Suicide In Sweden Research Articles

Economic burden of suicide in Sweden in 2022

Abstract Background Suicide and suicidal behaviors bring massive human, social and economic impacts. Estimates of the cost of suicide can give some guidance as to where research on developing new interventions might be focused to give the greatest potential gain. The aim of the study is to quantify the economic cost of suicide in Sweden in 2022. Methods Incidence of suicide attempts and mortality due to suicide, intentional and undetermined (ICD10 X60-X84 and Y10-Y34) were sourced from the Swedish National Board of Health and Welfare databases for 2022. Cost were estimated from a societal perspective, including costs for inpatient and outpatient care, medication, police and justice activities as well as productivity losses due to early mortality. Results In 2022, a total of 1,569 suicide death were registered in Sweden (1,102 men and 467 women). The incidence rate remains stable during the last ten years, 17 death per 100 000. In total, 18,854 patients (10, 359 women and 8,459 men) were treated in inpatient and outpatient hospital care with suicide-related diagnoses, generated 32,843 days in inpatient care and 11,471 outpatient care visits. Direct costs for suicide death including forensic examination, emergency services, police investigation and property damage were estimated as €6,02 million, while indirect costs for productivity losses totaled €690 million. Direct healthcare costs for suicide related treatment were estimated at €54.3 million. Overall, suicide and suicide attempts cost around €750 million per year to society. Conclusions Estimates of the economic burden of suicide are needed for the Swedish setting, and these amounted to €60.3 million in direct costs and €690 million in indirect costs in 2022. The cost might be underestimated because the societal cost of suicide bereaved persons was not considered. These cost estimates can provide useful inputs to a cost-effectiveness analysis of a specific preventive intervention, and to its subsequent evaluation. Key messages • Economic burden of suicide is substantial for society. • Public health policies aimed at the prevention of suicide should be increased.

Last general practitioner consultation during the final month of life: a national medical record review of suicides in Sweden

ObjectivesIndividuals who die by suicide often consult their general practitioners (GPs) in their final weeks of life. The aim of this study was to gain a deeper knowledge of the clinical characteristics and GP assessments and treatments among individuals who consulted their GPs during the month preceding suicide. Further, we compared these features in those with and without contact with psychiatric services (PC and NPC, respectively) during the two years that preceded the suicide.DesignA nationwide retrospective explorative study investigating medical records.SettingPrimary care in Sweden.ParticipantsIndividuals who died by suicide in Sweden in 2015 with a GP visit within 30 days of death.ResultsThe study cohort corresponds to one fifth (n = 238) of all suicides that occurred in Sweden in 2015 (n = 1179), representing all those with available primary care records showing contact with a GP during the final 30 days of life (NPC: n = 125; PC: n = 113). The mean age was 58 years ± 19. Patients in the NPC group were older (NPC: 63 years ± 19 vs. PC: 53 years ± 18, p < 0.0001) and presented psychiatric symptoms less often (NPC: 50% vs. PC: 67%, p < 0.006). Somatic symptoms were as common as psychiatric symptoms for the whole sample, being present in more than half of individuals. Suicide risk was noted in only 6% of all individuals. Referral to psychiatric services occurred in 14%, less commonly for the NPC group (NPC: 6% vs. PC: 22%, p < 0.001). Cardiovascular or respiratory symptoms were noted in 19%, more often in the NPC group (NPC: 30% vs. PC: 6%, p < 0.001), as were diagnoses involving the circulatory system (all 10%, NPC:14% vs. PC: 5%, p < 0.020).ConclusionA high level of somatic symptoms was observed in primary care patients both with and without psychiatric contact, and this might have influenced GPs’ management decisions. Psychiatric symptoms were noted in two thirds of those with psychiatric contact but only half of those without. While GPs noted psychiatric symptoms in over half of all individuals included in the study, they seldom noted suicide risk. These findings highlight the need for increased attention to psychiatric symptoms and suicide risk assessment, particularly among middle-aged and older individuals presenting with somatic symptoms.Strengths and limitations of this studyThe National Cause of Death Register has excellent coverage of suicide deaths and access to medical records was very good. The medical record review provided detailed information regarding primary care utilization before death by suicide. Because of the lack of statistical power, due to the limited number of persons with GP contact during the last month of life, we chose not to correct for multiple comparisons. Our study approach did not capture the reasons behind GPs’ documentation of elevated suicide risk. No systematic inter-rater reliability (IRR) testing was made, however, reviewers received training and continuous support from the research group.

