Sick-leave measures, socio-demographic factors and health care as risk indicators for suicidal behavior in patients with depressive disorders – a nationwide prospective cohort study in Sweden

Wang, M; Alexanderson, Kristina; Runeson, Bo; Mittendorfer‐Rutz, Ellenor

doi:10.1016/j.jad.2014.10.069

Cited by 19 publications

(11 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We found that high education level increased the risk for suicide more in women than men, whereas another study found an interaction with male gender and medium‐level education. In contrast to previous studies , we found no evidence on protective effects of having young children in the family. Conversely, in men this was statistically a significant risk factor, although marginal in magnitude of effect.…”

Section: Discussioncontrasting

confidence: 61%

“…In the Finnish psychological autopsy study in 1987–1988, male decedents with major depression had more often comorbid alcohol disorder and less often a history of psychiatric hospitalization . We found that high education level increased the risk for suicide more in women than men, whereas another study found an interaction with male gender and medium‐level education. In contrast to previous studies , we found no evidence on protective effects of having young children in the family.…”

Section: Discussionmentioning

confidence: 58%

See 1 more Smart Citation

Risk factors for suicide in depression in Finland: first‐hospitalized patients followed up to 24 years

Aaltonen

Isometsä

Sund

et al. 2018

Acta Psychiatr Scand

View full text Add to dashboard Cite

Risk factors for suicide in depression inFinland: first-hospitalized patients followed up to 24 years Aaltonen KI, Isomets€ a E, Sund R, Pirkola S. Risk factors for suicide in depression in Finland: first-hospitalized patients followed up to 24 years Objective: To examine longitudinally risk factors for suicide in depression, and gender differences in risk factors and suicide methods. Method: We linked data from (i) The Finnish Hospital Discharge Register, (ii) the Census Register of Statistics Finland, and (iii) Statistics Finland's register on causes of deaths. All 56 826 first-hospitalized patients (25 188 men, 31 638 women) in Finland in 1991-2011 with a principal diagnosis of depressive disorder were followed up until death (2587 suicides) or end of the year 2014 (maximum 24 years). Results: Clinical characteristics (severe depression adjusted hazard ratio [AHR] 1.19 [95% CI 1.08-1.30]; psychotic depression AHR 1.45 [1.30-1.62]; and comorbid alcohol dependence AHR 1.26 [1.13-1.41]), male gender (AHR 2.07 [1.91-2.24]), higher socioeconomic status and living alone at first hospitalization were long-term predictors of suicide deaths. Highest risk was associated with previous suicide attempts (cumulative probability 15.4% [13.7-17.3%] in men, 8.5% [7.3-9.7%] in women). Gender differences in risk factors were modest, but in lethal methods prominent. Conclusion: Sociodemographic and clinical characteristics at first hospitalization predict suicide in the long term. Inpatients with previous suicide attempts constitute a high-risk group. Despite some gender differences in risk factors, those in lethal methods may better explain gender disparity in risk. Significant outcomes• This national study of risk factors for suicide in depression is the largest cohort study published thus far in terms of sample size and number of suicide deaths. Of 13 risk factors, male sex, previous suicide attempts, severe or psychotic depression, comorbid alcohol dependence, higher family income, and higher education predicted future suicide.• During the long-term follow-up, a substantial proportion of patients hospitalized for depression with a history of suicide attempt eventually died by suicide.• Some gender differences in risk factors for suicide in depression were found to exist. However, there are marked gender differences in lethal methods used, which more likely explain the gender disparity in risk of suicide. Limitations• The cohort comprised first-hospitalized psychiatric inpatients. Generalizability of findings pertaining to risk factors among psychiatric outpatients or primary care patients remains to be confirmed.• Some risk factors remained uninvestigated in the study.• The study is based on clinical diagnoses. Diagnostic imprecisions likely exist in assessment of severity of depression, in poor recognition of delusional hopelessness of psychotic depression, and missed diagnoses of comorbid alcohol dependence.

show abstract

Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 58%

Risk factors for suicide in depression in Finland: first‐hospitalized patients followed up to 24 years

