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Sociodemographic, psychiatric and somatic risk factors for suicide: a Swedish national cohort study

Published online by Cambridge University Press:  23 April 2013

C. Crump*
Affiliation:
Department of Medicine, Stanford University, Stanford, CA, USA
K. Sundquist
Affiliation:
Center for Primary Health Care Research, Lund University, Malmö, Sweden Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
J. Sundquist
Affiliation:
Center for Primary Health Care Research, Lund University, Malmö, Sweden Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
M. A. Winkleby
Affiliation:
Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
*
*Address for correspondence: C. Crump, M.D., Ph.D., 211 Quarry Road, Suite 405, MC 5985, Palo Alto, CA 94304-1426, USA. (Email: kccrump@stanford.edu)

Abstract

Background

More effective prevention of suicide requires a comprehensive understanding of sociodemographic, psychiatric and somatic risk factors. Previous studies have been limited by incomplete ascertainment of these factors. We conducted the first study of this issue using sociodemographic and out-patient and in-patient health data for a national population.

Method

We used data from a national cohort study of 7140589 Swedish adults followed for 8 years for suicide mortality (2001–2008). Sociodemographic factors were identified from national census data, and psychiatric and somatic disorders were identified from all out-patient and in-patient diagnoses nationwide.

Results

There were 8721 (0.12%) deaths from suicide during 2001–2008. All psychiatric disorders were strong risk factors for suicide among both women and men. Depression was the strongest risk factor, with a greater than 15-fold risk among women or men and even higher risks (up to 32-fold) within the first 3 months of diagnosis. Chronic obstructive pulmonary disease (COPD), cancer, spine disorders, asthma and stroke were significant risk factors among both women and men (1.4–2.1-fold risks) whereas diabetes and ischemic heart disease were modest risk factors only among men (1.2–1.4-fold risks). Sociodemographic risk factors included male sex, unmarried status or non-employment; and low education or income among men.

Conclusions

All psychiatric disorders, COPD, cancer, spine disorders, asthma, stroke, diabetes, ischemic heart disease and specific sociodemographic factors were independent risk factors for suicide during 8 years of follow-up. Effective prevention of suicide requires a multifaceted approach in both psychiatric and primary care settings, targeting mental disorders (especially depression), specific somatic disorders and indicators of social support.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2013 