Lethal injuries in single stabs to the trunk – A study on homicides and suicides in Sweden

IntroductionHomicides using knives or other sharp objects are the most common type of homicide in Europe, and the second most common type of homicide worldwide. In contrast, suicides using sharp objects are rarer, constituting only a few per cent of all suicides in western countries. We investigated single stab injuries to the trunk in both homicides and suicides to assess differences in extent of injuries and in medical care, which could be of value for trauma management, public health and forensic assessment. MethodsWe identified all cases in Sweden between 2010 and 2021 that died of a single stab to the trunk, in either a homicide (n = 94) or a suicide (n = 45), and that were the subject of a forensic autopsy. We obtained data on demographics, hospital care and injured structures. To assess the severity of injuries, we applied AIS (Abbreviated Injury Score) and NISS (New Injury Severity Score). The inter-rater reliability of NISS between two raters was evaluated with intra-class correlation (ICC), with 95 % confidence intervals (CI). The data was analysed using Fisher's exact test, Mann-Whitney U test and logistic regression models. ResultsThe inter-rater reliability between the two NISS raters showed an ICC of 0.87 (95 % CI 0.68−0.95). We observed a larger variation of injuries in suicides, with a higher proportion of both unsurvivable (NISS 75) and minor injuries (NISS ≤ 8) (66.7 % and 8.9 % respectively) compared to in homicides (46.8 % and 0 % respectively). We observed a larger proportion of injuries to the heart in suicides (68.9% vs. 46.8 %, p = 0.018). In homicides, injuries involving vessels (52.1% vs. 13.3 %, p < 0.001) and hospital care (56.4 % vs. 8.9 %, p < 0.001) were significantly more common compared to suicides. Discussion and conclusionCausation (self-inflicted or assaults) seems to be associated with characteristics of injury and the likelihood of receiving hospital care. These findings could potentially be valuable for trauma management and forensic assessment of manner of death, however, determining the mortality of the injuries would require a comparison group comprising injured survivors.

Anxiety symptoms preceding suicide: A Swedish nationwide record review

BackgroundThe literature on the relationship between anxiety and suicidal behaviors is limited and findings are mixed. This study sought to determine whether physicians noted anxiety symptoms and suicidality in their patients in the weeks and months before suicide. MethodsData were derived from a nationwide medical record review of confirmed suicides in Sweden in 2015. Individuals with at least one documented physician consultation in any health care setting during 12 months before suicide (N = 956) were included. Clinical characteristics were compared between decedents with and without a notation of anxiety symptoms. Odds ratios were calculated to estimate associations between anxiety symptoms and suicidality in relation to suicide proximity. ResultsAnxiety symptoms were noted in half of individuals 1 week before suicide. Patients with anxiety were characterized by high rates of depressive symptoms, ongoing substance use issues, sleeping difficulties, and fatigue. After adjustment for mood disorders, the odds of having a notation of elevated suicide risk 1 week before death were doubled in persons with anxiety symptoms. Associations were similar across time periods (12 months – 1 week). Two-thirds had been prescribed antidepressants at time of death. LimitationsData were based on physicians' notations which likely resulted in underreporting of anxiety depending on medical specialty. Records were not available for all decedents. ConclusionsAnxiety symptoms were common in the final week before suicide and were accompanied by increases in documented elevated suicide risk. Our findings can inform psychiatrists, non-psychiatric specialists, and GPs who meet and assess persons with anxiety symptoms.

Fatal Intoxications with Zopiclone-A Cause for Concern?

