PP_pI_EUPHA
Download as PPTX, PDF
1 like229 views
Risk factors for suicidal behavior in people on disability pension due to common mental disorders in Sweden. Socio-demographic risk factors for suicide attempts included being female, younger age, lower education levels, and living single. Health care factors included previous outpatient or inpatient mental health diagnoses and treatment, as well as a history of suicide attempts. Medication use, including antidepressants, anxiolytics alone or combined, also increased risk. Risk factors for completed suicide included being male, living single, previous inpatient mental health treatment, and a history of suicide attempts. Antianxiety medication use alone or combined with antidepressants also increased suicide risk.
PP_pI_EUPHA
- 1. Risk factors for suicidal behaviour in people on disability pension due to common mental disorder in Sweden. In Collaboration with Prof Kristina Alexanderson, Associate Prof Jussi Jokinen and Associate Prof Ellenor Mittendorfer-Rutz Syed Rahman (syed.rahman@ki.se) Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- 2. Background In most OECD countries, there is a shift towards mental diagnoses for disability pension (DP) claim. Mental diagnoses were the primary cause of disability in 30% or more of all claims. Common mental disorders (CMD) comprise one of the main disability pension diagnoses. Brown J et al. 2009, J辰rvisalo J et al. 2005, OECD 2010 27 juli 2016Syed Rahman 2
- 3. Background People on DP seem to have a higher mortality. Gjesdal et al. 2009, Karlsson et al., 2007, Wallman et al., 2006 A significant association has been reported between DP and suicidal behaviour. Qin et al., 2003, Leinonen 2013, Jonsson et at., 2013 Information on consequences of DP is sparse. 27 juli 2016Syed Rahman 3
- 4. Aim To examine the association between different socio- demographic, health care factors and medication and subsequent suicidal behaviour among individuals on disability pension due to common mental disorders. 27 juli 2016Syed Rahman 4
- 5. Methods Design: nationwide register based prospective cohort study. Inclusion criteria: individuals aged 18-64 years, on DP due to CMD during 2005, n = 48 803. Exclusion criteria: schizophrenic spectrum and bipolar disorders during 2001-05, old-age pensioners in 2005. Final cohort: n = 46 745 individuals. 27 juli 2016Syed Rahman 5
- 6. Methods Follow-up (2006-10): Suicide attempt n=1 046, Suicide n=210. Censoring: for emigration, death (due to other causes in case of suicide). Statistical method: Hazard ratios and 95% CI were estimated by Cox proportional hazard regression models. 27 juli 2016Syed Rahman 6
- 7. Results- Suicide attempt Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI) Characteristics Total n (%) HR (95 % CI) Sex Female 736 (2.4) 1.15 (1.01-1.32) Male 310 (2) 1 Age 18-24 years 61 (7.2) 2.11 (1.552.89) 25-34 years 161 (4.8) 2.06 (1.642.59) 35-44 years 342 (3.5) 2.06 (1.692.52) 45-54 years 306 (2.1) 1.52 (1.251.85) 55-64 years 176 (1) 1 27 juli 2016Syed Rahman 7
- 8. Results- Suicide attempt Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI) Characteristics Total n (%) HR (95 % CI) Education (in years) University/ higher (13) 152 (1.2) 1 High school (10-12) 540 (2.5) 1.38 (1.151.65) Compulsory (0-9) 347 (2.9) 1.57 (1.291.91) Family status Married/cohab. with child 201 (1.9) 1 Married/cohab. no child 88 (0.9) 0.73 (0.56-0.95) Single with child 558 (2.8) 1.23 (1.04-1.45) Single no child 199 (3.1) 1.29 (1.06-1.57) 27 juli 2016Syed Rahman 8
- 9. Results- Suicide attempt Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI) 27 juli 2016Syed Rahman 9 Characteristics Total n (%) HR (95% CI) Outpt. care in 2001-05 Mental diagnoses 571 (4.4) 1.30 (1.14-1.48) Inpt. care in 2001-05 Somatic diagnoses 613 (3.9) 1.45 (1.26-1.67) Mental diagnoses 507 (10) 2.88 (2.47-3.35) Suicide attempt 314 (22) 3.89 (3.29-4.60) Medication in 2005 Antidepr. only 299 (2.2) 1.82 (1.52-2.17) Anxiolytics only 109 (3.2) 2.24 (1.77-2.82) Both prescribed 423 (5.8) 3.35 (2.83-3.98)
- 10. Results- suicide Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI) Characteristics Total n (%) HR (95 % CI) Sex Female 102 (0.3) 1 Male 108 (0.7) 2.14 (1.61-2.85) Family status Married/cohab. with child 30 (0.3) 1 Married/cohab. no child 29 (0.3) 1.23 (0.72-2.10) Single with child 25 (0.4) 1.48 (0.86-2.54) Single no child 125 (0.6) 1.68 (1.11-2.53) 27 juli 2016Syed Rahman 10
- 11. Results- suicide Multivariate Hazard Ratios (HR), 95% Confidence Intervals (CI) Characteristics Total n (%) HR (95 % CI) Inpat. care in 2001-05 Mental diagnoses 90 (1.8) 2.71 (1.94-3.80) Suicide attempt 46 (3.2) 3.00 (2.00-4.50) Medication in 2005 Antidepr. only 47 (0.4) 1.32 (0.89-1.97) Anxiolytics only 23 (0.7) 2.10 (1.28-3.44) Both prescribed 86 (1.2) 3.30 (2.31-4.72) 27 juli 2016Syed Rahman 11
- 12. Conclusion Risk factors for suicide attempt : Socio-demographic factors: female sex, young age, low education, living single. Health care factors: outpatient care due to mental diagnosis, inpatient care due to mental or somatic diagnoses and suicide attempt. Medication: antidepressant and anxiolytic alone or combined. 27 juli 2016Syed Rahman 12
- 13. Conclusion (continued) Risk factors for suicide: Socio-demographic factors: male sex, living single. Health care factors: inpatient care due to mental diagnoses and previous suicide attempt. Medication: anxiolytic alone and combined antidepressant with anxiolytic. 27 juli 2016Syed Rahman 13
- 14. Thank you
- 15. Diagnoses & frequency of DP cases Diagnosis (ICD 10 code) Total number (%) Depressive episode (F 32) 17 181 (36.8%) Reaction to severe stress and adjustment disorder (F 43) 11 022 (23.6%) Anxiety disorder (F 41) 9 799 (21.0%) Recurrent depressive disorder (F 33) 4 950 (10.6%) Phobic anxiety disorder (F 40) 2 783 (5.90%) Obsessive-compulsive disorder (F 42) 1 010 (2.20%) 27 juli 2016Syed Rahman 15