title: Suicide in married couples in Sweden: Is the risk greater in same-sex couples?
abstract: Minority sexual orientation is a predictor of suicide ideation and attempts, though its association with suicide mortality is less clear. We capitalize on Sweden's extensively linked databases, to investigate whether, among married individuals, same-sex marriage is associated with suicide. Using a population-based register design, we analyzed suicide risk among same-sex married women and men (n = 6456), as compared to different-sex married women and men (n = 1181723) in Sweden. We selected all newly partnered or married individuals in the intervening time between 1/1/1996 and 12/31/2009 and followed them with regard to suicide until 12/31/2011. Multivariate Poisson regression was used to calculate adjusted incidence risk ratios (IRR) with 95 % confidence intervals (CI). The risk of suicide was higher among same-sex married individuals as compared to different-sex married individuals (IRR 2.7, 95 % CI 1.5-4.8), after adjustment for time at risk and socioeconomic confounding. Sex-stratified analyses showed a tentatively elevated risk for same-sex married women (IRR 2.5, 95 % CI 0.8-7.7) as compared to different-sex married women. Among same-sex married men the suicide risk was nearly three-fold greater as compared to different-sex married (IRR 2.895 % CI 1.5-5.5). This holds true also after adjustment for HIV status. Even in a country with a comparatively tolerant climate regarding homosexuality such as Sweden, same-sex married individuals evidence a higher risk for suicide than other married individuals.
authors.affiliation: Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA. charlotte.bjorkenstam@ki.se.|Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. charlotte.bjorkenstam@ki.se.|Department of Sociology, Stockholm University, Stockholm, Sweden. charlotte.bjorkenstam@ki.se.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Björkenstam
authors.affiliation: Department of Sociology, Stockholm University, Stockholm, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Andersson
authors.affiliation: Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Christina
authors.initials: C
authors.lastname: Dalman
authors.affiliation: Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Cochran
authors.affiliation: Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Kyriaki
authors.initials: K
authors.lastname: Kosidou
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005191:Family Characteristics; D005260:Female; D020010:Heterosexuality / Q000523:psychology / Q000706:statistics & numerical data*; D006716:Homosexuality / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008393:Marriage; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D012725:Sexual Behavior / Q000523:psychology*; D012931:Social Environment; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: Gay; Homosexual; LGBT; Lesbian; Marriage; Registered partnership; Sexual minority; Suicide