Zopiclone, a controlled substance prescribed for insomnia, has become a common toxicological finding in forensic autopsy cases. This study investigated the role and extent of zopiclone use in fatal intoxications in Sweden. All forensic autopsy cases positive for zopiclone in femoral blood during 2012-2020 were selected. Among these cases, fatalities caused by intoxication according to the cause of death certificates issued by the forensic pathologist were identified. Intoxications where zopiclone contributed to the cause of death were included in the study. The Swedish Prescribed Drug Register was utilized to examine whether the included cases were prescribed zopiclone or not. In total 7320 fatal intoxications underwent a forensic autopsy during the study period, 573 of them were caused by zopiclone. Among the zopiclone fatalities, 87% (n = 494) had a prescription for zopiclone, and 8% (n = 43) were monointoxications. Most fatalities, 62% (n = 354) were suicides, and zopiclone was involved in about 17% (n = 354) of all intoxication suicides in Sweden. Women were significantly (p < 0.01) overrepresented in suicides with zopiclone, comprising 56% (n = 291) of fatalities. The median age was 55 years among zopiclone intoxications compared with 44 years amongst all fatal intoxications. This study demonstrates that the toxicity of zopiclone can be lethal both in combination with other substances and on its own. Most individuals dying in fatal zopiclone intoxications were prescribed zopiclone, which potentially indicates that a more restrictive prescribing rate could prevent future intoxication deaths, especially when caring for patients with an increased suicide risk.

Increased suicide risk among younger women in winter during full moon in northern Europe. An artifact or a novel finding?

Available evidence suggests that there is no effect of moon phases on suicidal behavior. However, a Finnish study recently reported elevated suicide rates during full-moon, but only among premenopausal women and only in winter. This could not be replicated in an Austrian study and stirred a discussion about whether the Finnish finding was false-positive or if there are unaccounted moderator variables differing between Finland and Austria. The goal of the present study was to provide another replication with data from Sweden, which is geographically more comparable to Finland than Austria. We also investigated the discussed moderator variables latitude and nightly artificial brightness. There were 48,537 suicides available for analysis. The fraction of suicides during the full-moon quarter in winter did not differ significantly from the expected 25% among premenopausal women (23.3%) and in the full sample (24.7%). The incidence risk ratios for full moon quarter in Poisson regression models were 0.96 (95% CI: 0.90–1.02) for premenopausal women and 1.01 (95% CI: 0.99–1.04) for the full sample. According to Bayes-factor analysis, the evidence supports the null-hypothesis (no association) over the alternative hypothesis (some association). We found similar results when we split the data by latitude and artificial nightly brightness, respectively. In line with the Austrian study, there was no increase of suicides in Sweden among premenopausal women in winter during full-moon. The results from the Finnish study are likely false positive, perhaps resulting from problematic but common research and publication practices, which we discuss.

Firearm suicides in Sweden

In a setting with restrictive firearm laws, prevention of firearm deaths is challenging. Around 100 firearm suicides occur annually in Sweden, representing the most common manner of death from firearm use. In order to explore a possible correlation between firearm suicides and firearm availability, legality of firearm possession, and demographic and geographical factors, all firearm suicides in Sweden among adults during the years 2016–2017 were studied. Data were collected from the National Board of Forensic Medicine and the Swedish Police. In total, 221 firearm suicides were found. Most victims were male (99%) and half (49%) were ≥65 years old. Firearm suicide rates were positively correlated with firearm ownership rates in Swedish counties. Legal firearms (80%) and long-barreled firearms (76%) predominated in the overall material, but illegal firearms were common among young suicide victims (18–29 years) and in urban areas. Prevention work needs to emphasize strategies to reach firearm owners at risk of suicide. Local health and healthcare-related factors, as well as geographic and demographic factors, should be considered in tailoring such strategies.

Relation between occupation, gender dominance in the occupation and workplace and suicide in Sweden: a longitudinal study

ObjectivesTo describe the association between occupations and suicide, and to explore the effect of gender dominance in the occupation and in the workplace on the risk of suicide.DesignRegister-based cohort study.Participants3...

