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1.  Psychosocial work environment, job mobility and gender differences in turnover behaviour: a prospective study among the Swedish general population 
BMC Public Health  2014;14:605.
Background
Throughout the literature, substantial evidence supports associations between poor psychosocial work characteristics and a variety of ill-health outcomes. Yet, few reports strategies workers carry out to improve detrimental work conditions and consequently their health, such as changing jobs. The aim of this study was to examine if adverse psychosocial work exposure, as measured with the job demand-control and effort-reward imbalance models, could predict job mobility over a 5 years observation period.
Method
Participants were working men and women (n = 940; 54.3% women), aged 24–60 years from the population of Gothenburg and surrounding metropolitan area. Job demand-control and effort-reward variables were compared with independent t-tests and chi2-test in persons with and without job mobility. Multivariate logistic regression was used to analyse whether psychosocial factors could predict job mobility. All regression analyses were stratified by gender.
Results
Exposure to a combination of high demands-low control or high imbalance between effort and reward was related to increased odds of changing jobs (OR 1.63; CI 1.03-2.59 and OR 1.46; CI 1.13-1.89 respectively). When analysing men and women separately, men had a higher OR of changing jobs when exposed to either high demands-low control (OR 2.72; CI 1.24-5.98) or high effort-reward imbalance (OR 1.74; CI 1.11-2.72) compared to reference values. The only significant associations for women was slightly decreased odds for turnover in high reward jobs (OR 0.96; CI 0.92-0.99).
Conclusions
The results indicate that workers will seek to improve poor work environment by changing jobs. There were notable gender differences, where men tended to engage in job mobility when exposed to adverse psychosocial factors, while women did not. The lack of measures for mechanisms driving job mobility was a limitation of this study, thus preventing conclusions regarding psychosocial factors as the primary source for job mobility.
doi:10.1186/1471-2458-14-605
PMCID: PMC4073185  PMID: 24927628
Job demand-control; Effort-reward imbalance; Job mobility
2.  Personality in women and associations with mortality: a 40-year follow-up in the Population Study of Women in Gothenburg 
BMC Women's Health  2014;14:61.
Background
The question of whether personality traits influence health has long been a focus for research and discussion. Therefore, this study was undertaken to examine possible associations between personality traits and mortality in women.
Methods
A population-based sample of women aged 38, 46, 50 and 54 years at initial examination in 1968–69 was followed over the course of 40 years. At baseline, 589 women completed the Cesarec-Marke Personality Schedule (the Swedish version of the Edwards Personal Preference Schedule) and the Eysenck Personality Inventory. Associations between personality traits and mortality were tested using Cox proportional hazards models.
Results
No linear associations between personality traits or factor indices and mortality were found. When comparing the lowest (Q1) and highest quartile (Q4) against the two middle quartiles (Q2 + Q3), the personality trait Succorance Q1 versus Q2 + Q3 showed hazard ratio (HR) = 1.37 (confidence interval (CI) = 1.08-1.74), and for the factor index Aggressive non-conformance, both the lowest and highest quartiles had a significantly higher risk of death compared to Q2 + Q3: for Q1 HR = 1.32 (CI = 1.03-1.68) and for Q4 HR = 1.36 (CI = 1.06-1.77). Neither Neuroticism nor Extraversion predicted total mortality.
Conclusions
Personality traits did not influence long term mortality in this population sample of women followed for 40 years from mid- to late life. One explanation may be that personality in women becomes more circumscribed due to the social constraints generated by the role of women in society.
doi:10.1186/1472-6874-14-61
PMCID: PMC4027992  PMID: 24779414
Personality traits; Secular trends; Population-based cohort; Women; Longevity
3.  Self-assessed mental health problems and work capacity as determinants of return to work: a prospective general population-based study of individuals with all-cause sickness absence 
BMC Psychiatry  2013;13:259.
