Stress and suicide in the Nurses' Health Study.
OBJECTIVE
Although stress is thought to be a risk factor for suicide, most research has been retrospective or has focused on attempted suicides or suicide ideation. This study examined prospectively the associations between self perceived stress, diazepam use, and death from suicide among adult women.


METHODS
A cohort study was conducted with 14 years of follow up. Stress at home and at work were assessed by questionnaire and scored on a four point scale: minimal, light, moderate, or severe.


METHODS
Eleven states within the United States.


METHODS
Female nurses (n=94 110) who were 36 to 61 years of age when they answered questions on stress and diazepam use in 1982.


RESULTS
During 1 272 000 person years of observation 73 suicides were identified. After adjustment for age, smoking, coffee consumption, alcohol intake, and marital status, the relation between self reported stress and suicide remained U shaped. Compared with the light home and work stress categories, which had the lowest incidences of suicide, risks were increased among women reporting either severe (relative risk (RR) = 3.7, 95% confidence intervals (CI) 1.7 to 8.3) or minimal (RR=2.1, 95% CI 1.0 to 4.5) home stress and either severe (RR=1.9, 95% CI 0.8 to 4.7) or minimal (RR=2.4, 95% CI 0.9 to 6.1) work stress. When responses to home and work stress were combined, there was an almost fivefold increase in risk of suicide among women in the high stress category. Risk of suicide was over eightfold among women reporting high stress or diazepam use compared with those reporting low stress and no diazepam use.


CONCLUSIONS
The relation between self reported stress and suicide seems to be U shaped among adult women. The excess risk for those reporting minimal stress may reflect denial or undiagnosed depression or an association with some other unmeasured risk factor for suicide.
Feskanich
D
D
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. diane.feskanich@channing.harvard.edu
Hastrup
J L
JL
Marshall
J R
JR
Colditz
G A
GA
Stampfer
M J
MJ
Willett
W C
WC
Kawachi
I
I
D000328:Adult; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003975:Diazepam / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D009726:Nurses / Q000523:psychology; D009784:Occupational Diseases / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D012650:Self Disclosure; D013222:State Medicine; D013315:Stress, Psychological / Q000209:etiology*; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States; D017132:Workplace / Q000523:psychology
D014151:Anti-Anxiety Agents; D003975:Diazepam