title: Suicide loss, changes in medical care utilization, and hospitalization for cardiovascular disease and diabetes mellitus.
abstract: OBJECTIVE
  The impact of suicide loss on family members' cardiometabolic health has little been evaluated in middle-aged and elderly people. We investigated the effect of suicide loss on risks for cardiovascular disease (CVD) and diabetes mellitus (DM) in suicide completers' family members using a national representative comparison group.
  
  
  RESULTS
  The study subjects were 4253 family members of suicide completers and 9467 non-bereaved family members of individuals who were age and gender matched with the suicide completers in the Republic of Korea. National health insurance data were used to identify medical care utilization during the year before and after a suicide loss. A recurrent-events survival analysis was performed to estimate the hazard ratios (HRs) of hospitalizations for CVD, DM, or psychiatric disorders, after adjusting for age, residence, and socioeconomic status. Among subjects without a past history of CVD, DM, or psychiatric disorders, the increased risks of recurrent hospitalizations were observed for CVD [HR 1.343, 95% confidence interval (CI) 1.001-1.800 in men; HR 1.240, 95% CI 1.025-1.500 in women] and DM (HR 2.238, 95% CI 1.379-3.362 in men; HR 1.786, 95% CI 1.263-2.527 in women). In subjects with a past history of CVD, DM, or psychiatric disorders, the number of medical care visits decreased after a suicide loss, and suicide completers' family members showed lower rates of hospitalization for CVD and DM than the comparison group.
  
  
  CONCLUSIONS
  Compared with non-bereaved family members, suicide completers' family members without a past history of CVD, DM, or psychiatric disorder showed a high risk of hospitalization for those conditions.
authors.affiliation: Department of Occupational and Environmental Medicine, Gachon University Gil Medical Center, 774 Namdong-daero, Incheon, Republic of Korea.
authors.forename: Jaelim
authors.initials: J
authors.lastname: Cho
authors.affiliation: Department of Preventive Medicine, School of Medicine, Ewha Womans University, Anyangcheon-ro, Seoul, Republic of Korea.
authors.forename: Sang Hyuk
authors.initials: SH
authors.lastname: Jung
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seoul, Republic of Korea Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA preman@yuhs.ac.
authors.forename: Changsoo
authors.initials: C
authors.lastname: Kim
authors.affiliation: National Cancer Center, 323 Ilsan-ro, Goyang, Republic of Korea.
authors.forename: Mina
authors.initials: M
authors.lastname: Suh
authors.affiliation: Research and Development Center, Health Insurance Review and Assessment Service, 267 Hyoryung-ro, Seoul, Republic of Korea.
authors.forename: Yoon Jung
authors.initials: YJ
authors.lastname: Choi
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seoul, Republic of Korea.
authors.forename: Jungwoo
authors.initials: J
authors.lastname: Sohn
authors.affiliation: Division of Environmental Health, Korea Environment Institute, 370 Sicheong-daero, Sejong, Republic of Korea.
authors.forename: Seong-Kyung
authors.initials: SK
authors.lastname: Cho
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seoul, Republic of Korea.
authors.forename: Il
authors.initials: I
authors.lastname: Suh
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seoul, Republic of Korea.
authors.forename: Dong Chun
authors.initials: DC
authors.lastname: Shin
authors.affiliation: Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rexrode
mesh_terms: D000328:Adult; D000368:Aged; D001601:Bereavement; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D005190:Family / Q000523:psychology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D056910:Republic of Korea / Q000453:epidemiology; D012111:Residence Characteristics; D012307:Risk Factors; D012423:Rural Health; D012959:Socioeconomic Factors; D013405:Suicide / Q000523:psychology*; D014504:Urban Health
keywords: Cardiovascular disease; Diabetes mellitus; Hospitalization; Suicide loss