Suicid efter suicidförsök – prognosen beror på psykiatrisk diagnos

Abstract

Syftet var att undersöka om olika psykiska sjukdomar ger olika hög suicidrisk efter suicidförsök. Därför genomfördes en kohortstudie med 21-31 års uppföljningstid av 39 685 personer vårdade för suicidförsök 1973-82, baserad på samkörda svenska register. Suiciddödligheten var generellt hög redan under första året efter suicidförsöket, upp till 23% i högriskgrupper. De olika diagnosgrupperna hade tydligt olika mönster för suiciddödlighet. De med diagnos som schizofreni eller unipolär/bipolär sjukdom vid suicidförsöket hade högst relativ suicidrisk på såväl kort som lång sikt, med 20-39% suiciddödlighet under hela uppföljningstiden. I absoluta tal inträffade flest suicid i gruppen med lindrigare depressioner, eftersom den gruppen var störst i undersökningen. Resultaten visar att psykiatrisk diagnos bör vägas in i vårdplaneringen efter suicidförsök.

Objective To investigate the impact of coexistent psychiatric morbidity on risk of suicide after a suicide attempt. Design Cohort study with follow-up for 21-31 years. Setting Swedish national register based study. Participants 39 685 people (53% women) admitted to hospital for attempted suicide during 1973-82. Main outcome measure Completed suicide during 1973-2003. Results Suicide mortality was high in all diagnostic categories, both in the short and long term. The highest short term risk was associated with schizophrenia (22% in men, 13% in women) and bipolar/unipolar disorder (23% in men, 9% in women). The strongest psychiatric predictors of completed suicide throughout the entire follow-up were schizophrenia (39% in men, 24% in women) and bipolar/unipolar disorder (36% in men, 20% in women). Increased risks were also found for other depressive disorder, anxiety disorder, alcohol misuse (women), drug misuse, and personality disorder. The highest population attributable fractions for suicide among people who had previously attempted suicide were found for other depression in women (population attributable fraction 9.3), followed by schizophrenia in men (4.6), and bipolar/unipolar disorder in women and men (4.1 and 4.0, respectively). Conclusion Type of psychiatric disorder coexistent with a suicide attempt substantially influences overall risk and temporality for completed suicide. To reduce this risk, high risk patients need aftercare, especially during the first years after attempted suicide among patients with schizophrenia or bipolar/ unipolar disorder.