Combined influence of serious mental illness and criminal offending on suicide risk in younger adults

  • Roger T. Webb
  • Ping Qin
  • Hanne Stevens
  • Louis Appleby
  • Jenny Shaw
  • Preben Bo Mortensen
Original Paper

Abstract

Purpose

We conducted a national epidemiological study to determine how mental illness and criminal offending combine to influence suicide risk in younger adults.

Methods

Using completely interlinked registers, we generated a nested case–control study from the cohort of all Danish people born 1965 and onwards. We identified 2,384 suicides aged 15–41 years during 1981–2006, and 56,016 age and sex-matched living controls. We examined all criminal charges from 1980, and all psychiatric admissions from 1969 and outpatient episodes from 1995. Exposure odds ratios were estimated using conditional logistic regression models.

Results

A quarter of male and 17 % of female suicides had histories of both criminal justice system contact and secondary care psychiatric treatment, with a marked elevation in risk seen compared with having neither risk factor: male odds ratio (OR) 34.0, 95 % confidence interval (CI) 29.1–39.6; female OR 72.7, CI 49.4–107.1. Among those treated for psychiatric illness, contact with the criminal justice system predicted higher risk: male OR 1.4, CI 1.1–1.7; female OR 1.7, CI 1.1–2.4, although these effects were attenuated and became non-significant with adjustment for socio-demographic risk factors. In men, risk was especially high if first criminal justice system contact occurred before first psychiatric treatment episode, and if these two challenging life events coalesced within a year of each other.

Conclusion

These younger age adults should be monitored carefully for signs of suicidal behaviour. The need for well coordinated multiagency care is indicated, and a broad range of psychiatric illnesses should be considered carefully when assessing their suicide risk.

