Hostname: page-component-745bb68f8f-grxwn Total loading time: 0 Render date: 2025-01-27T14:41:22.923Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk of suicide and suicide attempts associated with physical disorders: a population-based, balancing score-matched analysis

Published online by Cambridge University Press:  17 July 2014

J. M. Bolton ,
R. Walld ,
D. Chateau ,
G. Finlayson  and
J. Sareen
J. M. Bolton*
Affiliation:
Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
R. Walld
Affiliation:
Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
D. Chateau
Affiliation:
Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
G. Finlayson
Affiliation:
Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
J. Sareen
Affiliation:
Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
*
*Address for correspondence: J. M. Bolton, M.D., PZ430-771 Bannatyne Avenue, Winnipeg, Manitoba, CanadaR3E 3N4. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The association between physical disorders and suicide remains unclear. The aim of this study was to examine the relationship between physical disorders and suicide after accounting for the effects of mental disorders.

Method

Individuals who died by suicide (n = 2100) between 1996 and 2009 were matched 3:1 by balancing score to general population controls (n = 6300). Multivariate conditional logistic regression compared the two groups across physician-diagnosed physical disorders [asthma, chronic obstructive pulmonary disease (COPD), ischemic heart disease, hypertension, diabetes, cancer, multiple sclerosis and inflammatory bowel disease], adjusting for mental disorders and co-morbidity. Secondary analyses examined the risk of suicide according to time since first diagnosis of each physical disorder (1–90, 91–364, ⩾ 365 days). Similar analyses also compared individuals with suicide attempts (n = 8641) to matched controls (n = 25 923).

Results

Cancer was associated with increased risk of suicide [adjusted odds ratio (AOR) 1.40, 95% confidence interval (CI) 1.03–1.91, p < 0.05] even after adjusting for all mental disorders. The risk of suicide with cancer was particularly high in the first 90 days after initial diagnosis (AOR 4.10, 95% CI 1.71–9.82, p < 0.01) and decreased to non-significance after 1 year. Women with respiratory diseases had elevated risk of suicide whereas men did not. COPD, hypertension and diabetes were each associated with increased odds of suicide attempts in adjusted models (AORs ranged from 1.20 to 1.73).

Conclusions

People diagnosed with cancer are at increased risk of suicide, especially in the 3 months following initial diagnosis. Increased support and psychiatric involvement should be considered for the first year after cancer diagnosis.

