Suicide risk after nonfatal self-harm: a national cohort study, 2000-2008 (original) (raw)
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Purpose Psychiatric illness and deliberate self-harm (DSH) are major risk factors of suicide. In largely 15 % of psychiatric admissions in Denmark, the patient had an episode of DSH within the last year before admission. This study examined the survival and predictors of suicide in a suicidal high-risk cohort consisting of hospitalized psychiatric patients with recent DSH. Methods This national prospective register-based study examined all hospitalized psychiatric patients who selfharmed within a year before admission. All admitted patients, in the time period 1998-2006, were followed and survival analyses techniques were used to identify predictors of suicide. Results The study population consisted of 17,257 patients; 520 (3 %) died by suicide during follow-up; 50 % of the suicides occurred within a year from the index admission. A rate of 1,645 suicides per 100,000 personyears in the first year after psychiatric admission was found. Adjusted analyses showed that a higher degree of education, having DSH within a month before psychiatric admission and contact with a private psychiatrist increased the risk of suicide. Conclusions Psychiatric hospitalized patients with recent DSH revealed high suicide rates, even during hospitalization. When discharging psychiatric patients with recent DSH careful arrangement of follow-up treatment in the outpatient setting is recommendable.
BMJ, 2008
Objective To investigate the impact of coexistent psychiatric morbidity on risk of suicide after a suicide attempt. Design Cohort study with follow-up for 21-31 years. Setting Swedish national register based study. Participants 39 685 people (53% women) admitted to hospital for attempted suicide during 1973-82. Main outcome measure Completed suicide during 1973-2003. Results A high proportion of suicides in all diagnostic categories took place within the first year of follow-up (14-64% in men, 14-54% in women); the highest short term risk was associated with bipolar and unipolar disorder (64% in men, 42% in women) and schizophrenia (56% in men, 54% in women). The strongest psychiatric predictors of completed suicide throughout the entire follow-up were schizophrenia (adjusted hazard ratio 4.1, 95% confidence interval 3.5 to 4.8 in men, 3.5, 2.8 to 4.4 in women) and bipolar and unipolar disorder (3.5, 3.0 to 4.2 in men, 2.5, 2.1 to 3.0 in women). Increased risks were also found for other depressive disorder, anxiety disorder, alcohol misuse (women), drug misuse, and personality disorder. The highest population attributable fractions for suicide among people who had previously attempted suicide were found for other depression in women (population attributable fraction 9.3), followed by schizophrenia in men (4.6), and bipolar and unipolar disorder in women and men (4.1 and 4.0, respectively). Conclusion Type of psychiatric disorder coexistent with a suicide attempt substantially influences overall risk and temporality for completed suicide. To reduce this risk, high risk patients need aftercare, especially during the first two years after attempted suicide among patients with schizophrenia or bipolar and unipolar disorder.
Age-specific suicide mortality following non-fatal self-harm: national cohort study in Sweden
Psychological medicine, 2014
Background. Possible age-related differences in risk of completed suicide following non-fatal self-harm remain unexplored. We examined associations between self-harm and completed suicide across age groups of self-harming patients, and whether these associations varied by violent index method, presence of mental disorder, and repeated self-harm. Method. The design was a cohort study with linked national registers in Sweden. The study population comprised individuals aged ⩾10 years hospitalized during 1990-1999 due to non-fatal self-harm (n = 53 843; 58% females) who were followed for 9-19 years. We computed hazard ratios (HRs) across age groups (age at index self-harm episode), with time to completed suicide as outcome. Results. The 1-year HR for suicide among younger males (10-19 years) was 14.6 [95% confidence interval (CI) 4.1-51.9] for violent method and 8.4 (95% CI 1.8-40.0) for mental disorder. By contrast, none of the three potential risk factors increased the 1-year risks in...