Keywords

Suicide Forensic psychiatry Offenders Epidemiology 

References

  1. 1.
    Hawton K, van Heeringen K (2009) Suicide. Lancet 373:1372–1381Google Scholar
  2. 2.
    Hoven CW, Mandell DJ, Bertolote JM (2010) Prevention of mental ill-health and suicide: public health perspectives. Eur Psychiatr 25:252–256CrossRefGoogle Scholar
  3. 3.
    WHO (2002) World report on violence and health. World Health Organization, GenevaGoogle Scholar
  4. 4.
  5. 5.
    Rockett IRH (2010) Counting suicides and making suicide count as a public health problem. Crisis 31:227–230PubMedGoogle Scholar
  6. 6.
    Gunnell D, Middleton N (2003) National suicide rates as an indicator of the effect of suicide on premature mortality. Lancet 362:961–962PubMedCrossRefGoogle Scholar
  7. 7.
    Mortensen PB, Agerbo E, Erikson T, Qin P, Westergaard-Nielsen N (2000) Psychiatric illness and risk factors for suicide in Denmark. Lancet 355:9–12PubMedCrossRefGoogle Scholar
  8. 8.
    Evans J, Middleton N, Gunnell D (2004) Social fragmentation, severe mental illness and suicide. Soc Psychiatry Psychiatr Epidemiol 39:165–170PubMedCrossRefGoogle Scholar
  9. 9.
    Phillips MR (2010) Rethinking the role of mental illness in suicide. Am J Psychiatry 167:731–733PubMedCrossRefGoogle Scholar
  10. 10.
    Harris EC, Barraclough B (1997) Suicide as an outcome for mental disorders: a meta-analysis. Br J Psychiatry 170:205–228PubMedCrossRefGoogle Scholar
  11. 11.
    Logan J, Hall J, Karch D (2011) Suicide categories by patterns of known risk factors: a latent class analysis. Arch Gen Psychiatry 68:935–941PubMedCrossRefGoogle Scholar
  12. 12.
    Anckarsäter H, Radovic S, Svennerlind C, Höglund P, Radovic F (2009) Mental disorder is a cause of crime: the cornerstone of forensic psychiatry. Int J Law Psychiatry 32:342–347PubMedCrossRefGoogle Scholar
  13. 13.
    Peterson J, Skeem JL, Hart E, Vidal S, Keith F (2010) Analyzing offense patterns as a function of mental illness to test the criminalization hypothesis. Psychiatr Serv 61:1217–1222PubMedCrossRefGoogle Scholar
  14. 14.
    Munkner R, Haastrup S, Joergensen T, Kramp P (2003) The temporal relationship between schizophrenia and crime. Soc Psychiatry Psychiatr Epidemiol 38:347–353PubMedGoogle Scholar
  15. 15.
    Hodgins S, Mednick SA, Brennan PA, Schulsinger F, Engberg M (1996) Mental disorder and crime: evidence from a Danish birth cohort. Arch Gen Psychiatry 53:489–496PubMedCrossRefGoogle Scholar
  16. 16.
    Pandiani JA, Banks SM, Carroll BB, Schuleter MR (2007) Crime victims and criminal offenders among adults with serious mental illness. Psychiatr Serv 58:1483–1485PubMedCrossRefGoogle Scholar
  17. 17.
    Fazel S, Cartwright J, Norman-Nott A, Hawton K (2008) Suicide in prisoners: a systematic review of risk factors. J Clin Psychiatry 69:1721–1731PubMedCrossRefGoogle Scholar
  18. 18.
    Pratt D, Piper M, Appleby L, Webb R, Shaw J (2006) Suicide in recently prisoners: a population-based cohort study. Lancet 368:119–123PubMedCrossRefGoogle Scholar
  19. 19.
    Binswanger IA, Stern MF, Deyo RA, Heagerty PJ, Cheadle A, Elmore JG, Koepsell TD (2007) Release from prison: a high risk of death for former inmates. N Engl J Med 356:157–165PubMedCrossRefGoogle Scholar
  20. 20.
    Spaulding AC, Seals RM, MacCallum VA, Perez SD, Brzozowski AK, Steenland NK (2011) Prisoner survival inside and outside of the institution: implications for health-care planning. Am J Epidemiol 173:479–487PubMedCrossRefGoogle Scholar
  21. 21.
    Pritchard C, Cox M, Dawson A (1997) Suicide and ‘violent’ death in a six-year cohort of male probationers compared with the pattern of mortality in the general population: evidence of accumulative socio-psychiatric vulnerability. J R Soc Health 117:180–185PubMedCrossRefGoogle Scholar
  22. 22.
    Sattar G (2003) The death of offenders in England and Wales. Crisis 24:17–23PubMedGoogle Scholar
  23. 23.
    Webb RT, Qin P, Stevens H, Mortensen PB, Appleby L, Shaw J (2011) National study of suicide in all people with a criminal justice history. Arch Gen Psychiatry 68:591–599PubMedCrossRefGoogle Scholar
  24. 24.
    Clarke M, Davies S, Hollin C, Duggan C (2011) Long-term suicide risk in forensic psychiatric patients. Arch Suicide Res 15:16–28PubMedCrossRefGoogle Scholar
  25. 25.
    Pedersen CB, Gøtzshe H, Møller JO, Mortensen PB (2006) The Danish Civil Registration System. A cohort of eight million persons. Dan Med Bull 53:441–449PubMedGoogle Scholar
  26. 26.
    Juel K, Helweg-Larsen K (1999) The Danish registers of causes of death. Dan Med Bull 46:354–357PubMedGoogle Scholar
