Skip to main content
×
Home
    • Aa
    • Aa

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

  • C. Crump (a1), K. Sundquist (a2) (a3), J. Sundquist (a2) (a3) and M. A. Winkleby (a3)
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.

Copyright
Corresponding author
*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)
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

G Arsenault-Lapierre , C Kim , G Turecki (2004). Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry 4, 37.

RK Bailey , TC Patel , J Avenido , M Patel , M Jaleel , NC Barker , JA Khan , S Ali , S Jabeen (2011). Suicide: current trends. Journal of the National Medical Association 103, 614617.

GD Batty , M Kivimaki , IS Park , SH Jee (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.

G Borges , MK Nock , JM Haro Abad , I Hwang , NA Sampson , J Alonso , LH Andrade , MC Angermeyer , A Beautrais , E Bromet , R Bruffaerts , G de Girolamo , S Florescu , O Gureje , C Hu , EG Karam , V Kovess-Masfety , S Lee , D Levinson , ME Medina-Mora , J Ormel , J Posada-Villa , R Sagar , T Tomov , H Uda , DR Williams , RC Kessler (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.

AT Cheng (1995). Mental illness and suicide. A case-control study in east Taiwan. Archives of General Psychiatry 52, 594603.

Y Conwell , K Van Orden , ED Caine (2011). Suicide in older adults. Psychiatric Clinics of North America 34, 451468, ix.

IK Crombie (1990). Can changes in the unemployment rates explain the recent changes in suicide rates in developed countries? International Journal of Epidemiology 19, 412416.

C Crump , K Sundquist , J Sundquist , MA Winkleby (2011 a). Gestational age at birth and mortality in young adulthood. Journal of the American Medical Association 306, 12331240.

C Crump , K Sundquist , J Sundquist , MA Winkleby (2011 b). Neighborhood deprivation and psychiatric medication prescription: a Swedish national multilevel study. Annals of Epidemiology 21, 231237.

C Crump , MA Winkleby , K Sundquist , J Sundquist (2010). Preterm birth and psychiatric medication prescription in young adulthood: a Swedish national cohort study. International Journal of Epidemiology 39, 15221530.

K Fall , F Fang , LA Mucci , W Ye , O Andren , JE Johansson , SO Andersson , P Sparen , G Klein , M Stampfer , HO Adami , U Valdimarsdottir (2009). Immediate risk for cardiovascular events and suicide following a prostate cancer diagnosis: prospective cohort study. PLoS Medicine 6, e1000197.

F Fang , K Fall , MA Mittleman , P Sparen , W Ye , HO Adami , U Valdimarsdottir (2012). Suicide and cardiovascular death after a cancer diagnosis. New England Journal of Medicine 366, 13101318.

T Foster , K Gillespie , R McClelland (1997). Mental disorders and suicide in Northern Ireland. British Journal of Psychiatry 170, 447452.

RD Goodwin (2011). Is COPD associated with suicide behavior? Journal of Psychiatric Research 45, 12691271.

RD Goodwin , RT Demmer , S Galea , AR Lemeshow , AN Ortega , A Beautrais (2012). Asthma and suicide behaviors: results from the Third National Health and Nutrition Examination Survey (NHANES III). Journal of Psychiatric Research 46, 10021007.

EC Harris , B Barraclough (1997). Suicide as an outcome for mental disorders. A meta-analysis. British Journal of Psychiatry 170, 205228.

J Hawgood , D De Leo (2008). Anxiety disorders and suicidal behaviour: an update. Current Opinion in Psychiatry 21, 5164.

ME Heikkinen , ET Isometsa , MJ Marttunen , HM Aro , JK Lonnqvist (1995). Social factors in suicide. British Journal of Psychiatry 167, 747753.

KM Holma , TK Melartin , J Haukka , IA Holma , TP Sokero , ET Isometsa (2010). Incidence and predictors of suicide attempts in DSM-IV major depressive disorder: a five-year prospective study. American Journal of Psychiatry 167, 801808.

G Isacsson , A Holmgren , U Osby , J Ahlner (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.

G Isacsson , J Reutfors , FC Papadopoulos , U Osby , J Ahlner (2010). Antidepressant medication prevents suicide in depression. Acta Psychiatrica Scandinavica 122, 454460.