Background
Mental health problems are common in the work force and influence work capacity and sickness absence. The aim was to examine self-assessed mental health problems and work capacity as determinants of time until return to work (RTW).
Methods
Employed women and men (n=6140), aged 19–64 years, registered as sick with all-cause sickness absence between February 18 and April 15, 2008 received a self-administered questionnaire covering health and work situation (response rate 54%). Demographic data was collected from official registers. This follow-up study included 2502 individuals. Of these, 1082 were currently off sick when answering the questionnaire. Register data on total number of benefit compensated sick-leave days in the end of 2008 were used to determine the time until RTW. Self-reported persistent mental illness, the WHO (Ten) Mental Well-Being Index and self-assessed work capacity in relation to knowledge, mental, collaborative and physical demands at work were used as determinants. Multinomial and binary logistic regression analyses were used to estimate odds ratios with 95% confidence intervals (CI) for the likelihood of RTW.
Results
The likelihood of RTW (≥105 days) was higher among those with persistent mental illness OR= 2.97 (95% CI, 2.10-4.20) and those with low mental well-being OR= 2.89 (95% CI, 2.31-3.62) after adjusting for gender, age, SES, hours worked and sick leave 2007. An analysis of employees who were off sick when they answered the questionnaire, the likelihood of RTW (≥105 days) was higher among those who reported low capacity to work in relation to knowledge, mental, collaborative and physical demands at work. In a multivariable analysis, the likelihood of RTW (≥105 days) among those with low mental well-being remained significant OR=1.93 (95% CI 1.46-2.55) even after adjustment for all dimensions of capacity to work.
Conclusion
Self-assessed persistent mental illness, low mental well-being and low work capacity increased the likelihood of prolonged RTW. This study is unique because it is based on new sick-leave spells and is the first to show that low mental well-being was a strong determinant of RTW even after adjustment for work capacity. Our findings support the importance of identifying individuals with low mental well-being as a way to promote RTW.
doi:10.1186/1471-244X-13-259
PMCID: PMC4016129  PMID: 24124982
Self-reported mental health problems; Self-assessed work capacity; Return to work; Sickness absence
4.  Secular changes in at-risk drinking in Sweden: birth cohort comparisons in 75-year-old men and women 1976–2006 
Age and Ageing  2013;43(2):228-234.
Background: little is known about the prevalence of at-risk drinking in older adults.
Objective: to compare rates of at-risk drinking in 75-year-olds examined in 1976–77 and in 2005–06.
Design: cross-sectional survey.
Setting: two samples representative of the general population in Gothenburg, Sweden.
Participants: 75-year-olds born in 1901–02 (n = 303) and in 1930 (n = 753).
Methods: participants took part in a multidisciplinary study on health and ageing. Protocols regarding alcohol consumption were identical for both cohorts. Total weekly alcohol intake was estimated and at-risk drinking was defined as ≥100 g alcohol/week.
Results: the proportion abstaining differed significantly between birth cohorts (18% in 1976–77 versus 9% in 2005, P < 0.001). Frequencies of drinking beer and liquor were similar in the two cohorts for men, but were lower for women in the later-born cohort. Proportions drinking wine were higher in the later-born cohort for both sexes. Total weekly alcohol intake was higher for both men and women. At-risk drinking was observed in 19.3% of the men in the earlier-born cohort, and in 27.4% in the later-born cohort (P = 0.117). Corresponding figures for women were 0.6 and 10.4% (P < 0.001). At-risk drinking was significantly associated with birth cohort in women (OR: 13.77, CI: 1.82–104.0, P = 0.011) and the occupational group in men (OR: 1.60, CI: 1.13–2.26, P = 0.008).
