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Hospitalization for physical illness and risk of subsequent suicide: a population study
Author(s) -
Qin P.,
Webb R.,
Kapur N.,
Sørensen H. T.
Publication year - 2013
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/j.1365-2796.2012.02572.x
Subject(s) - medicine , population , comorbidity , risk factor , poison control , incidence (geometry) , suicide attempt , logistic regression , mental illness , injury prevention , demography , psychiatry , emergency medicine , environmental health , mental health , physics , sociology , optics
Objective To examine suicide risk in relation to physical illness across a broad range of illnesses, including hospitalization history, specific organ or system illness and comorbidity. Design A nested case–control study. Setting Data were retrieved from five D anish national registers. Subjects On the basis of the entire population of D enmark, this study included 27 262 suicide cases, and 468 007 live controls matched for sex and date of birth. Main outcome measures Risk of suicide was assessed using conditional logistic regression. Results In the study population, 63.5% of suicide cases and 44.5% of comparison controls had a history of hospitalization for physical illness. A physical illness significantly increased the risk of subsequent suicide (incidence rate ratios 2.13, 95% CI 2.07–2.18) with a substantially greater effect in women than in men ( P < 0.01). The elevated risk increased progressively with frequency and recency of hospitalization and was significant for diseases occurring in all organs or systems of the body. Comorbidity involving several organs or systems increased the risk substantially. The associated estimates were to some extent reduced but remained highly significant after adjustment for psychiatric history and socio‐economic status. Taking into account both prevalence and adjusted effect size, physical illness accounted for 24.4%, 21.0% and 32.3% of population attributable risk for suicide in total, male and female populations, respectively. Conclusions Physical illness constitutes a significant risk factor for suicide independent of psychiatric and socio‐economic factors. Clinicians treating physically ill patients should be aware of the risk, especially amongst those with multiple or recent hospitalizations, or multiple comorbidities.