Health care utilisation two years prior to suicide in Sweden: a retrospective explorative study based on medical records

ObjectivePrevious literature has suggested that identifying putative differences in health care seeking patterns before death by suicide depending on age and gender may facilitate more targeted suicide preventive approaches. The aim of this study is to map health care utilisation among individuals in the two years prior to suicide in Sweden in 2015 and to examine possible age and gender differences.MethodsDesign: A retrospective explorative study with a medical record review covering the two years preceding suicide.Setting: All health care units located in 20 of Sweden’s 21 regions.Participants: All individuals residing in participating regions who died by suicide during 2015 (n = 949).ResultsAlmost 74% were in contact with a health care provider during the 3 months prior to suicide, and 60% within 4 weeks. Overall health care utilisation during the last month of life did not differ between age groups. However, a higher proportion of younger individuals (< 65 years) were in contact with psychiatric services, and a higher proportion of older individuals (≥ 65 years) were in contact with primary and specialised somatic health care. The proportion of women with any type of health care contact during the observation period was larger than the corresponding proportion of men, although no gender difference was found among primary and specialised somatic health care users within four weeks and three months respectively prior to suicide.ConclusionCare utilisation before suicide varied by gender and age. Female suicide decedents seem to utilise health care to a larger extent than male decedents in the two years preceding death, except for the non-psychiatric services in closer proximity to death. Older adults seem to predominantly use non-psychiatric services, while younger individuals seek psychiatric services to a larger extent.

Utilization of psychiatric services prior to suicide- a retrospective comparison of users with and without previous suicide attempts

Introduction The aim was to investigate psychiatric health care utilization two years before death by suicide among individuals with previous suicide attempts (PSA) compared with those without (NSA). Method A retrospective population-based cohort study was conducted including 484 individuals who died by suicide in Sweden in 2015 and were in contact with psychiatric services within the two years preceding death, identified through the Cause of Death register. Data on psychiatric health care two years before death, including suicide attempts according to notes in the medical record was used. Associations between having at least one PSA vs. NSA and health care utilization were estimated as odds ratios (OR) with 95% confidence intervals (CI) by logistic regression analyses. Results Of the 484 individuals included, 51% had PSA. Those with PSA were more likely than NSA to have received a psychiatric diagnosis [OR 1.96 (CI 95% 1.17–3.30)], to have ongoing psychotropic medication [OR 1.96 (CI 95% 1.15–3.36)] and to have been absent from appointments during the last three months [1.97 (1.25–3.13)]. In addition, elevated suicide risk was more often noted in the psychiatric case records of those with a PSA than those without [OR 2.17 (CI 95% 1.24–3.79)]. Conclusion The results underline the importance of improved suicide risk assessment as well as thorough diagnostic assessment and when indicated, psychiatric treatment as suicide preventive interventions regardless of PSA. Furthermore, the larger proportion of absence from appointments in individuals with PSA may indicate a need of improved alliance between psychiatric care providers and individuals with PSA. HIGHLIGHTS Being assessed with elevated suicide risk was more common among those with previous attempt/s (PSA). One-fifth of all with no previous attempt (NSA) had no psychiatric diagnosis, compared to one in ten in those with PSA. Receiving psychotropic medication was more common among those with PSA.

Child suicides in Sweden, 2000\u20132018

Although child mortality is decreasing in Sweden, an increase in suicide rates has been previously observed among children and adolescents collectively. To increase knowledge about trends, demographics, and means in child suicides, data including all child (< 18 years) suicides in Sweden in 2000 through 2018 were retrieved from the Swedish National Board of Forensic Medicine. In all, a total of 416 child suicides were found in a 19-year period, accounting for an annual suicide rate of 1.1/100,000 child population. The number of suicides increased with 2.2% by each successive year during the study period (p < 0.001). The mean age in both sexes was 16 years; boys accounted for 55% and girls for 45% of all study cases. The majority of the children who died by suicide (96%) were teenagers (13–17 years old) and suicides in children younger than 10 years were uncommon. Suicide methods were 59% hanging, 20% lying/jumping in front of a moving object, 8% jumping from a height, 7% firearm injury, 4% poisoning, and 2% other methods. Sex differences were significant (p < 0.001) only for firearms being preferably used by boys. The vast majority of firearms used were licensed long-barreled weapons.Conclusion: The number of child suicides in Sweden is relatively low but increasing. Most of the children used a violent and highly lethal method. Prevention of premature mortality is an urgent concern with an emphasis on resolutely reducing the availability of suicide means.What is Known:• Suicide is a significant cause of death globally among children, bringing tragic consequences for young individuals, their family, and the entire society.• Suicide rates and distribution of suicide methods in children differ between countries and settings, but studies of time trends are scarce.What is New:• Increasing number of minors’ suicides and the predominance of violent methods emphasize the importance of prevention strategies tailored for a child population.• Even in a setting of very restrictive firearm laws, firearm suicides in children must not be overlooked.

