title: Are all-cause and diagnosis-specific sickness absence, and sick-leave duration risk indicators for suicidal behaviour? A nationwide register-based cohort study of 4.9 million inhabitants of Sweden.
abstract: OBJECTIVE
  Recent studies have found an increased risk of suicide in people on sickness absence, but less is known about to what extent diagnosis-specific sickness absence is a risk indicator for suicidal behaviour. This study aimed to examine all-cause and diagnosis-specific sickness absence and sick-leave duration as risk indicators for suicide attempt and suicide.
  
  
  METHODS
  This is a population-based prospective cohort study. All non-retired adults (n = 4 923 404) who lived in Sweden as on 31 December 2004 were followed-up for 6 years regarding suicide attempt and suicide (2005-2010). HRs and 95% CIs for suicidal behaviour were calculated, using people with no sick-leave spells in 2005 as reference.
  
  
  RESULTS
  In analyses adjusted for sociodemographic factors and previous mental healthcare, suicide attempt and current antidepressants prescription, sickness absence predicted suicide attempt (HR 2.37; 95% CI 2.25 to 2.50 for women; HR 2.69; 95% CI 2.53 to 2.86 for men) and suicide (HR 1.91; 95% CI 1.60 to 2.29 for women; HR 1.92; 95% CI 1.71 to 2.14 for men), particularly mental sickness absence (range of HR: 2.74-3.64). The risks were also increased for somatic sickness absence, for example, musculoskeletal and digestive diseases and injury/poisoning (range of HR: 1.57-3.77). Moreover, the risks increased with sick-leave duration.
  
  
  CONCLUSIONS
  Sickness absence was a clear risk indicator for suicidal behaviour, irrespective of sick-leave diagnoses, among women and men. Awareness of such risks is recommended when monitoring sickness certification. Further studies are warranted in order to gain more detailed knowledge on these associations.
authors.affiliation: Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mo
authors.initials: M
authors.lastname: Wang
authors.forename: Kristina
authors.initials: K
authors.lastname: Alexanderson
authors.forename: Bo
authors.initials: B
authors.lastname: Runeson
authors.forename: Jenny
authors.initials: J
authors.lastname: Head
authors.forename: Maria
authors.initials: M
authors.lastname: Melchior
authors.forename: Aleksander
authors.initials: A
authors.lastname: Perski
authors.forename: Ellenor
authors.initials: E
authors.lastname: Mittendorfer-Rutz
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications; D011041:Poisoning / Q000150:complications; D011446:Prospective Studies; D012042:Registries; D012306:Risk; D012737:Sex Factors; D018582:Sick Leave; D013405:Suicide; D013406:Suicide, Attempted; D013548:Sweden; D014937:Work; D014947:Wounds and Injuries / Q000150:complications; D055815:Young Adult