Keywords

Cancerepidemiologyphysical diseasesuicidesuicide attempt
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 3 , February 2015 , pp. 495 - 504
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Batty, GD, Kivimaki, M, Park, IS, Jee, SH (2012). Diabetes and raised blood glucose as risk factors for future suicide: cohort study of 1,234,927 Korean men and women. Journal of Epidemiology and Community Health 66, 650–652.Google Scholar
Beautrais, AL (2001). Suicides and serious suicide attempts: two populations or one? Psychological Medicine 31, 837–845.CrossRefGoogle ScholarPubMed
Bolton, JM, Robinson, J (2010). Population-attributable fractions of Axis I and Axis II mental disorders for suicide attempts: findings from a representative sample of the adult, noninstitutionalized US population. American Journal of Public Health 100, 2473–2480.CrossRefGoogle ScholarPubMed
Bronnum-Hansen, H, Stenager, E, Nylev Stenager, E, Koch-Henriksen, N (2005). Suicide among Danes with multiple sclerosis. Journal Neurology, Neurosurgery and Psychiatry 76, 1457–1459.Google Scholar
Cavanagh, J, Carson, A, Shapre, M, Lawrie, S (2003). Psychological autopsy studies of suicide: a systematic review. Psychological Medicine 33, 395–405.Google Scholar
CDC (2013). National Suicide Statistics at a Glance. Centers for Disease Control and Prevention (www.cdc.gov/ViolencePrevention/suicide/statistics/leading_causes.html). Accessed 22 March 2013.Google Scholar
Druss, B, Pincus, H (2000). Suicidal ideation and suicide attempts in general medical illnesses. Archives of Internal Medicine 160, 1522–1526.Google Scholar
Fall, K, Fang, F, Mucci, LA, Ye, W, Andren, O, Johansson, JE, Andersson, SO, Sparen, P, Klein, G, Stampfer, M, Adami, HO, Valdimarsdottir, U (2009). Immediate risk for cardiovascular events and suicide following a prostate cancer diagnosis: prospective cohort study. PLoS Medicine 6, e1000197.CrossRefGoogle ScholarPubMed
Fang, F, Fall, K, Mittleman, MA, Sparen, P, Ye, W, Adami, HO, Valdimarsdottir, U (2012). Suicide and cardiovascular death after a cancer diagnosis. New England Journal of Medicine 366, 1310–1318.CrossRefGoogle ScholarPubMed
Fragoso, YD, Frota, ER, Lopes, JS, Noal, JS, Giacomo, MC, Gomes, S, Goncalves, MV, de Gama, PD, Finkelsztejn, A (2010). Severe depression, suicide attempts, and ideation during the use of interferon beta by patients with multiple sclerosis. Clinical Neuropharmacology 33, 312–316.CrossRefGoogle ScholarPubMed
Fransoo, R, Martens, P, Burland, E, The Need to Know Team, Prior, H, Burchill, C (2009). Manitoba RHA Indicators Atlas 2009. Manitoba Centre for Health Policy, University of Manitoba (http://mchp-appserv.cpe.umanitoba.ca/reference/RHA_Atlas_Report.pdf). Accessed 22 March 2013.Google Scholar
Fredrikson, S, Cheng, Q, Jiang, GX, Wasserman, D (2003). Elevated suicide risk among patients with multiple sclerosis in Sweden. Neuroepidemiology 22, 146–152.Google Scholar
Giltay, EJ, Zitman, FG, Menotti, A, Nissinen, A, Jacobs, DR Jr., Adachi, H, Kafato, A, Kromhout, D; Seven Countries Study Group (2010). Respiratory function and other biological risk factors for competed suicide: 40 years of follow-up of European cohorts of the Seven Countries Study. Journal of Affective Disorders 120, 249–253.CrossRefGoogle Scholar
Goodwin, RD, Demmer, RT, Galea, S, Lemeshow, AR, Ortega, AN, Beautrais, A (2012). Asthma and suicide behaviors: results from the Third National Health and Nutrition Examination Survey (NHANES III). Journal of Psychiatric Research 46, 1002–1007.Google Scholar
Goodwin, RD, Eaton, WW (2005). Asthma, suicidal ideation, and suicide attempts: findings from the Baltimore epidemiologic catchment area follow-up. American Journal of Public Health 95, 717–722.Google Scholar
Goodwin, RD, Marusic, A, Hoven, CW (2003). Suicide attempts in the United States: the role of physical illness. Social Science and Medicine 56, 1783–1788.CrossRefGoogle ScholarPubMed
Harris, EC, Barraclough, B (1997). Suicide as an outcome for mental disorders. A meta-analysis. British Journal of Psychiatry 170, 205–228.CrossRefGoogle ScholarPubMed
Harris, EC, Barraclough, BM (1994). Suicide as an outcome for medical disorders. Medicine (Baltimore) 73, 281–296.CrossRefGoogle ScholarPubMed
Hawton, K, van Heeringen, K (2009). Suicide. Lancet 373, 1372–1381.CrossRefGoogle ScholarPubMed
HHS (2012). National Strategy for Suicide Prevention: Goals and Objectives for Action. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General and National Action Alliance for Suicide Prevention: Washington, DC.Google Scholar