Contributions of specific causes of death by age to the shorter life expectancy in depression: a register-based observational study from Denmark, Finland, Sweden and Italy

BackgroundThe reasons for the shorter life expectancy of people with depression may vary by age. We quantified the contributions of specific causes of death by age to the life-expectancy gap in four European countries. MethodsUsing register-based cohort data, we calculated annual mortality rates in between 1993 and 2007 for psychiatric inpatients with depression identified from hospital-care registers in Denmark, Finland and Sweden, and between 2000 and 2007 for antidepressant-treated outpatients identified from medication registers in Finland and Turin, Italy. We decomposed the life-expectancy gap at age 15 years by age and cause of death. ResultsThe life-expectancy gap was especially large for psychiatric inpatients (12.1 to 21.0 years) but substantial also for antidepressant-treated outpatients (6.3 to 14.2 years). Among psychiatric inpatients, the gap was largely attributable to unnatural deaths below age 55 years. The overall contribution was largest for suicide in Sweden (43 to 45%) and Finland (37 to 40%). In Denmark, ‘other diseases’ (25 to 34%) and alcohol-attributable causes (10 to 18%) had especially large contributions. Among antidepressant-treated outpatients, largest contributions were observed for suicide (18% for men) and circulatory deaths (23% for women) in Finland, and cancer deaths in Turin (29 to 36%). Natural deaths were concentrated at ages above 65 years. LimitationsThe indication of antidepressant prescription could not be ascertained from the medication registers. ConclusionsInterventions should be directed to self-harm and substance use problems among younger psychiatric inpatients and antidepressant-treated young men. Rigorous monitoring and treatment of comorbid somatic conditions and disease risk factors may increase life expectancy for antidepressant-treated outpatients, especially women.

Sildenafil and suicide in Sweden

Much theory asserts that sexual intimacy sustains mental health. Experimental tests of such theory remain rare and have not provided compelling evidence because ethical, practical, and cultural constraints bias samples and results. An epidemiologic approach would, therefore, seem indicated given the rigor the discipline brings to quasi-experimental research. For reasons that remain unclear, however, epidemiologist have largely ignored such theory despite the plausibility of the processes implicated, which engender, for example, happiness, feelings of belonging and self-worth, and protection against depression. We use an intent-to-treat design, implemented via interrupted time-series methods, to test the hypothesis that the monthly incidence of suicide, a societally important distal measure of mental health in a population, decreased among Swedish men aged 50–59 after July 2013 when patent rights to sildenafil (i.e., Viagra) ceased, prices fell, and its use increased dramatically. The test uses 102 pre, and 18 post, price-drop months. 65 fewer suicides than expected occurred among men aged 50–59 over test months following the lowering of sildenafil prices. Our findings could not arise from shared trends or seasonality, biased samples, or reverse causation. Our results would appear by chance fewer than once in 10,000 experiments. Our findings align with theory indicating that sexual intimacy reinforces mental health. Using suicide as our distal measure of mental health further implies that public health programming intended to address the drivers of self-destructive behavior should reduce barriers to intimacy in the middle-aged populations.

Adherence to psychotropic medication in completed suicide in Sweden 2006\u20132013: a forensic-toxicological matched case-control study

ObjectiveTo investigate the influence of adherence to psychotropic medications upon the risk of completed suicide by comparing person-level prescriptions and postmortem toxicological findings among complete-suicide cases and non-suicide controls in Sweden 2006–2013.MethodsUsing national registries with full coverage on dispensed prescriptions, results of medico-legal autopsies, causes of death, and diagnoses from inpatient care, estimated continuous drug use for 30 commonly prescribed psychotropic medications was compared with forensic-toxicological findings. Subjects who had died by suicide (cases) were matched (1:2) with subjects who had died of other causes (controls) for age, sex, and year of death. Odds ratios were calculated using logistic regression to estimate the risk of completed suicide conferred by partial adherence and non-adherence to pharmacotherapy. Adjustments were made for previous inpatient care and the ratio of initiated and discontinued dispensed prescriptions, a measure of the continued need of treatment preceding death.ResultsIn 5294 suicide cases and 9879 non-suicide controls, after adjusting for the dispensation ratio and other covariates, partial adherence and non-adherence to antipsychotics were associated with 6.7-fold and 12.4-fold risks of completed suicide, respectively, whereas corresponding risk estimates for antidepressant treatment were not statistically significant and corresponding risk increases for incomplete adherence to antidepressant treatment were lower (1.6-fold and 1.5-fold, respectively) and lacked statistical significance.ConclusionAfter adjustment for the need of treatment, biochemically verified incomplete adherence to antipsychotic pharmacotherapy was associated with markedly increased risks of completed suicide.

