Trends in Suicide Risk Associated With Hospitalized Psychiatric Illness: A Case-Control Study Based on Danish Longitudinal Registers
J Clin Psychiatry 2006;67:1936-1941
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: In light of the consistent
reduction in suicide rate during the past 20 years in
Denmark, this study aims to investigate trends in
suicide risk associated with hospitalized
psychiatric illness and to explore differences in the
changes with regard to clinical phases of illness, sex,
age, and diagnosis.
Method: This population-based study
includes all of 21,169 suicides in Denmark during
the years 1981 through 1997 and 423,128 controls matched for sex, age, and time (using a
nested case-control design). Personal data on
psychiatric history and socioeconomic status were
retrieved from Danish longitudinal registers. Data
were analyzed using conditional logistic regression.
Results: This study shows that the
reduction in suicide rate is generally faster among
individuals with a history of psychiatric
admission than among individuals without such a
history. However, this substantial reduction is mainly
accounted for by the reduction among patients who had been discharged from psychiatric
hospitals for more than 1 year. For patients who had
been discharged from hospitals within 1 year, the
reduction is similar to that of the general population; while for patients hospitalized for
treatment at the time of suicide or the index date, the
reduction in suicide rate is relatively slower.
Such trends hold for all diagnostic groups.
Further analyses stratified by age indicate that the
faster reduction in suicide rate associated with
history of hospitalized psychiatric illness is more
pronounced among patients aged 36 years and older.
Conclusion: The reduction in suicide rate
is substantial for patients who have been
discharged from psychiatric hospitals for more than 1
year and for middle-aged and older patients.
Recent improvement in psychiatric care and
treatment and promotion of new generation
antidepressants may contribute to these changes.