Conclusions: alcohol consumption in 75-year-olds has changed markedly, especially in women. Studies need to be carried out in varied settings in order to evaluate the clinical and public health implications of changing trends in alcohol consumption.
doi:10.1093/ageing/aft136
PMCID: PMC3927771  PMID: 24067499
older people; alcohol; at-risk drinking; cohort comparisons
5.  Common psychosocial stressors in middle-aged women related to longstanding distress and increased risk of Alzheimer's disease: a 38-year longitudinal population study 
BMJ Open  2013;3(9):e003142.
Objective
To study the relation among psychosocial stressors, long-standing distress and incidence of dementia, in a sample of women followed from midlife to late life.
Design
Prospective longitudinal population study.
Setting
The analyses originate from the prospective population study of women in Gothenburg, Sweden, a representative sample of women examined in 1968 (participation rate 90%) and re-examined in 1974, 1980, 1992, 2000 and 2005.
Participants
800 women born in 1914, 1918, 1922 and 1930 who were systematically selected for a psychiatric examination at baseline, in 1968.
Primary and secondary outcome measures
18 psychosocial stressors (eg, divorce, widowhood, work problems and illness in relative) were obtained at baseline. Symptoms of distress were measured according to a standardised question at each study wave. Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria based on information from neuropsychiatric examinations, informant interviews, hospital records, and registry data, and measured through the whole study period.
Results
During the 37 years of follow-up, 153 women developed dementia (104 of those had Alzheimer's disease (AD)). Number of psychosocial stressors in 1968 was associated (HR, 95% CI) with higher incidence of dementia (1.15, 1.04 to 1.27) and AD (1.20, 1.07 to 1.35) between 1968 and 2005, in multivariate Cox regressions. Number of psychosocial stressors in 1968 was also associated (OR, 95% CI) with distress in 1968 (1.48, 1.32 to 1.67), 1974 (1.31, 1.17 to 1.46), 1980 (1.27, 1.11 to 1.45), 2000 (1.39, 1.14 to 1.70) and 2005 (1.35, 1.02 to 1.79), in multivariate logistic regressions. Number of psychosocial stressors (HR 1.17, 95% CI 1.03 to 1.33) and long-standing distress (1968–1974–1980) (HR 1.58, 95% CI 1.03 to 2.45) were independently associated with AD.
Conclusions
Our study shows that common psychosocial stressors may have severe and long-standing physiological and psychological consequences. However, more studies are needed to confirm these results and investigate whether more interventions such as stress management and behavioural therapy should be initiated in individuals who have experienced psychosocial stressors.
doi:10.1136/bmjopen-2013-003142
PMCID: PMC3787482  PMID: 24080094
EPIDEMIOLOGY
6.  Research to reduce the suicide rate among older adults: methodology roadblocks and promising paradigms 
The National Institute of Mental Health and the National Action Alliance for Suicide Prevention have requested input into the development of a national suicide research agenda. In response, a working group of the American Association for Geriatric Psychiatry has prepared recommendations to ensure that the suicide prevention dialogue includes older adults, a large and fast-growing population at high risk of suicide. In this Open Forum, the working group describes three methodology roadblocks to research into suicide prevention among elderly persons and three paradigms that might provide directions for future research into suicide prevention strategies for older adults.
doi:10.1176/appi.ps.003582012
PMCID: PMC3742079  PMID: 23728601
7.  A Systematic Review of Elderly Suicide Prevention Programs 
Crisis  2011;32(2):88-98.
Background
Suicide rates are highest among the elderly, yet research on suicide prevention in old age remains a much-neglected area.
Aims
We carried out a systematic review to examine the results of interventions aimed at suicidal elderly persons and to identify successful strategies and areas needing further exploration.
Methods
Searches through various electronic databases yielded 19 studies with an empirical evaluation of a suicide prevention or intervention program designed especially for adults aged 60 years and older.
Results
Most studies were centered on the reduction of risk factors (depression screening and treatment, and decreasing isolation), but when gender was considered, programs were mostly efficient for women. The empirical evaluations of programs attending to the needs of high-risk older adults seemed positive; most studies showed a reduction in the level of suicidal ideation of patients or in the suicide rate of the participating communities. However, not all studies used measures of suicidality to evaluate the outcome of the intervention, and rarely did they aim at improving protective factors.