Suicide and mortality related to mental disorder in three Swedish cohorts
year: 2010, 2010
Aims The subject of this thesis is suicide and other premature death related to mental disorder. The overall aim is to provide knowledge to improve prevention strategies. The specific aims are as follows: Study I: To identify predictors of suicide in a cohort with long-term mental disorder. Study II: To analyse mortality by mental health service and psychiatric diagnosis in a cohort with long-term mental disorder. Study III: To investigate the impact of psychiatric morbidity on suicide risk following a suicide attempt. Study IV: To examine familial suicide risks in a total population sample. Methods Studies I and II: Adult residents with mental disorder in Stockholm County, Sweden, were identified in 1997. This register (n=12,247) was linked to national registers. Discharges from psychiatric inpatient care during 1990-2000 and deaths during 1997-2000 were identified. Predictors of suicide in the cohort were investigated; standardised mortality ratios were calculated. Study III: Data on all people living in Sweden 1973-82 were linked to national registers. People hospitalised during the period 1973-82 due to attempted suicide were identified. The cohort (n=39,685) consisted of those with a studied psychiatric diagnosis present at index attempt (cases) and those without a psychiatric diagnosis within a year after the suicide attempt (reference subjects). Patients were followed for 21-31 years. Survival curves for suicide were plotted and hazard ratios computed. Study IV: A population-based cohort (n=7,969,645) was created by linkage of Swedish national registers. Persons with death classified as definite or uncertain suicide 1952-2003 were identified (n=83,951). Odds ratios for suicide in relatives of suicide probands were calculated in relation to relatives of controls. Results Study I: Predictors of suicide included previous suicide attempt, a history of psychiatric inpatient care, and unmet need of a contact person. Borderline personality disorder was the strongest diagnostic predictor. Study II: Excess mortality was greater among those with a history of psychiatric inpatient care. The number of excess deaths due to natural causes was threefold that due to external causes. Study III: High proportions of suicides in all diagnostic groups took place within one year. The strongest predictors of completed suicide throughout the entire follow-up were schizophrenia and bipolar/unipolar disorder, with up to 39% suicide mortality. Study IV: The risk increase was threefold in full-siblings and twofold in children. The odds ratio for full-siblings was higher than that for maternal half-siblings. Odds ratios for second-and third-degree relatives were similar. Partners of suicide probands had a higher odds ratio than most biological relatives. Conclusions Treatment programs for persons with long-term mental disorder should target both physical and mental health. Unmet needs may signal increased suicide risk in persons with mental disorder. Psychiatric case management should focus on more intensive aftercare during the first years after a suicide attempt in patients with bipolar and unipolar disorder or schizophrenia. The findings of Study IV are not entirely consistent with variance by degree of genetic correlation; the study could identify impact of both shared environment and shared genes in familial transmission of suicidal behaviour.
Journal of the Royal Society of Medicine, 2014
Background Psychiatric illnesses are known risk factors for self-harm but associations between self-harm and physical illnesses are less well established. We aimed to stratify selected chronic physical and psychiatric illnesses according to their relative risk of self-harm. Design Retrospective cohort studies using a linked dataset of Hospital Episode Statistics (HES) for 1999–2011. Participants Individuals with selected psychiatric or physical conditions were compared with a reference cohort constructed from patients admitted for a variety of other conditions and procedures. Setting All admissions and day cases in National Health Service (NHS) hospitals in England. Main outcome measures Hospital episodes of self-harm. Rate ratios (RRs) were derived by comparing admission for self-harm between cohorts. Results The psychiatric illnesses studied (depression, bipolar disorder, alcohol abuse, anxiety disorders, eating disorders, schizophrenia and substance abuse) all had very high RRs (...
Risk factors for suicide in bipolar disorder: a cohort study of 12 850 patients
Acta Psychiatrica Scandinavica
Land en M. Risk factors for suicide in bipolar disorder: a cohort study of 12 850 patients. Objective: Bipolar disorder carries a high risk of suicide. Identification of risk factors is important. The aim of this study was to study risk factors for suicide in a large cohort of men and women with bipolar disorder. Method: A prospective cohort study using clinical data from the Swedish National Quality Register for Bipolar Affective Disorder (Bipol€ aR). The outcome variable was suicide captured in the Cause of Death Register between 2004 and 2014. Hazard ratios (HR) were calculated using Cox proportional hazards models. Results: Of 12 850 persons (4844 men and 8006 women) with bipolar disorder, 90 (55 men and 35 women) died by suicide during the followup period (between 1 and 10 years). Male sex (HR 2.56), living alone (HR 2.45), previous suicide attempts (HR 4.10), comorbid psychiatric disorder (HR 2.64), recent affective episodes (HR 2.39), criminal conviction (HR 4.43), psychiatric inpatient care (HR 2.79), and involuntary commitment (HR 3.50) were significant risk factors for suicide. Several of the statistically significant risk factors for suicide in bipolar disorder differed between men and women. Conclusions: Risk factors for suicide in bipolar disorder include factors associated with suicide in general, but also diagnosis-specific factors.