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References

Anell, A, Glenngard, AH, Merkur, S (2012). Sweden: health system review. Health Systems in Transition 14, 1159.Google ScholarPubMed
Arsenault-Lapierre, G, Kim, C, Turecki, G (2004). Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry 4, 37.Google Scholar
Bailey, RK, Patel, TC, Avenido, J, Patel, M, Jaleel, M, Barker, NC, Khan, JA, Ali, S, Jabeen, S (2011). Suicide: current trends. Journal of the National Medical Association 103, 614617.Google Scholar
Batty, GD, Kivimaki, M, Park, IS, Jee, SH (2012). Diabetes and raised blood glucose as risk factors for future suicide: cohort study of 1 234 927 Korean men and women. Journal of Epidemiology and Community Health 66, 650652.Google Scholar
Borges, G, Nock, MK, Haro Abad, JM, Hwang, I, Sampson, NA, Alonso, J, Andrade, LH, Angermeyer, MC, Beautrais, A, Bromet, E, Bruffaerts, R, de Girolamo, G, Florescu, S, Gureje, O, Hu, C, Karam, EG, Kovess-Masfety, V, Lee, S, Levinson, D, Medina-Mora, ME, Ormel, J, Posada-Villa, J, Sagar, R, Tomov, T, Uda, H, Williams, DR, Kessler, RC (2010). Twelve-month prevalence of and risk factors for suicide attempts in the World Health Organization World Mental Health Surveys. Journal of Clinical Psychiatry 71, 16171628.Google Scholar
Cavanagh, JT, Carson, AJ, Sharpe, M, Lawrie, SM (2003). Psychological autopsy studies of suicide: a systematic review. Psychological Medicine 33, 395405.Google Scholar
Cheng, AT (1995). Mental illness and suicide. A case-control study in east Taiwan. Archives of General Psychiatry 52, 594603.Google Scholar
Conwell, Y, Van Orden, K, Caine, ED (2011). Suicide in older adults. Psychiatric Clinics of North America 34, 451468, ix.Google Scholar
Crombie, IK (1990). Can changes in the unemployment rates explain the recent changes in suicide rates in developed countries? International Journal of Epidemiology 19, 412416.CrossRefGoogle ScholarPubMed
Crump, C, Sundquist, K, Sundquist, J, Winkleby, MA (2011 a). Gestational age at birth and mortality in young adulthood. Journal of the American Medical Association 306, 12331240.Google Scholar
Crump, C, Sundquist, K, Sundquist, J, Winkleby, MA (2011 b). Neighborhood deprivation and psychiatric medication prescription: a Swedish national multilevel study. Annals of Epidemiology 21, 231237.CrossRefGoogle ScholarPubMed
Crump, C, Winkleby, MA, Sundquist, K, Sundquist, J (2010). Preterm birth and psychiatric medication prescription in young adulthood: a Swedish national cohort study. International Journal of Epidemiology 39, 15221530.CrossRefGoogle ScholarPubMed
Fall, K, Fang, F, Mucci, LA, Ye, W, Andren, O, Johansson, JE, Andersson, SO, Sparen, P, Klein, G, Stampfer, M, Adami, HO, Valdimarsdottir, U (2009). Immediate risk for cardiovascular events and suicide following a prostate cancer diagnosis: prospective cohort study. PLoS Medicine 6, e1000197.CrossRefGoogle ScholarPubMed
Fang, F, Fall, K, Mittleman, MA, Sparen, P, Ye, W, Adami, HO, Valdimarsdottir, U (2012). Suicide and cardiovascular death after a cancer diagnosis. New England Journal of Medicine 366, 13101318.CrossRefGoogle ScholarPubMed
Foster, T, Gillespie, K, McClelland, R (1997). Mental disorders and suicide in Northern Ireland. British Journal of Psychiatry 170, 447452.Google Scholar
Garrett, JM (1997). gr23: graphical assessment of the Cox model proportional hazards assumption. Stata Technical Bulletin 35, 914.Google Scholar
Goodwin, RD (2011). Is COPD associated with suicide behavior? Journal of Psychiatric Research 45, 12691271.CrossRefGoogle ScholarPubMed
Goodwin, RD, Demmer, RT, Galea, S, Lemeshow, AR, Ortega, AN, Beautrais, A (2012). Asthma and suicide behaviors: results from the Third National Health and Nutrition Examination Survey (NHANES III). Journal of Psychiatric Research 46, 10021007.Google Scholar
Harris, EC, Barraclough, B (1997). Suicide as an outcome for mental disorders. A meta-analysis. British Journal of Psychiatry 170, 205228.CrossRefGoogle ScholarPubMed
Hawgood, J, De Leo, D (2008). Anxiety disorders and suicidal behaviour: an update. Current Opinion in Psychiatry 21, 5164.CrossRefGoogle ScholarPubMed
Heikkinen, ME, Isometsa, ET, Marttunen, MJ, Aro, HM, Lonnqvist, JK (1995). Social factors in suicide. British Journal of Psychiatry 167, 747753.Google Scholar
Holma, KM, Melartin, TK, Haukka, J, Holma, IA, Sokero, TP, Isometsa, ET (2010). Incidence and predictors of suicide attempts in DSM-IV major depressive disorder: a five-year prospective study. American Journal of Psychiatry 167, 801808.Google Scholar
Isacsson, G, Holmgren, A, Osby, U, Ahlner, J (2009). Decrease in suicide among the individuals treated with antidepressants: a controlled study of antidepressants in suicide, Sweden 1995–2005. Acta Psychiatrica Scandinavica 120, 3744.CrossRefGoogle ScholarPubMed
Isacsson, G, Reutfors, J, Papadopoulos, FC, Osby, U, Ahlner, J (2010). Antidepressant medication prevents suicide in depression. Acta Psychiatrica Scandinavica 122, 454460.CrossRefGoogle ScholarPubMed