Conclusions
Innovative strategies should improve resilience and positive aging, engage family and community gatekeepers, use telecommunications to reach vulnerable older adult, and evaluate the effects of means restriction and physicians education on elderly suicide.
doi:10.1027/0227-5910/a000076
PMCID: PMC3728773  PMID: 21602163
suicide; suicidal ideation; prevention; intervention; systematic review; elderly
8.  Acupuncture and physical exercise for affective symptoms and health-related quality of life in polycystic ovary syndrome: secondary analysis from a randomized controlled trial 
Background
Women with polycystic ovary syndrome (PCOS) have symptoms of depression and anxiety and impaired health related quality of life (HRQoL). Here we test the post-hoc hypothesis that acupuncture and exercise improve depression and anxiety symptoms and HRQoL in PCOS women.
Methods
Seventy-two PCOS women were randomly assigned to 16 weeks of 1) acupuncture (n = 28); 2) exercise (n = 29); or 3) no intervention (control) (n = 15). Outcome measures included: change in Montgomery Åsberg Depression Rating Scale (MADRS-S), Brief Scale for Anxiety (BSA-S), Swedish Short-Form 36 (SF-36), and PCOS Questionnaire (PCOSQ) scores from baseline to after 16-week intervention, and to 16-week post-intervention follow-up.
Results
A reduction in MADRS-S and BSA-S from baseline to 16-weeks post-intervention follow-up was observed for the acupuncture group. The SF-36 domains role physical, energy/vitality, general health perception and the mental component of summary scores improved in the acupuncture group after intervention and at follow-up. Within the exercise group the role physical decreased after treatment, while physical functioning and general health perception scores increased at follow-up. The emotion domain in the PCOSQ improved after 16-weeks of intervention within all three groups, and at follow-up in acupuncture and exercise groups. At follow-up, improvement in the infertility domain was observed within the exercise group.
Conclusion
There was a modest improvement in depression and anxiety scores in women treated with acupuncture, and improved HRQoL scores were noted in both intervention groups. While not a primary focus of the trial, these data suggest continued investigation of mental health outcomes in women treated for PCOS.
Trial registration number
ClinicalTrials.gov Identifier: NCT00484705
doi:10.1186/1472-6882-13-131
PMCID: PMC3684530  PMID: 23763822
Acupuncture; Anxiety; Depression; Exercise; Health-related quality of life; Polycystic ovary syndrome
9.  A Systematic Review of Social Factors and Suicidal Behavior in Older Adulthood 
Suicide in later life is a global public health problem. The aim of this review was to conduct a systematic analysis of studies with comparison groups that examined the associations between social factors and suicidal behavior (including ideation, non-fatal suicidal behavior, or deaths) among individuals aged 65 and older. Our search identified only 16 articles (across 14 independent samples) that met inclusion criteria. The limited number of studies points to the need for further research. Included studies were conducted in Canada (n = 2), Germany (n = 1), Hong Kong (n = 1), Japan (n = 1), Singapore (n = 1), Sweden (n = 2), Taiwan (n = 1), the U.K. (n = 2), and the U.S. (n = 3). The majority of the social factors examined in this review can be conceptualized as indices of positive social connectedness—the degree of positive involvement with family, friends, and social groups. Findings indicated that at least in industrialized countries, limited social connectedness is associated with suicidal ideation, non-fatal suicidal behavior, and suicide in later life. Primary prevention programs designed to enhance social connections as well as a sense of community could potentially decrease suicide risk, especially among men.
doi:10.3390/ijerph9030722
PMCID: PMC3367273  PMID: 22690159
death wishes; suicidal ideation; non-fatal suicidal behavior; suicide; social factors; social support; systematic review; older adults
10.  Are sedatives and hypnotics associated with increased suicide risk of suicide in the elderly? 
BMC Geriatrics  2009;9:20.
