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HomePsychiatrySuicide spouses at increased risk for disorders – and suicide

Suicide spouses at increased risk for disorders – and suicide

People bereaved by the suicide of a spouse were at increased risk for mental and physical disorders, suicidal behavior, death and adverse social events, according to a nationwide study based on registry data conducted in Denmark.

The study by Dr Annette Erlangsen, of the Danish Research Institute for Suicide Prevention, Mental Health Centre in Copenhagen, and co-authors compared people bereaved by spousal suicide with the general population and people bereaved by spousal death of any other manner.

The study population included almost 3.5m men (4,814 of whom were bereaved by spousal suicide) and more than 3.5m women (10,793 of whom who were bereaved by spousal suicide).

Among the findings were: spouses bereaved by a partner's suicide had higher risk than the general population of developing mental health disorders within five years of the loss; spouses bereaved by a partner's suicide had elevated risk for developing physical disorders, such as cirrhosis and sleep disorders, which may be attributed to unhealthy coping styles, than the general population; spouses bereaved by a partner's suicide were more likely to use more sick leave benefits, disability pension funds and municipal support than the general population; and compared with spouses bereaved by other manners of death for a partner, those bereaved by suicide had higher risks for developing mental health disorders, suicidal behaviors and death.

The authors note that most people bereaved by suicide do not experience health complications. The study design also cannot establish causality.

"Bereavement following suicide constitutes a psychological stressor and remains a public health burden… More proactive outreach and linkage to support mechanisms is needed for people bereaved by spousal suicide to help them navigate their grief," the article concludes.

Abstract
Importance: Bereavement after spousal suicide has been linked to mental disorders; however, a comprehensive assessment of the effect of spousal suicide is needed.
Objective: To determine whether bereavement after spousal suicide was linked to an excessive risk of mental, physical, and social health outcomes when compared with the general population and spouses bereaved by other manners.
Design, Setting, and Participants: This nationwide, register-based cohort study conducted in Denmark of 6.7 million individuals aged 18 years and older from 1980 to 2014 covered more than 136 million person-years and compared people bereaved by spousal suicide with the general population and people bereaved by other manners of death. Incidence rate ratios were calculated using Poisson regressions while adjusting for sociodemographic characteristics and the presence of mental and physical disorders.
Main Outcomes and Measures: Mental disorders (any disorder, mood, posttraumatic stress disorder, anxiety, alcohol use disorders, drug use disorders, and self-harm); physical disorders (cancers, diabetes, sleep disorder, cardiovascular diseases, chronic lower respiratory tract diseases, liver cirrhosis, and spinal disc herniation); causes of mortality (all-cause, natural, unintentional, suicide, and homicide); social health outcomes; and health care use.
Results: The total study population included 3 491 939 men, 4814 of whom were bereaved by spousal suicide, and 3 514 959 women, 10 793 of whom were bereaved by spousal suicide. Spouses bereaved by a partner’s suicide had higher risks of developing mental disorders within 5 years of the loss (men: incidence rate ratio, 1.8; 95% CI, 1.6-2.0; women: incidence rate ratio, 1.7; 95% CI, 1.6-1.8) than the general population. Elevated risks for developing physical disorders, such as cirrhosis and sleep disorders, were also noted as well as the use of more municipal support, sick leave benefits, and disability pension funds than the general population.Compared with spouses bereaved by other manners of death, those bereaved by suicide had higher risks for developing mental disorders (men: incidence rate ratio, 1.7; 95% CI, 1.5-1.9; women: incidence rate ratio, 2.0; 95% CI, 1.9-2.2), suicidal behaviors, mortality, and municipal support. Additionally, a higher level of mental health care use was noted.
Conclusions and Relevance: Exposure to suicide is stressful and affects the bereaved spouse on a broad range of outcomes. The excess risks of mental, physical, and social health outcomes highlight a need for more support directed toward spouses bereaved by suicide.

Authors
Annette Erlangsen; Bo Runeson; James M Bolton; Holly C Wilcox; Julie L Forman; Jesper Krogh; M Katherine Shear; Merete Nordentoft; Yeates Conwell

[link url="https://www.sciencedaily.com/releases/2017/03/170322143220.htm"]JAMA material[/link]
[link url="http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2609649"]JAMA Psychiatry abstract[/link]
[link url="http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2609646"]JAMA Psychiatry editorial comment[/link]

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