title: Suicide risk and suicide method in patients with personality disorders.
abstract: The influence of psychopathology on suicide method has revealed different distributions among different psychiatric disorders. However, evidence is still scarce. We hypothesized that having a diagnosis of personality disorder (PD) affect the suicide method, and that different PD clusters would influence the suicide method in different ways. In addition, we hypothesized that the presence of psychiatric and somatic co-morbidity also affects the suicide method.
  
  
  
  We examined 25,217 individuals aged 15-64 who had been hospitalized in Sweden with a main diagnosis of PD the years 1987-2013 (N = 25,217). The patients were followed from the date of first discharge until death or until the end of the follow-up period, i.e. December 31, 2013, for a total of 323,508.8 person-years, with a mean follow up time of 11.7 years. The SMR, i.e. the ratio between the observed number of suicides and the expected number of suicides, was used as a measure of risk.
  
  
  
  Overall PD, different PD-clusters, and comorbidity influenced the suicide method. Hanging evidenced highest SMR in female PD patients (SMR 34.2 (95% CI: 29.3-39.8)), as compared to non-PD patients and jumping among male PD patients (SMR 24.8 (95% CI: 18.3-33.6)), as compared to non PD-patients. Furthermore, the elevated suicide risk was related to both psychiatric and somatic comorbidity.
  
  
  
  The increased suicide risk was unevenly distributed with respect to suicide method and type of PD. However, these differences were only moderate and greatly overshadowed by the overall excess suicide risk in having PD. Any attempt from society to decrease the suicide rate in persons with PD must take these characteristics into account.
authors.affiliation: Department of Clinical Neurosciences, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA; Department of Sociology, Stockholm University, Stockholm, Sweden. Electronic address: charlotte.bjorkenstam@ki.se.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Björkenstam
authors.affiliation: Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
authors.forename: Lisa
authors.initials: L
authors.lastname: Ekselius
authors.affiliation: Department of Sociology, Stockholm University, Stockholm, Sweden; Department of Statistics, Monitoring and Evaluation, National Board of Health and Welfare, Stockholm, Sweden.
authors.forename: Marie
authors.initials: M
authors.lastname: Berlin
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Gerdin
authors.affiliation: Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences, Fielding School of Public Health and California Center for Population Research, University of California Los Angeles, Los Angeles, CA, USA.
authors.forename: Emma
authors.initials: E
authors.lastname: Björkenstam
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D010554:Personality Disorders / Q000453:epidemiology* / Q000523:psychology*; D012189:Retrospective Studies; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data*; D013548:Sweden; D055815:Young Adult
keywords: Personality disorder; Register; Suicide; Suicide method; Sweden