This study investigates the association between the use of glucagon-like peptide-1 (GLP-1) receptor agonists and the risk of suicide death, self-harm, and depression in a cohort of adults with type 2 diabetes. Using nationwide register data from Sweden and Denmark from 2013 to 2021, the study included adults aged 18 to 84 years who initiated treatment with GLP-1 receptor agonists or sodium-glucose cotransporter-2 (SGLT2) inhibitors. The primary outcome was suicide death, while secondary outcomes included suicide death and nonfatal self-harm, and incident depression and anxiety-related disorders. The study found no statistically significant increased risk of suicide death among users of GLP-1 receptor agonists compared to SGLT2 inhibitors. The weighted incidence rate for suicide death was 0.23 events per 1000 person-years for GLP-1 receptor agonists and 0.18 for SGLT2 inhibitors, with a hazard ratio (HR) of 1.25 (95% CI: 0.83-1.88). The absolute difference in incidence rates was 0.05 events per 1000 person-years. For suicide death and nonfatal self-harm, the HR was 0.83 (95% CI: 0.70-0.97), and for incident depression and anxiety-related disorders, the HR was 1.01 (95% CI: 0.97-1.06). The study concludes that the use of GLP-1 receptor agonists is not associated with an increased risk of suicide death, self-harm, or depression in patients with type 2 diabetes. However, the absolute risks of suicide death remain low, and further studies with larger sample sizes are needed to assess potential smaller risk differences.This study investigates the association between the use of glucagon-like peptide-1 (GLP-1) receptor agonists and the risk of suicide death, self-harm, and depression in a cohort of adults with type 2 diabetes. Using nationwide register data from Sweden and Denmark from 2013 to 2021, the study included adults aged 18 to 84 years who initiated treatment with GLP-1 receptor agonists or sodium-glucose cotransporter-2 (SGLT2) inhibitors. The primary outcome was suicide death, while secondary outcomes included suicide death and nonfatal self-harm, and incident depression and anxiety-related disorders. The study found no statistically significant increased risk of suicide death among users of GLP-1 receptor agonists compared to SGLT2 inhibitors. The weighted incidence rate for suicide death was 0.23 events per 1000 person-years for GLP-1 receptor agonists and 0.18 for SGLT2 inhibitors, with a hazard ratio (HR) of 1.25 (95% CI: 0.83-1.88). The absolute difference in incidence rates was 0.05 events per 1000 person-years. For suicide death and nonfatal self-harm, the HR was 0.83 (95% CI: 0.70-0.97), and for incident depression and anxiety-related disorders, the HR was 1.01 (95% CI: 0.97-1.06). The study concludes that the use of GLP-1 receptor agonists is not associated with an increased risk of suicide death, self-harm, or depression in patients with type 2 diabetes. However, the absolute risks of suicide death remain low, and further studies with larger sample sizes are needed to assess potential smaller risk differences.