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- Title
Variations in Suicide Risk and Risk Factors After Hospitalization for Depression in Finland, 1996-2017.
- Authors
Aaltonen, Kari; Sund, Reijo; Hakulinen, Christian; Pirkola, Sami; Isometsä, Erkki
- Abstract
Key Points: Question: What are the immediate and long-term risks and risk factors for suicide after hospitalization for patients with depression, and are there factor-specific time-dependent risks? Findings: In this cohort study including all 193 197 hospitalizations for depression in Finland from 1996 to 2017, patients hospitalized for depression had extremely high risk of suicide in the first days after discharge, with 7 factors modifying overall risk manyfold. The relative risk of each factor showed diverging temporal patterns, being constant, declining, or increasing. Meaning: Discharged patients with depression form a very high-risk group for immediate suicide, with the risk influenced by several factors with characteristic temporal patterns of observed potency. This cohort study examines the absolute risk and risk factors for suicide in hospitalized patients with depression starting from the first days after discharge up to 2 years and evaluates whether the size of relative risk by factor displays temporal patterns over consecutive phases of follow-up. Importance: Although incidence of suicide in depression varies remarkably temporally, risk factors have been modeled as constant and remain uncharted in the short term. How effectively factors measured at one point in time predict risk at different time points is unknown. Objective: To examine the absolute risk and risk factors for suicide in hospitalized patients with depression starting from the first days after discharge up to 2 years and to evaluate whether the size of relative risk by factor displays temporal patterns over consecutive phases of follow-up. Design, Setting, and Participants: This population-based study using Finnish registers (hospital discharge, population, and cause of death registers) included all hospitalizations for depression as the principal diagnosis in Finland from 1996 to 2017, with a maximum follow-up of 2 years. Data were analyzed from January 2022 to November 2023. Main Outcomes and Measures: Incidence rate (IR), IR ratios, hazard functions, and hazard ratios for suicide by consecutive time periods (0 to 3 days, 4 to 7 days, 7 to 30 days, 31 to 90 days, 91 to 365 days, and 1 to 2 years) since discharge. Results: This study included 193 197 hospitalizations among 91 161 individuals, of whom 51 197 (56.2%) were female, and the mean (SD) age was 44.0 (17.3) years. Altogether, patients were followed up to 226 615 person-years. A total of 1219 men and 757 women died of suicide. Incidence of suicide was extremely high during the first days after discharge (IR of 6062 [95% CI, 4963-7404] per 100 000 on days 0 to 3; IR of 3884 [95% CI, 3119-4835] per 100 000 on days 4 to 7) and declined thereafter. Several factors were associated with risk of suicide over the first days after discharge. Current suicide attempt by hanging or firearms increased the risk of suicide most on days 0 to 3 (IR ratio, 18.9; 95% CI, 3.1-59.8) and on days 0 to 7 (IR ratio, 10.1; 95% CI, 1.7-31.5). Temporal patterns of the size of the relative risk diverged over time, being constant, declining, or increasing. Clinical factors had the strongest association immediately. Relative risk remained constant among men and even increased among those with alcohol or substance use disorder. Conclusions and Relevance: In this study, patients hospitalized for depression had extremely high risk of suicide during the first days after discharge. Thereafter, incidence declined steeply but remained high. Within the periods of the highest risk of suicide, several factors increased overall risk manyfold. Risk factors' observed potencies varied over time and had characteristic temporal patterns.
- Subjects
FINLAND; SUICIDE risk factors; ALCOHOLISM; ATTEMPTED suicide; MENTAL depression; HOSPITAL care; CAUSES of death
- Publication
JAMA Psychiatry, 2024, Vol 81, Issue 5, p506
- ISSN
2168-622X
- Publication type
Article
- DOI
10.1001/jamapsychiatry.2023.5512