SH Jee , M Kivimaki , HC Kang , IS Park , JM Samet , GD Batty (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.

LM Johansson , J Sundquist , SE Johansson , B Bergman (1997). Ethnicity, social factors, illness and suicide: a follow-up study of a random sample of the Swedish population. Acta Psychiatrica Scandinavica 95, 125131.

SE Johansson , J Sundquist (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.

DN Juurlink , N Herrmann , JP Szalai , A Kopp , DA Redelmeier (2004). Medical illness and the risk of suicide in the elderly. Archives of Internal Medicine 164, 11791184.

AJ Kposowa (2000). Marital status and suicide in the National Longitudinal Mortality Study. Journal of Epidemiology and Community Health 54, 254261.

DM Lawrence , CD Holman , AV Jablensky , SA Fuller (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.

G Lewis , K Hawton , P Jones (1997). Strategies for preventing suicide. British Journal of Psychiatry 171, 351354.

G Lewis , A Sloggett (1998). Suicide, deprivation, and unemployment: record linkage study. British Medical Journal 317, 1283–126.

S Lofman , P Rasanen , H Hakko , A Mainio (2011). Suicide among persons with back pain: a population-based study of 2310 suicide victims in Northern Finland. Spine 36, 541548.

JF Ludvigsson , E Andersson , A Ekbom , M Feychting , JL Kim , C Reuterwall , M Heurgren , PO Olausson (2011). External review and validation of the Swedish National Inpatient Register. BMC Public Health 11, 450.

JJ Mann , A Apter , J Bertolote , A Beautrais , D Currier , A Haas , U Hegerl , J Lonnqvist , K Malone , A Marusic , L Mehlum , G Patton , M Phillips , W Rutz , Z Rihmer , A Schmidtke , D Shaffer , M Silverman , Y Takahashi , A Varnik , D Wasserman , P Yip , H Hendin (2005). Suicide prevention strategies: a systematic review. Journal of the American Medical Association 294, 20642074.

PB Mortensen , E Agerbo , T Erikson , P Qin , N Westergaard-Nielsen (2000). Psychiatric illness and risk factors for suicide in Denmark. Lancet 355, 912.

E Murphy , N Kapur , R Webb , N Purandare , K Hawton , H Bergen , K Waters , J Cooper (2012). Risk factors for repetition and suicide following self-harm in older adults: multicentre cohort study. British Journal of Psychiatry 200, 399404.

M Nordentoft , PB Mortensen , CB Pedersen (2011). Absolute risk of suicide after first hospital contact in mental disorder. Archives of General Psychiatry 68, 10581064.

D Osborn , G Levy , I Nazareth , M King (2008). Suicide and severe mental illnesses. Cohort study within the UK general practice research database. Schizophrenia Research 99, 134138.

U Osby , L Brandt , N Correia , A Ekbom , P Sparen (2001). Excess mortality in bipolar and unipolar disorder in Sweden. Archives of General Psychiatry 58, 844850.

P Qin (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.

P Qin , E Agerbo , PB Mortensen (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.

P Qin , M Nordentoft (2005). Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Archives of General Psychiatry 62, 427432.

S Saha , D Chant , J McGrath (2007). A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Archives of General Psychiatry 64, 11231131.

EN Stenager , C Madsen , E Stenager , J Boldsen (1998). Suicide in patients with stroke: epidemiological study. British Medical Journal 316, 1206.

D Tidemalm , N Langstrom , P Lichtenstein , B Runeson (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.

M Waern , BS Runeson , P Allebeck , J Beskow , E Rubenowitz , I Skoog , K Wilhelmsson (2002). Mental disorder in elderly suicides: a case-control study. American Journal of Psychiatry 159, 450455.

RT Webb , E Kontopantelis , T Doran , P Qin , F Creed , N Kapur (2012). Suicide risk in primary care patients with major physical diseases: a case-control study. Archives of General Psychiatry 69, 256264.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 10
Total number of PDF views: 112 *
Loading metrics...

Abstract views

Total abstract views: 723 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 27th May 2017. This data will be updated every 24 hours.