Hospitalisation for physical illness and risk of subsequent suicide: a population study.
J Intern Med. 2012 Jul 9;
Authors: Qin P, Webb R, Kapur N, Sørensen HT
OBJECTIVE: To examine suicide risk in relation to physical illness across a broad range of illnesses, including hospitalisation history, specific organ or system illness and comorbidity. DESIGN: A nested case-control study. SETTING: Data were retrieved from five Danish national registers. SUBJECTS: Based on the entire population of Denmark, this study included 27,262 suicide cases and 468,007 live controls matched for sex and date of birth. MAIN OUTCOME MEASURES: Risk of suicide was assessed using conditional logistic regression. RESULTS: In the study population, 63.5% of suicide cases and 44.5% of comparison controls had a history of hospitalisation for physical illness. A physical illness significantly increased the risk of subsequent suicide (IRR 2.13, 95% CI 2.07-2.18) with a substantially greater effect in women than in men (P<0.01). The elevated risk increased progressively with frequency and recency of hospitalisation, and was significant for diseases occurring in all organs or systems of the body. Comorbidity involving several organs or systems increased the risk substantially. The associated estimates were to some extent reduced but remained highly significant after adjustment for psychiatric history and socioeconomic status. Taking into account both prevalence and adjusted effect size, physical illness accounted for 24.4%, 21.0% and 32.3% of population attributable risk for suicide in the total, male and female populations, respectively. CONCLUSIONS: Physical illness constitutes a significant risk factor for suicide independent of psychiatric and socioeconomic factors. Clinicians treating physically ill patients should be aware of the risk, especially among those with multiple or recent hospitalisations, or multiple comorbidities. © 2012 The Association for the Publication of the Journal of Internal Medicine.
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