title: Suicide and pesticide use among pesticide applicators and their spouses in the agricultural health study.
abstract: BACKGROUND
  An association may exist between pesticide exposure and suicide.
  
  
  OBJECTIVE
  We sought to evaluate the existence of an association between pesticide use and suicide using data from the Agricultural Health Study (AHS), a prospective cohort study of licensed pesticide applicators and their spouses in Iowa and North Carolina.
  
  
  METHODS
  Via linkage to state mortality files and the National Death Index, we identified 110 suicides occurring between enrollment in the AHS (from 1993 to 1997) and 31 May 2009, among 81,998 cohort members contributing 1,092,943 person-years of follow-up. The average length of follow-up was 13.3 years. AHS participants provided data on pesticide use and potential confounders via self-administered questionnaires at enrollment. We evaluated several measures of pesticide use: use of any pesticide, ever use of 50 specific pesticides, cumulative lifetime days of use and intensity-adjusted cumulative lifetime days of use of 22 specific pesticides, and ever use of 10 functional and chemical classes of pesticides. We used Cox proportional hazards regression models to estimate adjusted hazard ratios and 95% confidence intervals.
  
  
  RESULTS
  After adjusting for age at enrollment, sex, number of children in family, frequency of alcohol consumption during the past 12 months, and smoking status, we found no association between prior pesticide use and suicide in applicators and their spouses. Results were the same for applicators and spouses together or for applicators alone and were consistent across several measures of pesticide use.
  
  
  CONCLUSIONS
  Our findings do not support an association between moderate pesticide use and suicide.
authors.affiliation: Department of Health Science, College of Life Sciences, Brigham Young University, Provo, Utah, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Beard
authors.forename: David M
authors.initials: DM
authors.lastname: Umbach
authors.forename: Jane A
authors.initials: JA
authors.lastname: Hoppin
authors.forename: Marie
authors.initials: M
authors.lastname: Richards
authors.forename: Michael C R
authors.initials: MC
authors.lastname: Alavanja
authors.forename: Aaron
authors.initials: A
authors.lastname: Blair
authors.forename: Dale P
authors.initials: DP
authors.lastname: Sandler
authors.forename: Freya
authors.initials: F
authors.lastname: Kamel
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007484:Iowa / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D016273:Occupational Exposure; D010575:Pesticides / Q000633:toxicity*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D018454:Spouses; D013405:Suicide / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D010575:Pesticides