Adherence to Psychotropic Medication in Completed Suicide in Sweden 2006-2013: A Forensic-Toxicological Matched Case-Control Study

Background: The aim of the study was to investigate how incomplete adherence to psychotropic medication influences the risk of completed suicide by comparing person-level information regarding dispensed prescriptions and postmortem toxicological findings among complete-suicide cases and non-suicide controls in Sweden 2006-2013. Method: Using national registries with full coverage on dispensed prescriptions, results of medico-legal autopsies, causes of death, diagnoses from inpatient care and continuous drug use, estimated by the prescription-based algorithm PRE2DUP, psychotropic drug use was compared with forensic-toxicological findings for 30 commonly prescribed psychotropic medications. Subjects who had died by suicide (cases) were matched (1:2) with subjects who had died from other causes (controls) for age, sex, and year of death. Odds ratios were calculated using logistic regression to estimate risk of completed suicide conferred by partial adherence and non-adherence to pharmacotherapy. Adjustments were made for previous inpatient psychiatric and somatic care, and ratio of initiated and discontinued prescriptions prior to death. Outcome: In data from autopsies performed in 5294 suicide cases and 9879 non-suicide controls, dispensation ratios for psychotropic medications (postulated as a measure of continued need of treatment) increased in cases, yet decreased in controls, the months prior to death. After adjustments for the ratio and other covariates, partial adherence and non-adherence to antipsychotics were associated with 6·7-fold and 12·4-fold risks, respectively, of completed suicide. The effect sizes for antidepressants were smaller and not statistically significant. Interpretation: After adjustment for continued need of treatment, biochemically verified incomplete adherence to antipsychotic pharmacotherapy was associated with markedly increased risks of completed suicide. Funding Statement: The study has in part been funded by Psykiatrifonden. Funders of the study had no role in study design, data collection, analysis, and interpretation, or the writing of the report. The corresponding author had full access to all data and final responsibility for the decision to submit the report for publication. Declaration of Interests: HT, JT and AT have participated in research projects funded by Janssen-Cilag and Eli Lilly, with grants paid to the institution where they were employed. AT is a member of the JanssenCilag advisory board. JT has served as a consultant to the European Medical Agency and the Finnish Medicines Agency and has received lecture fees from Eli Lilly, Janssen-Cilag, Lundbeck, and Otsuka, and grants from the Stanley Foundation and the Sigrid Juselius Foundation. JF and TM have no conflict of interest. All studied pharmacological products in this paper were generic substances without exclusive ownership by any company. Ethics Approval Statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. In this registry-based postmortem study, all personal information was anonymized, rendering unnecessary the need for formal consent or ethical approval. The study was nonetheless reviewed and approved by the Regional Ethical Review Board in Stockholm (2013/1411‐31/5).

Intergenerational involvement in out-of-home care and death by suicide in Sweden: A population-based cohort study

Background: Individuals involved in out-of-home care are at higher risk of death by suicide. We aimed to determine whether parents with two generations of involvement in out-of-home care (themselves as children, and their own children) are at increased risk of death by suicide than parents with no involvement or parents with one generation of involvement in out-of-home care.Method: This population-based cohort study included all individuals born in Sweden between 1973 and 1980 who had at least one child between 1990 and 2012 (n = 487,948). Women (n = 259,275) and men (n = 228,673) were examined separately.Results: When compared with mothers with no involvement in out-of-home care, mothers with two generations of involvement were at more than five times greater risk of death by suicide (aHR = 5.52; 95% CI 2.91–10.46); mothers with one generation of involvement were also at significantly higher risk of death by suicide (mothers were in care as children: aHR = 2.35; 95% CI 1.27–4.35; child was placed in care: aHR = 3.23; 95% CI 1.79–5.83). Involvement in out-of-home care (in either generation) did not affect risk of death by suicide for fathers.Limitations: Reason for placement in out-of-home care is not known; these reasons could also be associated with risk of death by suicideConclusion: Mothers with involvement in out-of-home care, either as children or when their child was placed in care, are at significantly higher risk of death by suicide. Mental health services should be provided to individuals involved in out-of-home care.