Aaltonen

Isometsä

Sund

et al. 2018

Acta Psychiatr Scand

View full text Add to dashboard Cite

show abstract

“…Studies of sick leave due to mental disorders have also shown increased risk of premature death [19][20][21] including suicide [22]. The risk of suicide was also higher in those on sick leave due to depression than those with depression that were not on sick leave [23]. Hence, some indications exist that severity of the depression or an adverse effect of the sick leave itself may also play a role in the association between sick leave and mortality.…”

Section: Introductionmentioning

confidence: 99%

Sick leave due to mental disorders, morbidity and mortality: a prospective study of discordant twin pairs

Mather

Narusyte

Ropponen

et al. 2019

Soc Psychiatry Psychiatr Epidemiol

View full text Add to dashboard Cite

Purpose To investigate if sick leave due to mental disorders increases the risk of morbidity measured by inpatient and specialized outpatient care, and mortality among women and men, independent of familial factors. Methods An open cohort study of 4979 twin pairs discordant for sick leave due to mental disorders was conducted in 2005-2013. Twins were followed up in the cause of death and national patient registries until the end of study, emigration, death, and inpatient and specialized outpatient care. Conditional Cox proportional hazard regression, adjusting for the familial factors shared by the twins, was used to calculate hazard ratios (HR) with 95% confidence intervals (CI). In case of non-proportional hazards, time-varying covariates were used. Results Sick leave due to mental disorders increased the risk for inpatient care among men (

show abstract

“…However, the predominant focus of previous research is on facilitating return to work and risk factors for SA/DP, rather than on consequences of being on SA/DP [12,13]. To date, few studies have investigated the association between SA/DP and subsequent suicidal behaviour, reporting that the risk of suicide attempt and suicide in individuals on SA/DP due to CMDs is particularly high compared to those without SA/DP [14][15][16][17]. Still, the knowledge on the associations between specific SA/DP diagnoses and suicide attempt is limited.…”

Section: Introductionmentioning

confidence: 99%

Suicide attempt following sickness absence and disability pension due to common mental disorders: a prospective Swedish twin study

Wang

Mather

Svedberg

et al. 2019

Soc Psychiatry Psychiatr Epidemiol

Self Cite

View full text Add to dashboard Cite

The aim of this study was to investigate if sickness absence and disability pension (SA/DP) in general and due to specific common mental disorders (CMDs) are associated with subsequent suicide attempt among women and men by taking familial factors (genetics and shared environment) into consideration. Methods This register-based cohort study includes 4871 twin pairs 18-65 years of age discordant for SA/DP due to CMDs 2005-2010. Twins were followed up for suicide attempt from inpatient and specialised outpatient care until December 2012. Conditional Cox proportional hazards regression models, adjusting for familial factors, were used to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results SA/DP due to CMDs was associated with a higher risk of suicide attempt (HR 3.14, CI 2.51-3.93). The risk of suicide attempt was five times higher among men and three times higher among women, compared to the SA/DP unaffected co-twins. In the diagnosis-specific analysis, SA/DP due to anxiety disorders resulted in the highest HR (4.09, CI 2.37-7.06) for suicide attempt, followed by depressive disorders (HR 3.70, CI 2.66-5.14) and stress-related disorders (HR 1.96, CI 1.35-2.84). The stratified analysis on zygosity indicates that there seems to be a genetic influence on the associations between SA/DP due to CMDs and suicide attempt, particularly among women and among those with SA/DP due to depressive disorders. Conclusions SA/DP due to CMDs was a risk factor for suicide attempt among women and men. Genetic factors might explain part of the associations for women and for those with SA/DP due to depressive disorders.

show abstract

Sick-leave measures, socio-demographic factors and health care as risk indicators for suicidal behavior in patients with depressive disorders – a nationwide prospective cohort study in Sweden

Cited by 19 publications

References 50 publications

Risk factors for suicide in depression in Finland: first‐hospitalized patients followed up to 24 years

Risk factors for suicide in depression in Finland: first‐hospitalized patients followed up to 24 years

Sick leave due to mental disorders, morbidity and mortality: a prospective study of discordant twin pairs

Suicide attempt following sickness absence and disability pension due to common mental disorders: a prospective Swedish twin study

Contact Info

Product

Resources

About