The impact of psychiatric illness on suicide: Differences by diagnosis of disorders and by sex and age of subjects

doi:10.1016/j.jpsychires.2011.06.002

Journal of Psychiatric Research

Volume 45, Issue 11, November 2011, Pages 1445-1452

https://doi.org/10.1016/j.jpsychires.2011.06.002 Get rights and content

Abstract

People with a psychiatric illness are at high risk for suicide; however, variation of the risk by patients’ sex and age and by specific diagnosis needs to be explored in a more detail. This large population study systematically assesses suicide incidence rate ratio (IRR) and population attributable risk (PAR) associated with various psychiatric disorders by comparing 21,169 suicides in Denmark over a 17-year period with sex-age-time-matched population controls. The study shows that suicide risk is significantly increased for persons with a hospitalized psychiatric disorder and the associated risk varies significantly by diagnosis and by sex and age of subjects. Further adjustment for personal socioeconomic differences eliminates the IRRs associated with various disorders only to a limited extend. Recurrent depression and borderline personality disorder increase suicide risk the strongest while dementia increases the risk the least for both males and females. The influence of various disorders generally weakens with increasing age; however, there are important exceptions. Schizophrenia affects people aged ≤35 years the strongest in terms of both IRR and PAR. Recurrent depression increases suicide risk particularly strong in all age groups and the associated PAR increases steadily with age. Borderline personality disorder has a strong effect in young people, especially those ≤35 years. Alcohol use disorder accounts the highest PAR of suicides in males of 36–60 years old. For the elderly above 60 years old, reaction to stress and adjustment disorder increases the risk for suicide the most in both sexes. These findings suggest that approaches to psychiatric suicide prevention should be varied according to diagnosis and sex and age of subjects.

Section snippets

Objectives of the study

Suicide in people with psychiatric illness is a major health concern in many countries. Evidence, from both clinical and population-based studies, has consistently demonstrated that patients with various psychiatric disorders are at an excess mortality of suicide (Harris and Barraclough, 1997) and that a history of psychiatric illness is the strongest risk factor for suicide in the general population (Cheng, 1995, Foster et al., 1997, Hawgood and De Leo, 2008, Oldham, 2006, Osborn et al., 2008,

Settings

This study is based on the entire 5.2 million population of Denmark (Pedersen et al., 2006), a country where hospital treatment is free of charge for all residents. Individual data were retrieved from several Danish longitudinal registers including the Cause-of-Death Register (Juel and Helweg-Larsen, 1999), the Danish Psychiatric Central Register (Munk-Jorgensen and Mortensen, 1997), and the Integrated Database for Labour Market Research (so-called IDA Database) (Danmarks Statistik, 1991).

Results

In the study population, 37% of male and 57% of female suicide cases had a recorded history of hospitalization because of psychiatric illness (Table 2). By age group, the prevalence was 38.7%, 43.6% and 25.7%, respectively, for male suicides aged ≤35 years, 36–60 years and >60 years, whilst it was 57.1%, 65.1% and 46.8%, respectively, for female suicides of the corresponding age groups (Table 3). The most commonly diagnosed disorder was schizophrenia for suicides ≤35 years old and recurrent

Strengths and limitations

In Denmark, all residents have equal access to psychiatric hospitals and hospital treatment is free of charge, ensuring that all psychiatric admissions are represented in the Danish Psychiatric Central Register. The decision of admitting a patient for hospital treatment is based upon the clinical evaluation from psychiatrists. These advantages enable us to obtain precise information about personal history of hospitalized psychiatric illness and our data are not subject to differences in access

Conclusion and implications

This study adds to the existing evidence that people with psychiatric illness forms a well-defined high risk group for completed suicide. Although the majority of people with serious psychiatric illness neither attempt nor die by suicide, the risk for suicide is significantly increased for people with virtually any of psychiatric disorders that leads to a hospitalization for treatment. While caution is needed in the generalization of research findings from Denmark to other countries with

Role of funding sources

Dr Qin P is funded by a grant from the Sygekassernes Helsefond in Denmark. The sponsor had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Contributors

Dr Qin P is the sole author of this paper.

Conflict of interest

The author declares no conflict of interest.

Acknowledgments

None.

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The impact of psychiatric illness on suicide: Differences by diagnosis of disorders and by sex and age of subjects

Abstract

Section snippets

Objectives of the study

Settings

Results

Strengths and limitations

Conclusion and implications

Role of funding sources

Contributors

Conflict of interest

Acknowledgments

Clinical Psychology Review

The Lancet

The Lancet

Schizophrenia Research

Clinical Psychology Review

Lancet Neurology

Diagnostic and statistical manual of mental disorders

Self-mutilation and symptoms of depression, anxiety, and borderline personality disorder

Suicide and Life-Threatening Behavior

A case control study of suicide and attempted suicide in older adults

Suicide and Life-Threatening Behavior

Affective disorders and suicide risk: a reexamination

American Journal of Psychiatry

Etiology of borderline personality disorder: disentangling the contributions of intercorrelated antecedents

The Journal of Nervous and Mental Disease

Estimating the population attributable risk for multiple risk factors using case-control data

American Jounal of Epidemiology

Parental age and risk of schizophrenia: a case-control study

Archives of General Psychiatry

Mental illness and suicide. A case-control study in east Taiwan

Archives of General Psychiatry

Statistical models in epidemiology

IDA – en integreret database for arbejdsmarkedsforskning

Mental disorders and suicide in Northern Ireland

The British Journal of Psychiatry

Suicidality and substance abuse in affective disorders

The Journal of Clinical Psychiatry

Reducing suicide: a national imperative

Posttraumatic stress disorder and completed suicide

American Journal of Epidemiology

Suicide as an outcome for mental disorders. A meta-analysis

The British Journal of Psychiatry

Dementia and suicidal behavior: a review of the literature

International Psychogeriatrics