  27. 27.
    WHO (1967) Manual of the International Classification of Diseases (ICD-8). World Health Organization, GenevaGoogle Scholar
  28. 28.
    WHO (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization, GenevaGoogle Scholar
  29. 29.
    Linsley KR, Schapira K, Kelly TP (2001) Open verdict vs. suicide—importance to research. Br J Psychiatry 178:465–468PubMedCrossRefGoogle Scholar
  30. 30.
    Atkinson MW, Kessel N, Dalgaard JB (1975) The comparability of suicide rates. Br J Psychiatry 127:247–256PubMedCrossRefGoogle Scholar
  31. 31.
    Walsh D, Mosbech J, Adelstein A, Spooner J, Dean G (1984) Suicide and self-poisoning in three countries—a study from Ireland, England and Wales, and Denmark. Int J Epidemiol 13:472–474PubMedCrossRefGoogle Scholar
  32. 32.
    Kyvsgaard B (2003) The Criminal Career: the Danish Longitudinal Study. Cambridge University Press, CambridgeGoogle Scholar
  33. 33.
    Munk-Jørgensen P, Mortensen PB (1997) The Danish psychiatric central register. Dan Med Bull 44:82–84PubMedGoogle Scholar
  34. 34.
    Qin P, Agerbo E, Mortensen PB (2003) Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997. Am J Psychiatry 160:765–772PubMedCrossRefGoogle Scholar
  35. 35.
    Danmarks Statistik (Statistics Denmark) (1991) IDA—en integret database for arbejdsmarkedsforskning. [IDA—an integrated database for labor market research]. Danmarks Statistiks trykkeri, CopenhagenGoogle Scholar
  36. 36.
    Clayton D, Hills M (1993) Statistical models in epidemiology. Oxford University Press, OxfordGoogle Scholar
  37. 37.
    Rothman KJ, Greenland S (eds) (1998) Modern epidemiology, 2nd edn. Lippincott-Raven, PhiladelphiaGoogle Scholar
  38. 38.
    Hennessy S, Bilker WB, Berlin JA, Strom BL (1999) Factors influencing the optimal control-to-case ratio in matched case-control studies. Am J Epidemiol 149:195–197PubMedCrossRefGoogle Scholar
  39. 39.
    McNamee R (2005) Regression modelling and other methods to control confounding. Occup Environ Med 62:500–506PubMedCrossRefGoogle Scholar
  40. 40.
    Qin P, Nordentoft M (2005) Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Arch Gen Psychiatry 62:427–432PubMedCrossRefGoogle Scholar
  41. 41.
    Gravseth HM, Mehlum L, Bjerkedal T, Kristensen P (2010) Suicide in young Norwegians in a life course perspective: population-based cohort study. J Epidemiol Community Health 64:407–412PubMedCrossRefGoogle Scholar
  42. 42.
    Haycock J (1993) Double jeopardy: suicide rates in forensic hospitals. Suicide Life Threat Behav 23:130–138PubMedGoogle Scholar
  43. 43.
    Reiter K (1974) Mortality and cause of death in men found to be mentally abnormal by forensic psychiatrists. Scand J Soc Med 2:1–3PubMedGoogle Scholar
  44. 44.
    Heikkinen M, Aro H, Lonnqvist J (1994) Recent life events, social support and suicide. Acta Psychiatr Scand Suppl 377:65–72PubMedCrossRefGoogle Scholar
  45. 45.
    Foster T (2011) Adverse life events proximal to adult suicide: a synthesis of findings from psychological autopsy studies. Arch Suicide Res 15:1–15PubMedCrossRefGoogle Scholar
  46. 46.
    Cooper J, Appleby L, Amos T (2002) Life events preceding suicide by young people. Soc Psychiatry Psychiatr Epidemiol 37:271–275PubMedCrossRefGoogle Scholar
  47. 47.
    Breslow NE, Day NE (1980) Statistical methods in cancer research, Volume I: the analysis of case–control studies. WHO/International Agency for Research on Cancer, LyonGoogle Scholar
  48. 48.
    Mortensen PB, Allebeck P, Munk-Jørgensen P (1996) Population-based registers in psychiatric research. Nord J Psychiatry 50:67–72CrossRefGoogle Scholar
  49. 49.
    Pokorny AD (1983) Prediction of suicide in psychiatric patients. Report of a prospective study. Arch Gen Psychiatry 40:249–257PubMedCrossRefGoogle Scholar
  50. 50.
    Mortensen PB (1999) Can suicide research lead to suicide prevention? Acta Psychiatr Scand 99:397–398PubMedCrossRefGoogle Scholar
  51. 51.
    HM Government (2011) Consulting on preventing suicide in England: a cross-government outcomes strategy to save lives. http://www.dh.gov.uk

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Roger T. Webb
    • 1
  • Ping Qin
    • 2
  • Hanne Stevens
    • 2
  • Louis Appleby
    • 1
  • Jenny Shaw
    • 1
  • Preben Bo Mortensen
    • 2
  1. 1.Centre for Suicide Prevention, Centre for Mental Health and RiskUniversity of ManchesterManchesterUK
  2. 2.National Centre for Register-based ResearchUniversity of AarhusAarhus CDenmark

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