Kapusta, ND, Tran, US, Rockett, IR, De Leo, D, Naylor, CP, Niederkrotenthaler, T, Voracek, M, Etzersdorfer, E, Sonneck, G (2011). Declining autopsy rates and suicide misclassification: a cross-national analysis of 35 countries. Archives of General Psychiatry 68, 1050–1057.Google Scholar
Kim, HM, Smith, EG, Stano, CM, Ganoczy, D, Zivin, K, Walters, H, Valenstein, M (2012). Validation of key behaviorally based mental health diagnoses in administrative data: suicide attempt, alcohol abuse, illicit drug abuse and tobacco use. BMC Health Services Research 12, 18.CrossRefGoogle ScholarPubMed
Kozyrskyj, A, Lix, L, Dahl, M, Soodeen, R (2005). High-Cost Users of Pharmaceuticals: Who Are They? Manitoba Centre for Health Policy: Winnipeg, MB.Google Scholar
Lossnitzer, N, Muller-Tasch, T, Lowe, B, Zugck, C, Nelles, M, Remppis, A, Haass, M, Rauch, B, Junger, J, Herzog, W, Wild, B (2009). Exploring potential associations of suicidal ideation and ideas of self-harm in patients with congestive heart failure. Depression and Anxiety 26, 764–768.Google Scholar
MacLean, J, Kinley, DJ, Jacobi, J, Bolton, JM, Sareen, J (2011). The relationship between physical conditions and suicidal behavior among those with mood disorders. Journal of Affective Disorders 130, 245–250.Google Scholar
Martens, PJ (2010). A Profile of Metis Health Status and Healthcare Utilization in Manitoba: A Population-Based Study. Manitoba Centre for Health Policy: Winnipeg, MB.Google Scholar
Misono, S, Weiss, NS, Fann, JR, Redman, M, Yueh, B (2008). Incidence of suicide in persons with cancer. Journal of Clinical Oncology 26, 4731–4738.Google Scholar
Mortensen, PB, Agerbo, E, Erikson, T, Qin, P, Westergaard-Nielsen, N (2000). Psychiatric illness and risk factors for suicide in Denmark. Lancet 355, 9–12.Google Scholar
Pompili, M, Lester, D, Iliceto, P, Tatarelli, R, Girardi, P (2007). No increase in suicide risk among cardiopathic patients. American Heart Hospital Journal 5, 103–106.Google Scholar
Radobuljac, MD, Bratina, NU, Battelino, T, Tomori, M (2009). Lifetime prevalence of suicidal and self-injurious behaviors in a representative cohort of Slovenian adolescents with type 1 diabetes. Pediatric Diabetes 10, 424–431.Google Scholar
Rasic, DT, Belik, SL, Bolton, JM, Chochinov, HM, Sareen, J (2008). Cancer, mental disorders, suicidal ideation and attempts in a large community sample. Psychooncology 17, 660–667.Google Scholar
Robinson, D, Renshaw, C, Okello, C, Moller, H, Davies, EA (2009). Suicide in cancer patients in South East England from 1996 to 2005: a population-based study. British Journal of Cancer 101, 196–201.CrossRefGoogle Scholar
Roos, LL, Nicol, JP (1999). A research registry: uses, development, and accuracy. Journal of Clinical Epidemiology 52, 39–47.Google Scholar
Roy-Byrne, PP, Davidson, KW, Kessler, RC, Asmundson, GJG, Goodwin, RD, Kubzansky, L, Lydiard, RB, Massie, MJ, Katon, W, Laden, SK, Stein, MB (2008). Anxiety disorders and comorbid medical illness. General Hospital Psychiatry 30, 208–225.Google Scholar
Sareen, J, Cox, BJ, Afifi, TO, Clara, IP, Yu, BN (2005). Perceived need for mental health treatment in a nationally representative Canadian sample. Canadian Journal of Psychiatry 50, 643–651.Google Scholar
Scott, KM, Bruffaerts, R, Tsang, A, Ormel, J, Alonso, J, Angermeyer, MC, Benjet, C, Bromet, E, de Girolamo, G, de Graaf, R, Gasquet, I, Gureje, O, Haro, JM, He, Y, Kessler, RC, Levinson, D, Mneimneh, ZN, Oakley Browne, MA, Posada-Villa, J, Stein, DJ, Takeshima, T, Von Korff, M (2007). Depression-anxiety relationship with chronic physical conditions: results from the World Mental Health Surveys. Journal of Affective Disorders 103, 113–120.Google Scholar
Tidemalm, D, Langstrom, N, Lichtenstein, P, Runeson, B (2008). Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up. British Medical Journal 337, 1–6.Google Scholar
Turaga, KK, Malafa, MP, Jacobsen, PB, Schell, MJ, Sarr, MG (2011). Suicide in patients with pancreatic cancer. Cancer 117, 642–647.CrossRefGoogle ScholarPubMed
Webb, RT, Kontopantelis, E, Doran, T, Qin, P, Creed, F, Kapur, N (2012). Suicide risk in primary care patients with major physical diseases: a case-control study. Archives of General Psychiatry 69, 256–264.Google Scholar
Yang, B, Lester, D (2007). Recalculating the economic cost of suicide. Death Studies 31, 351–361.Google Scholar
Supplementary material: File

Bolton Supplementary Material

Appendix

Download Bolton Supplementary Material(File)
File 31.2 KB