Published 18 November 2008, doi:10.1136/bmj.a2205
Cite this as: BMJ 2008;337:a2205

Research

Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up

¹ Department of Clinical Neuroscience, Karolinska Institutet, Division of Psychiatry, St Göran, SE-112 81 Stockholm, Sweden, ² Centre for Violence Prevention, Karolinska Institutet, ³ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, ⁴ Department of Clinical Neuroscience, Karolinska Institutet

Objective To investigate the impact of coexistent psychiatric morbidity on risk of suicide after a suicide attempt.

Design Cohort study with follow-up for 21-31 years.

Setting Swedish national register based study.

Participants 39 685 people (53% women) admitted to hospital for attempted suicide during 1973-82.

Main outcome measure Completed suicide during 1973-2003.

Results A high proportion of suicides in all diagnostic categories took place within the first year of follow-up (14-64% in men, 14-54% in women); the highest short term risk was associated with bipolar and unipolar disorder (64% in men, 42% in women) and schizophrenia (56% in men, 54% in women). The strongest psychiatric predictors of completed suicide throughout the entire follow-up were schizophrenia (adjusted hazard ratio 4.1, 95% confidence interval 3.5 to 4.8 in men, 3.5, 2.8 to 4.4 in women) and bipolar and unipolar disorder (3.5, 3.0 to 4.2 in men, 2.5, 2.1 to 3.0 in women). Increased risks were also found for other depressive disorder, anxiety disorder, alcohol misuse (women), drug misuse, and personality disorder. The highest population attributable fractions for suicide among people who had previously attempted suicide were found for other depression in women (population attributable fraction 9.3), followed by schizophrenia in men (4.6), and bipolar and unipolar disorder in women and men (4.1 and 4.0, respectively).

Conclusion Type of psychiatric disorder coexistent with a suicide attempt substantially influences overall risk and temporality for completed suicide. To reduce this risk, high risk patients need aftercare, especially during the first two years after attempted suicide among patients with schizophrenia or bipolar and unipolar disorder.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Suicide risk after a suicide attempt

Udo Reulbach and Stefan Bleich
BMJ 2008 337: a2512. [Extract] [Full Text]

Improving iron status in children in poor environments

Andrew Tomkins
BMJ 2002 325: 1125. [Extract] [Full Text] [PDF]

Suicide rate 22 years after parasuicide: cohort study

Gary R Jenkins, Robert Hale, Maria Papanastassiou, Michael J Crawford, and Peter Tyrer
BMJ 2002 325: 1155. [Extract] [Full Text] [PDF]

Time trends in schizophrenia mortality in Stockholm County, Sweden: cohort study

Urban Ösby, Nestor Correia, Lena Brandt, Anders Ekbom, and Pär Sparén
BMJ 2000 321: 483-484. [Extract] [Full Text] [PDF]

Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition

Keith Hawton, Ella Arensman, Ellen Townsend, Sandy Bremner, Eleanor Feldman, Robert Goldney, David Gunnell, Philip Hazell, Kees van Heeringen, Allan House, David Owens, Isaac Sakinofsky, and Lil Träskman-Bendz
BMJ 1998 317: 441-447. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• (2008). Suicide Risk After Recent Attempt or Psychiatric Hospitalization. JWatch Psychiatry 2008: 1-1 [Full text]  
• (2008). Coexistent Psychiatric Illness Affects Risk for Completed Suicide After Suicide Attempt. JWatch General 2008: 7-7 [Full text]  
• Reulbach, U., Bleich, S. (2008). Suicide risk after a suicide attempt. BMJ 337: a2512-a2512 [Full text]  

Rapid Responses:

Read all Rapid Responses

Completed Suicide After a Suicide Attempt in a Community Sample

Wen-Hung Kuo
bmj.com, 21 Dec 2008 [Full text]

Online poll

Find out more >>