Life expectancy after the first suicide attempt.

To assess excess mortality among suicide attempters compared to the general population. Remaining life expectancy was calculated for a nationwide cohort of all 187 894 persons 18 years or older hospitalised for the first time attempted suicide in Sweden in 1971-2010. Life expectancy was shortened throughout the lifespan for both men and women debuting with suicide attempt. The reduction in life expectancy for men debuting with a suicide attempt at 20 years of age was 18 years while the reduction for men debuting at 50 years of age was 10 years. For women attempting suicide, the life expectancy was shortened by 11 and 8 years respectively. The gender difference in life expectancy attenuated in patients making their first suicide attempt at age 70 years or older. Suicide deaths explained about 20% of the total mortality within 10 years of the suicide attempt and 5% in those with duration of four decades since the first suicide attempt. The life expectancy is dramatically reduced in patients attempting suicide. With most excess deaths being due to physical health conditions, public efforts should be directed both towards improving physical health and to prevent suicide.

Antidepressants and suicide among young women in Sweden 1999–2013

OBJECTIVE:To establish whether the young women (15–24 year old) who committed suicide in Sweden (1999–2013) received antidepressant treatment or not, and to what extent, prior to and/or at the time of suicide. To investigate the belief that increased prescription of antidepressants would drastically reduce the number of suicides.METHODS:An analysis of data from the Swedish Prescribed Drug Register, the Causes of Death Register, with registers cross checked, and from the National Board of Forensic Medicine.RESULTS:This analysis shows a covariance between increased prescription of antidepressants and an increasing trend in the number of suicides among young women. In the period 1999–2003 antidepressants were found in toxicological analyses done in 23% of the young women who committed suicide, and in 39% of cases for 2009–2013.CONCLUSION:An increasingly larger proportion of young women who later committed suicide, had in the last few years been treated with antidepressants, prior to and at the time of the suicide. The previous assumptions that treatment with antidepressants would lead to a drastic reduction in suicide rates, are incorrect for the population of young women. On the contrary, it was found that an increasing tendency of completed suicides follow the increased prescription of antidepressants.

Death of a Close Relative and the Risk of Suicide in Sweden—A Large Scale Register-Based Case-Crossover Study

BackgroundBereavement is thought to be a risk factor for suicide but the association has not been thoroughly investigated according to specific sensitive time periods and risk groups using a self-matched design. We aimed to 1) determine the risk of suicide within the first year after death of a close relative, 2) investigate if and how the risk changes within this time window and 3) determine if sex, age, and type of relationship, affect this association.MethodsA self-matched, case-crossover study was performed by linking Swedish registers. In total, 31 059 individuals with suicide between 1990 and 2011 were included. Different periods within the year prior to the suicide were compared with corresponding periods one year earlier in the same individual’s life. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for suicide after death of a close relative.ResultsIncreased ORs of suicide were seen during the first month, OR 1·77 (95% CI 1·35–2·34), and the first half-year, 1·27 (1·13–1·43). An even higher OR was found within the first week, 3·43 (1·89–6·22). Patterns were similar for women and men and across age groups. Death of a partner or child but not death of a sibling or parent was associated with a significantly increased suicide risk. The strongest association was seen after death of a partner in individuals aged 45 and older.DiscussionThese findings provide knowledge of sensitive time periods and at-risk groups in the early period of bereavement. Due to the use of a self-matched study design, methodological challenges of unmeasured residual confounding could be overcome.

Psychological morbidity among suicide-bereaved and non-bereaved parents: a nationwide population survey

ObjectiveTo determine how psychological premorbidity affects the risk of depression in parents who lost a child through suicide.DesignPopulation-based survey.SettingSweden, between 2009 and 2010.ParticipantsAll parents who lost a child, age 15–30,...