title: Future risk of labour market marginalization in young suicide attempters--a population-based prospective cohort study.
abstract: BACKGROUND
  Research on future labour market marginalization following suicide attempt at young age is scarce. We investigated the effects of suicide attempts on three labour market outcomes: unemployment, sickness absence and disability pension.
  
  
  METHODS
  We conducted a prospective cohort study based on register linkage of 1,613,816 individuals who in 1994 were 16-30 years old and lived in Sweden. Suicide attempters treated in inpatient care during the 3 years preceding study entry, i.e. 1992-94 (N=5649) were compared with the general population of the same age without suicide attempt between 1973 and 2010 (n=1,608,167). Hazard ratios (HRs) for long-term unemployment (>180 days), sickness absence (>90 days) and disability pension in 1995-2010 were calculated by Cox regression models, adjusted for a number of parental and individual risk markers, and stratified for previous psychiatric inpatient care not due to suicide attempt.
  
  
  RESULTS
  The risks for unemployment [HR 1.58; 95% confidence interval (CI) 1.52-1.64], sickness absence (HR 2.16; 2.08-2.24) and disability pension (HR 4.57; 4.34-4.81) were considerably increased among suicide attempters. There was a dose-response relationship between number of suicide attempts and the risk of disability pension, for individuals both with or without previous psychiatric hospitalizations not due to suicide attempts. No such relationship was present with regard to unemployment.
  
  
  CONCLUSIONS
  This study highlights the strong association of suicide attempts with future marginalization from the labour market, particularly for outcomes that are based on a medical assessment. Studies that focus only on unemployment may largely underestimate the true detrimental impact of suicide attempt on labour market marginalization.
authors.affiliation: Medical University Vienna, Center for Public Health, Institute of Social Medicine, Vienna, Austria, Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, Stockholm, Sweden, Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatric Research, Stockholm, Sweden and Columbia University, NYS Psychiatric Institute, New York, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Niederkrotenthaler
authors.affiliation: Medical University Vienna, Center for Public Health, Institute of Social Medicine, Vienna, Austria, Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, Stockholm, Sweden, Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatric Research, Stockholm, Sweden and Columbia University, NYS Psychiatric Institute, New York, USA.
authors.forename: Petter
authors.initials: P
authors.lastname: Tinghög
authors.affiliation: Medical University Vienna, Center for Public Health, Institute of Social Medicine, Vienna, Austria, Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, Stockholm, Sweden, Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatric Research, Stockholm, Sweden and Columbia University, NYS Psychiatric Institute, New York, USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Alexanderson
authors.affiliation: Medical University Vienna, Center for Public Health, Institute of Social Medicine, Vienna, Austria, Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, Stockholm, Sweden, Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatric Research, Stockholm, Sweden and Columbia University, NYS Psychiatric Institute, New York, USA.
authors.forename: Marie
authors.initials: M
authors.lastname: Dahlin
authors.affiliation: Medical University Vienna, Center for Public Health, Institute of Social Medicine, Vienna, Austria, Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, Stockholm, Sweden, Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatric Research, Stockholm, Sweden and Columbia University, NYS Psychiatric Institute, New York, USA.
authors.forename: Mo
authors.initials: M
authors.lastname: Wang
authors.affiliation: Medical University Vienna, Center for Public Health, Institute of Social Medicine, Vienna, Austria, Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, Stockholm, Sweden, Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatric Research, Stockholm, Sweden and Columbia University, NYS Psychiatric Institute, New York, USA.
authors.forename: Karin
authors.initials: K
authors.lastname: Beckman
authors.affiliation: Medical University Vienna, Center for Public Health, Institute of Social Medicine, Vienna, Austria, Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, Stockholm, Sweden, Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatric Research, Stockholm, Sweden and Columbia University, NYS Psychiatric Institute, New York, USA.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Gould
authors.affiliation: Medical University Vienna, Center for Public Health, Institute of Social Medicine, Vienna, Austria, Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, Stockholm, Sweden, Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatric Research, Stockholm, Sweden and Columbia University, NYS Psychiatric Institute, New York, USA ellenor.mittendorfer-rutz@ki.se.
authors.forename: Ellenor
authors.initials: E
authors.lastname: Mittendorfer-Rutz
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D015994:Incidence; D008297:Male; D010415:Pensions / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data*; D062487:Social Marginalization; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: Attempted suicide; Sweden; cohort studies; disability insurance; sick leave; social marginalization; unemployment