Jee, SH, Kivimaki, M, Kang, HC, Park, IS, Samet, JM, Batty, GD (2011). Cardiovascular disease risk factors in relation to suicide mortality in Asia: prospective cohort study of over one million Korean men and women. European Heart Journal 32, 27732780.Google Scholar
Johansson, LM, Sundquist, J, Johansson, SE, Bergman, B (1997). Ethnicity, social factors, illness and suicide: a follow-up study of a random sample of the Swedish population. Acta Psychiatrica Scandinavica 95, 125131.Google Scholar
Johansson, SE, Sundquist, J (1997). Unemployment is an important risk factor for suicide in contemporary Sweden: an 11-year follow-up study of a cross-sectional sample of 37,789 people. Public Health 111, 4145.Google Scholar
Juurlink, DN, Herrmann, N, Szalai, JP, Kopp, A, Redelmeier, DA (2004). Medical illness and the risk of suicide in the elderly. Archives of Internal Medicine 164, 11791184.CrossRefGoogle ScholarPubMed
Kposowa, AJ (2000). Marital status and suicide in the National Longitudinal Mortality Study. Journal of Epidemiology and Community Health 54, 254261.CrossRefGoogle ScholarPubMed
Lawrence, DM, Holman, CD, Jablensky, AV, Fuller, SA (1999). Suicide rates in psychiatric in-patients: an application of record linkage to mental health research. Australian and New Zealand Journal of Public Health 23, 468470.CrossRefGoogle ScholarPubMed
Lewis, G, Hawton, K, Jones, P (1997). Strategies for preventing suicide. British Journal of Psychiatry 171, 351354.Google Scholar
Lewis, G, Sloggett, A (1998). Suicide, deprivation, and unemployment: record linkage study. British Medical Journal 317, 1283–126.Google Scholar
Lofman, S, Rasanen, P, Hakko, H, Mainio, A (2011). Suicide among persons with back pain: a population-based study of 2310 suicide victims in Northern Finland. Spine 36, 541548.Google Scholar
Ludvigsson, JF, Andersson, E, Ekbom, A, Feychting, M, Kim, JL, Reuterwall, C, Heurgren, M, Olausson, PO (2011). External review and validation of the Swedish National Inpatient Register. BMC Public Health 11, 450.Google Scholar
Mann, JJ, Apter, A, Bertolote, J, Beautrais, A, Currier, D, Haas, A, Hegerl, U, Lonnqvist, J, Malone, K, Marusic, A, Mehlum, L, Patton, G, Phillips, M, Rutz, W, Rihmer, Z, Schmidtke, A, Shaffer, D, Silverman, M, Takahashi, Y, Varnik, A, Wasserman, D, Yip, P, Hendin, H (2005). Suicide prevention strategies: a systematic review. Journal of the American Medical Association 294, 20642074.CrossRefGoogle ScholarPubMed
Mortensen, PB, Agerbo, E, Erikson, T, Qin, P, Westergaard-Nielsen, N (2000). Psychiatric illness and risk factors for suicide in Denmark. Lancet 355, 912.Google Scholar
Murphy, E, Kapur, N, Webb, R, Purandare, N, Hawton, K, Bergen, H, Waters, K, Cooper, J (2012). Risk factors for repetition and suicide following self-harm in older adults: multicentre cohort study. British Journal of Psychiatry 200, 399404.Google Scholar
National Board of Health and Welfare (2011). Causes of Death 2010. National Board of Health and Welfare: Stockholm, Sweden.Google Scholar
Nordentoft, M, Mortensen, PB, Pedersen, CB (2011). Absolute risk of suicide after first hospital contact in mental disorder. Archives of General Psychiatry 68, 10581064.Google Scholar
Osborn, D, Levy, G, Nazareth, I, King, M (2008). Suicide and severe mental illnesses. Cohort study within the UK general practice research database. Schizophrenia Research 99, 134138.Google Scholar
Osby, U, Brandt, L, Correia, N, Ekbom, A, Sparen, P (2001). Excess mortality in bipolar and unipolar disorder in Sweden. Archives of General Psychiatry 58, 844850.CrossRefGoogle ScholarPubMed
Qin, P (2011). The impact of psychiatric illness on suicide: differences by diagnosis of disorders and by sex and age of subjects. Journal of Psychiatric Research 45, 14451452.Google Scholar
Qin, P, Agerbo, E, Mortensen, PB (2003). Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997. American Journal of Psychiatry 160, 765772.Google Scholar
Qin, P, Nordentoft, M (2005). Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Archives of General Psychiatry 62, 427432.Google Scholar
Saha, S, Chant, D, McGrath, J (2007). A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Archives of General Psychiatry 64, 11231131.Google Scholar
StataCorp (2010). Stata Statistical Software: Release 11.0. StataCorp: College Station, TX.Google Scholar
Stenager, EN, Madsen, C, Stenager, E, Boldsen, J (1998). Suicide in patients with stroke: epidemiological study. British Medical Journal 316, 1206.CrossRefGoogle ScholarPubMed
Tidemalm, D, Langstrom, N, Lichtenstein, P, Runeson, B (2008). Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up. British Medical Journal 337, a2205.Google Scholar
Waern, M, Runeson, BS, Allebeck, P, Beskow, J, Rubenowitz, E, Skoog, I, Wilhelmsson, K (2002). Mental disorder in elderly suicides: a case-control study. American Journal of Psychiatry 159, 450455.CrossRefGoogle ScholarPubMed
Webb, RT, Kontopantelis, E, Doran, T, Qin, P, Creed, F, Kapur, N (2012). Suicide risk in primary care patients with major physical diseases: a case-control study. Archives of General Psychiatry 69, 256264.CrossRefGoogle ScholarPubMed