Hospitalization for physical illness and risk of subsequent suicide: a population study
Version of Record online: 12 AUG 2012
© 2012 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine
Volume 273, Issue 1, pages 48–58, January 2013
How to Cite
Hospitalization for physical illness and risk of subsequent suicide: a population study. J Intern Med 2012; doi: 10.1111/j.1365-2796.2012.02572.x., , , (National Centre for Register-Based Research, University of Aarhus, Denmark; Centre for Mental Health and Risk, University of Manchester, UK; and Department of Clinical Epidemiology, Aarhus University Hospital, Denmark).
- Issue online: 27 DEC 2012
- Version of Record online: 12 AUG 2012
- Accepted manuscript online: 9 JUL 2012 12:27AM EST
- Sygekassernes Helsefonden. Grant Number: 2009B063
- nested case–control design;
- physical illness;
- population study;
- suicide risk
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.
A nested case–control study.
Data were retrieved from five Danish national registers.
On the basis of the entire population of Denmark, 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.
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.
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.