than asking “does this person have a diagnosis?”, RDoC asks: “in what ways was this person’s psychological functioning disrupted?”
To extract this from NVDRS death narratives, the researchers applied two machine learning methods. One was a token-based scoring system. The other was a large language model (LLM), the technology behind modern AI tools. Both had previously been validated against psychiatric inpatient records.
What the Research Found About Psychological Dysfunction and Suicide
The study analysed death records for 72,585 people who died by suicide in 2020 and 2021. These came from all 50 US states. The results were striking.
Using the LLM scoring method, more than 90% of suicide decedents showed at least one clinically significant RDoC domain score. This means evidence of dysfunction serious enough to require treatment. It was true in both law enforcement and coroner narratives.
Compare that to what the NVDRS had recorded: only 44.4% with any mental health disorder and only 27.9% described as currently depressed.
The domains most frequently elevated were negative valence and arousal processes. These capture hopelessness, distress, anxiety, and agitation. These are emotional states that do not always lead to a formal diagnosis. Yet they are deeply relevant to suicide risk and mental health outcomes.
Female decedents and younger decedents showed consistently higher levels of dysfunction across most domains. Among younger adults aged 25 to 44, clinically relevant arousal process dysfunction appeared in around 65% of law enforcement narratives. Among those aged 65 and over, this figure dropped to around 41%. Even so, dysfunction remained widespread in that older group.
Substance Use and Psychological Dysfunction and Suicide
One finding deserves particular attention. The RDoC framework links positive valence dysfunction directly to substance use patterns and their effects on reward processing. This dysfunction was significantly more common among decedents than standard NVDRS alcohol and drug measures suggested.
The standard NVDRS measure recorded problematic alcohol or drug use in 27.5% of decedents. But RDoC positive valence dysfunction, which captures disrupted reward and motivation, showed clinically relevant levels in around 31 to 41% of decedents.
Substance use does not just create health risks in isolation. It fundamentally alters how people experience reward, motivation, and relief from distress. It reshapes emotional life in ways that heighten vulnerability. That connection is essential to understand.
Why This Changes the Conversation
The traditional approach to suicide prevention has often focused on identifying people with a clinical diagnosis. If someone has a recorded diagnosis of depression or an anxiety disorder, systems are more likely to flag them for intervention. But a large proportion of people who die by suicide do not have that flag.
The RDoC approach offers a different way in. By looking at how someone is actually functioning, it is possible to detect risk that a diagnosis alone would miss.
This is especially relevant for men. Men made up 80.6% of decedents in this study. They were consistently less likely than women to have formal mental health diagnoses recorded. The suffering was still there. It was simply less likely to have been named.
(Complete Research: JAMA Network)