Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up.
OBJECTIVE
To investigate the impact of coexistent psychiatric morbidity on risk of suicide after a suicide attempt.


METHODS
Cohort study with follow-up for 21-31 years.


METHODS
Swedish national register based study.


METHODS
39 685 people (53% women) admitted to hospital for attempted suicide during 1973-82.


METHODS
Completed suicide during 1973-2003.


RESULTS
A high proportion of suicides in all diagnostic categories took place within the first year of follow-up (14-64% in men, 14-54% in women); the highest short term risk was associated with bipolar and unipolar disorder (64% in men, 42% in women) and schizophrenia (56% in men, 54% in women). The strongest psychiatric predictors of completed suicide throughout the entire follow-up were schizophrenia (adjusted hazard ratio 4.1, 95% confidence interval 3.5 to 4.8 in men, 3.5, 2.8 to 4.4 in women) and bipolar and unipolar disorder (3.5, 3.0 to 4.2 in men, 2.5, 2.1 to 3.0 in women). Increased risks were also found for other depressive disorder, anxiety disorder, alcohol misuse (women), drug misuse, and personality disorder. The highest population attributable fractions for suicide among people who had previously attempted suicide were found for other depression in women (population attributable fraction 9.3), followed by schizophrenia in men (4.6), and bipolar and unipolar disorder in women and men (4.1 and 4.0, respectively).


CONCLUSIONS
Type of psychiatric disorder coexistent with a suicide attempt substantially influences overall risk and temporality for completed suicide. To reduce this risk, high risk patients need aftercare, especially during the first two years after attempted suicide among patients with schizophrenia or bipolar and unipolar disorder.
Tidemalm
Dag
D
Department of Clinical Neuroscience, Karolinska Institutet, Division of Psychiatry, St Göran, SE-112 81 Stockholm, Sweden. dag.tidemalm@ki.se
Långström
Niklas
N
Lichtenstein
Paul
P
Runeson
Bo
B
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D012307:Risk Factors; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult