Trends in suicide risk associated with hospitalized psychiatric illness: A case-control study based on Danish longitudinal registers

National Centre for Register-Based Research, University of Aarhus, Denmark.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 01/2007; 67(12):1936-41. DOI: 10.4088/JCP.v67n1214
Source: PubMed


In light of the consistent reduction in suicide rate during the past 20 years in Denmark, this study aims to investigate trends in suicide risk associated with hospitalized psychiatric illness and to explore differences in the changes with regard to clinical phases of illness, sex, age, and diagnosis.
This population-based study includes all of 21,169 suicides in Denmark during the years 1981 through 1997 and 423,128 controls matched for sex, age, and time (using a nested case-control design). Personal data on psychiatric history and socioeconomic status were retrieved from Danish longitudinal registers. Data were analyzed using conditional logistic regression.
This study shows that the reduction in suicide rate is generally faster among individuals with a history of psychiatric admission than among individuals without such a history. However, this substantial reduction is mainly accounted for by the reduction among patients who had been discharged from psychiatric hospitals for more than 1 year. For patients who had been discharged from hospitals within 1 year, the reduction is similar to that of the general population; while for patients hospitalized for treatment at the time of suicide or the index date, the reduction in suicide rate is relatively slower. Such trends hold for all diagnostic groups. Further analyses stratified by age indicate that the faster reduction in suicide rate associated with history of hospitalized psychiatric illness is more pronounced among patients aged 36 years and older.
The reduction in suicide rate is substantial for patients who have been discharged from psychiatric hospitals for more than 1 year and for middle-aged and older patients. Recent improvement in psychiatric care and treatment and promotion of new generation antidepressants may contribute to these changes.

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    • "Psychiatric hospitalization is associated with a significantly higher suicide risk immediately after discharge and in the months following.[42] [43] Smoking rates and suicide risk are usually studied in specific psychiatric diagnostic groups. This is not representative of clinical practice in which practice setting has profound implications on risk and co-morbidity is typically the rule rather than the exception. "
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    ABSTRACT: The aim of the study was to define the extent of current and lifetime smoking by diagnostic groups and suicide risk as reason for admission in a geographically defined psychiatric inpatient cohort. The study used a population-based retrospective chart review. Smoking status and discharge diagnoses for Olmsted County, Minnesota, inpatients aged 18 to 65 admitted for psychiatric hospitalization in 2004 and 2005 were abstracted from the electronic medical record. Diagnostic groups were compared to each other using chi(2) tests and Fisher exact test to analyze smoking status within the inpatient sample with significance defined as P <or= .05. Eighty percent (80.41) of our sample of 776 patients was hospitalized due to acute suicide risk. Discharge diagnostic group composition included affective disorders (80.3%), substance abuse disorders (36.1%), anxiety disorders (19%), psychotic disorders (16.4%), and personality disorders (10.3%). Of the sample, 72.2% had at least one comorbid disorder. Of the 776 patients, 356 (45.9%) were current smokers. Substance abuse and psychotic disorder diagnoses were significantly correlated with current smoking status (<.0001, .02) with 77.1% and 55.9%, respectively, being current smokers compared to other psychiatric inpatient groups. All diagnostic groups smoked at higher rates and had less success stopping than the US general population. Our findings clearly demonstrate stratification of current smoking and quit rates in psychiatric inpatient' diagnostic groups vs the US general population and Minnesota. Further research into the association between suicide risk, smoking, and mortality in the seriously mentally ill is necessary. Recognizing and addressing smoking in psychiatric patients in both hospital and outpatient settings is critical to addressing survival differences compared to the general population.
    Comprehensive psychiatry 11/2009; 50(6):526-32. DOI:10.1016/j.comppsych.2009.01.004 · 2.25 Impact Factor
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    • "In a longitudinal register study it is argued that the general population in Denmark has experienced positive changes in risk factors over the past 20 years and these changes might have contributed to the decline of suicide rate in the general population. The positive changes is reduced availability of lethal suicide means, better somatic and psychiatric treatment of suicide attempts, increased social and cultural stability in society and more focus on prevention are all preventive factors that is suggested as explanations for the declining suicide rate (Qin et al., 2006). The present paper focus on the early onset suicide behavior defined as first time suicide attempts or completed suicide and in this context suicide attempts will count for most of the cases. "
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    ABSTRACT: The study explore risk factors associated with the onset of suicidal behavior in young people aged 15 to 24. The study survey possible risk factors and protective factors in order to evaluate if altering the conditions of children's upbringing, structural factors, geographical segregation, or individual resource deficits could reduce their suicidal behavior (first time suicide attempts and completed suicides). These issues are being examined using data gathered during a 10-year longitudinal study of two births cohorts of more than 145,000 young people born in 1966 or 1980. In the Nordic welfare model it is an ambition to level-out inequalities and give children the same opportunities despite parental income or educational resources. The paper focuses on suicidal behavior as an extreme indicator of individual disadvantage and social disintegration in order to disentangle groups of risk factors and their contribution to the number of first time suicide attempts and suicides among teenagers and young adults.
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    ABSTRACT: Thesis (doctoral)--Københavns universitet, 2007.
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