title: Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up.
abstract: 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.
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Division of Psychiatry, St Göran, SE-112 81 Stockholm, Sweden. dag.tidemalm@ki.se
authors.forename: Dag
authors.initials: D
authors.lastname: Tidemalm
authors.forename: Niklas
authors.initials: N
authors.lastname: Långström
authors.forename: Paul
authors.initials: P
authors.lastname: Lichtenstein
authors.forename: Bo
authors.initials: B
authors.lastname: Runeson
mesh_terms: 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