Abstract
BackgroundSuicide in young adults remains an important public health issue in Australia. The attributable risks associated with broader socioeconomic factors, compared to more proximal psychiatric disorders, have not been considered previously in individual-level studies of young adults. This study compared the relative contributions of psychiatric disorder and socio-economic disadvantage associated with suicide in terms of relative and attributable risk in young adults.MethodA population-based case–control study of young adults (18–34 years) compared cases of suicide (n = 84) with randomly selected controls (n = 250) from population catchments in New South Wales (Australia), with exposure information collected from key informant interviews (for both cases and controls). The relative and attributable risk of suicide associated with ICD-10 defined substance use, affective, and anxiety disorder was compared with educational achievement and household income, adjusting for key confounders. Prevalence of exposures from the control group was used to estimate population attributable fractions (PAF).ResultsStrong associations were evident between mental disorders and suicide for both males and females (ORs 3.1 to 18.7). The strongest association was for anxiety disorders (both males and females), followed by affective disorders and substance use disorders. Associations for socio-economic status were smaller in magnitude than for mental disorders for both males and females (ORs 1.1 to 4.8 for lower compared to high SES groups). The combined PAF% for all mental disorders (48% for males and 52% for females) was similar in magnitude to socio-economic status (46% for males and 58% for females).ConclusionSocio-economic status had a similar magnitude of population attributable risk for suicide as mental disorders. Public health interventions to reduce suicide should incorporate socio-economic disadvantage in addition to mental illness as a potential target for intervention.
Highlights
Suicide in young adults remains an important public health issue in Australia
Strong associations were evident between mental disorders and suicide for both males and females in univariable analyses ranging from OR = 3.47 (95%CI 1.71-7.03, P < 0.001) for substance use disorder in males to OR = 18.68 (95%CI3.13-111.34) for anxiety disorders in females (Table 1), which were attenuated following adjustment for socio-economic status and other variables (Table 2)
Anxiety disorders were most strongly associated with suicide (OR = 5.25, 95%CI 1.18-23.45, P = 0.030), followed by Affective Disorders (OR = 3.63, 95%CI 1.48-8.91, P = 0.005), and Substance Use Disorder (OR = 3.26, 95%CI 1.45-7.36, P = 0.004), after adjusting for marital status, family history and socioeconomic status (Table 2)
Summary
Suicide in young adults remains an important public health issue in Australia. The attributable risks associated with broader socioeconomic factors, compared to more proximal psychiatric disorders, have not been considered previously in individual-level studies of young adults. Psychiatric disorders, are relatively uncommon in the general population with median period prevalence ranging from approximately 1% to 12% based on control groups in individual-level, population-based studies [10]. Such prevalences are consistent with 12-month population prevalences found in Australian mental health surveys, ranging from 5% to 14% [11]. These mental disorders have available partially effective treatments and prevention interventions, and so are generally accepted as legitimate targets for a public health approach to suicide prevention
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