Predictors of suicidal behaviour in 36,304 individuals sickness absent due to stress-related mental disorders - a Swedish register linkage cohort study

Abstract

BackgroundStress-related mental disorders (SRMD), which correspond to the diagnostic code F43 in the International Classification of Diseases, version 10, rank among the leading causes of sickness absence in several European countries. Despite the size of this health problem, research on risk factors for severe medical outcomes, like suicidal behavior, is lacking to date. The aim of this study was to investigate predictors of suicide attempt and suicide among sickness absentees with SRMD.MethodsA cohort of 36,304 non-retired individuals, aged 16–64 years on 31.12.2004, with at least one sickness absence spell due to SRMD, initiated in 2005, was followed up with regard to suicide attempt (2006–2009) and suicide (2006–2008). Univariate and multivariate hazard ratios (HR) with 95% confidence intervals (CI) were estimated for a number of predictors.ResultsDuring the follow-up period, 266 individuals attempted suicide and 34 committed suicide. In the multivariate analyses, the following factors increased the risk of suicide attempt: =< 25 years of age, low educational level, lone parenthood, > 1 sickness absence spell, long duration of the first spell of sickness absence due to SRMD (> 180 days), > 4 and > 8 days of inpatient care due to somatic or mental diagnoses (2000–2005), and > 4 and > 1 outpatient visits due to somatic or mental diagnoses (2001–2005), respectively. Hazard ratios ranged from 1.4 to 4.2. Health care due to mental diagnoses and > 1 spell of sickness absence regardless of diagnosis were predictive of suicide.ConclusionsSeveral predictors related to socio-demographics, sickness absence and health-care consumption were identified as risk factors for suicidal behavior. Consideration of these risk factors is of both clinical and public health importance.

Can Satisfy with Life People be Unwilling to Live?

“…The study complements research done in other countries (Andres, Collings, Qin, 2010;Brown, Beck, Steer, & Grisham, 2000;Arria et al, 2009;Brown et al, 2000;Khan, Leventhal et al, 2002;Sareen, Cox, Afifi, de Graaf, Asmundson, et al, 2005;Have, de Graaf, van Dorsselaer, Verdurmen et al, 2009;Crump, Sundquist, Sundquist, Winkleby, 2013;Ishtiak-Ahmed, Perski, Mittendorfer-Rutz, 2013). The present study showed that: 1) Unwillingness to live was more expressed in Lithuanian women than in men.…”

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

“…The lifetime risk of suicide is around 4-15% for patients with depressive disorders (Guze and Robins, 1970;Blair-West et al, 1997;Inskip et al, 1998;Nordentoft et al, 2011). Suicide attempts occur more frequently than completed suicides and the lifetime risk among patients with depressive disorders is estimated to be 8-17% (Isometsa et al, 1994;Sokero et al, 2005;Vuorilehto et al, 2006;Hawton and van Heeringen, 2009;Riihimaki et al, 2013).…”

“…Mental disorders, particularly depressive disorders, are one of the largest diagnostic groups behind sickness absence, especially long-term sickness absence (Hensing and Wahlström, 2004;Waddell and Burton, 2006;OECD, 2013) and may increase the risk of permanent occupational disability and granting of disability pension (Järvisalo et al, 2005;Gjesdal et al, 2008;Danielsson and Berlin, 2012), and mortality (Kivimaki et al, 2003;Mittendorfer-Rutz et al, 2012). Recent studies have reported higher risks for suicide attempt as well as suicide among people having sickness absence in general as well as due to specific diagnoses (Qin et al, 2000(Qin et al, , 2003Vahtera et al, 2004;Melchior et al, 2010;Jansson et al, 2012;Ishtiak-Ahmed et al, 2013;Wang et al, 2014), including sickness absence due to affective disorders .…”

“…For that reason, more than one sick-leave measure would be needed to cover its complexity (Hensing et al, 1998;Borg et al, 2006). So far, within this area only one study has taken different measures of sickness absence into consideration (Ishtiak-Ahmed et al, 2013). That study reported higher risk of suicide attempt and suicide among individuals with a mental disorder, namely those sickness absent due to stress-related mental disorders.…”

“…That study reported higher risk of suicide attempt and suicide among individuals with a mental disorder, namely those sickness absent due to stress-related mental disorders. That study accounted for sickleave duration, grade, diagnoses, and number of spells and found that more than one sick-leave spell and long duration of the fist spell were risk factors for suicidal behavior (Ishtiak-Ahmed et al, 2013). Investigation of sickness absence measured in different ways is important as they may cover health burden and sex differences to varying degrees (Hensing, 2009).…”