Risk of suicide by psychiatric diagnosis in Stockholm County

A longitudinal study of 80,970 psychiatric inpatients
  • Christer Allgulander
  • Peter Allebeck
  • Thomas R. Przybeck
  • John P. Rice
Original Articles

Summary

The risk of suicide associated with different psychiatric diagnoses was estimated in 80,970 inpatients in Stockholm County (population 1.6 million). All patients discharged with at least one psychiatric diagnosis between 1973 and 1986 were followed by linkage with the cause-of-death registry through 1987. There were 1,115 definite suicides and 467 undetermined suicides among these during the 15-year follow-up. When 12 diagnostic categories were entered in a proportional hazards model, the highest relative risk (RR) of definite suicide, controlling for sex and age, was noted for affective disorders (RR 2.82), followed by unspecified psychoses (RR 2.69), paranoid psychoses (RR 2.60), addiction to prescription drugs (RR 2.38), neuroses and reactive psychoses (RR 1.96), and schizophrenia (RR 1.64). Alcoholism, personality disorders, organic psychoses, and street drug addiction did not have significantly increased risks of suicide. Male sex increased the risk for definite suicide by 1.56, while the risk was somewhat higher among the young. Having more than one diagnosis increased the relative risk by 1.42. When undetermined suicides were included in the analysis, to alcoholism and street drug abuse were attributed significantly increased risks of suicide, probably owing to the greater difficulty of verifying such cases. We conclude that several psychiatric disorders were conductive to suicide, but that the risk did not vary much with the type of diagnosis. Further studies of confounders are needed, such as the reasons for being admitted to inpatient care, and the impact of somatic and psychiatric comorbidity.

Key words

Suicide Psychopathology Proportional hazards 

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References

  1. Allebeck P, Wistedt B (1986) Mortality in schizophrenia. Arch Gen Psychiatry 43:650–653Google Scholar
  2. Allebeck P, Allgulander C (1988) Predictors of completed suicide in a cohort of 50,465 young men: role of personality and deviant behaviour. BMJ 297:176–178Google Scholar
  3. Allebeck P, Allgulander C (1990) Suicide among young men: psychiatric illness, deviant behaviour and substance abuse. Acta Psychiatr Scand 81:565–570Google Scholar
  4. Allebeck P, Allgulander C, Henningsohn L, Jakobsson SW (1991) Causes of death in a cohort of 50,465 young men. Validity of recorded suicide as underlying cause of death. Scand J Soc Med 19:242–247Google Scholar
  5. Allgulander C, Ljungberg L, Fisher LD (1987) Long-term prognosis in addiction on sedative and hypnotic drugs analyzed with the Cox regression model. Acta Psychiatr Scand 75:521–531Google Scholar
  6. Allgulander C, Fisher LD (1990) Clinical predictors of completed suicide and repeated self-poisoning in 8895 self-poisoning patients. Eur Arch Psychiatr Neurol Sci 239:270–276Google Scholar
  7. Allgulander C, Lavori PW (1991) Excess mortality among 3302 patients with ‘pure’ anxiety neurosis. Arch Gen Psychiatry 48: 599–602Google Scholar
  8. Angst J, Clayton P (1986) Premorbid personality of depressive, bipolar, and schizophrenic patients with special reference to suicidal issues. Compr Psychiatry 27:511–532Google Scholar
  9. Arato M, Demeter E, Rihmer Z, Somogyi E (1988) Retrospective psychiatric assessment of 200 suicides in Budapest. Acta Psychiatr Scand 77:454–456Google Scholar
  10. Balon R (1987) Suicide, can we predict it? Compr Psychiatry 28: 236–241Google Scholar
  11. Blumenthal SJ (1990) Youth suicide: Risk factors, assessment, and treatment of adolescent and young adult suicidal patients. Psychiatr Clin N Am 13:511–556Google Scholar
  12. Goldstein RB, Black DW, Nasrallah A, Winokur G (1991) The prediction of suicide. Arch Gen Psychiatry 48:418–422Google Scholar
  13. Kalbfleisch JD, Prentice RL (1980) The Statistical Analysis of Failure Time Data. Wiley, New YorkGoogle Scholar
  14. Marttunen MJ, Aro HM, Henriksson MM, Lönnqvist JK (1991) Mental disorders in adolescent suicide. Arch Gen Psychiatry 48:834–839Google Scholar
  15. Miles CP (1977) Conditions predisposing to suicide: A review. J Nerv Mend Dis 1164:231–246Google Scholar
  16. Modestin J (1989) Completed suicide in psychogeriatric patients. Int J Geriatr Psychiatry 4:209–214Google Scholar
  17. Monk M (1987) Epidemiology of suicide. Epidemiol Rev 9:51–69Google Scholar
  18. Murphy GW (1983) On suicide prediction and prevention. Arch Gen Psychiatry 40:343–344Google Scholar
  19. Murphy GE, Wetzel RD (1990) The lifetime risk of suicide in alcoholism. Arch Gen Psychiatry 47:383–392Google Scholar
  20. Pokorny AD (1964) Suicide rates in various psychiatric disorders. J Nerv Ment Dis 139:499–506Google Scholar
  21. Rich CL, Ricketts JE, Fowler RC, Young D (1988) Some differences between men and women who commit suicide. Am J Psychiatry 145:718–722Google Scholar
  22. Robins E (1981) The Final Months. A Study of the Lives of 134 Persons Who Committed Suicide. University Press, New York OxfordGoogle Scholar
  23. Tsuang MT, Woolson RF, Fleming JA (1980) Premature deaths in schizophrenia and affective disorders: An analysis of survival curves and variables affecting the shortened survival. Arch Gen Psychiatry 37:979–983Google Scholar
  24. Vogel R, Wolfersdorf M (1989) Suicide and mental illness in the elderly. Psychopathology 22:202–207Google Scholar

Copyright information

© Springer-Verlag 1992

Authors and Affiliations

  • Christer Allgulander
    • 1
  • Peter Allebeck
    • 2
  • Thomas R. Przybeck
    • 3
  • John P. Rice
    • 4
  1. 1.Department of PsychiatryHuddinge University HospitalStockholmSweden
  2. 2.Department of Community MedicineHuddinge University HospitalStockholmSweden
  3. 3.Department of PsychiatryWashington University School of MedicineSt. LouisUSA
  4. 4.Department of Psychiatry, Division of BiostatisticsWashington University School of MedicienSt. LouisUSA

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