Background
While antidepressant-induced suicidality is a concern in younger age groups, there is mounting evidence that these drugs may reduce suicidality in the elderly. Regarding a possible association between other types of psychoactive drugs and suicide, results are inconclusive. Sedatives and hypnotics are widely prescribed to elderly persons with symptoms of depression, anxiety, and sleep disturbance. The aim of this case-control study was to determine whether specific types of psychoactive drugs were associated with suicide risk in late life, after controlling for appropriate indications.
Methods
The study area included the city of Gothenburg and two adjacent counties (total 65+ population 210 703 at the start of the study). A case controlled study of elderly (65+) suicides was performed and close informants for 85 suicide cases (46 men, 39 women mean age 75 years) were interviewed by a psychiatrist. A population based comparison group (n = 153) was created and interviewed face-to-face. Primary care and psychiatric records were reviewed for both suicide cases and comparison subjects. All available information was used to determine past-month mental disorders in accordance with DSM-IV.
Results
Antidepressants, antipsychotics, sedatives and hypnotics were associated with increased suicide risk in the crude analysis. After adjustment for affective and anxiety disorders neither antidepressants in general nor SSRIs showed an association with suicide. Antipsychotics had no association with suicide after adjustment for psychotic disorders. Sedative treatment was associated with an almost fourteen-fold increase of suicide risk in the crude analyses and remained an independent risk factor for suicide even after adjustment for any DSM-IV disorder. Having a current prescription for a hypnotic was associated with a four-fold increase in suicide risk in the adjusted model.
Conclusion
Sedatives and hypnotics were both associated with increased risk for suicide after adjustment for appropriate indications. Given the extremely high prescription rates, a careful evaluation of the suicide risk should always precede prescribing a sedative or hypnotic to an elderly individual.
doi:10.1186/1471-2318-9-20
PMCID: PMC2695460  PMID: 19497093
11.  Excess mortality in persons with severe mental disorder in Sweden: a cohort study of 12 103 individuals with and without contact with psychiatric services 
Background
Investigating mortality in those with mental disorder is one way of measuring effects of mental health care reorganisation. This study's aim was to investigate whether the excess mortality in those with severe mental disorder remains high in Sweden after the initiation of the Community Mental Health Care Reform. We analysed excess mortality by gender, type of mental health service and psychiatric diagnosis in a large community-based cohort with long-term mental disorder.
Methods
A survey was conducted in Stockholm County, Sweden in 1997 to identify adults with long-term disabling mental disorder (mental retardation and dementia excluded). The 12 103 cases were linked to the Hospital Discharge Register and the Cause of Death Register. Standardised mortality ratios (SMRs) for 1998–2000 were calculated for all causes of death, in the entire cohort and in subgroups based on treatment setting and diagnosis.
Results
Mortality was increased in both genders, for natural and external causes and in all diagnostic subgroups. Excess mortality was greater among those with a history of psychiatric inpatient care, especially in those with substance use disorder. For the entire cohort, the number of excess deaths due to natural causes was threefold that due to external causes. SMRs in those in contact with psychiatric services where strikingly similar to those in contact with social services.
Conclusion
Mortality remains high in those with long-term mental disorder in Sweden, regardless of treatment setting. Treatment programs for persons with long-term mental disorder should target physical as well as mental health.
doi:10.1186/1745-0179-4-23
PMCID: PMC2576252  PMID: 18854034
12.  Secular trends in self reported sexual activity and satisfaction in Swedish 70 year olds: cross sectional survey of four populations, 1971-2001 
BMJ : British Medical Journal  2008;337(7662):151-154.
Objective To study secular trends in self reported sexual behaviour among 70 year olds.
Design Cross sectional survey.
Settings Four samples representative of the general population in Gothenburg, Sweden.
Participants 1506 adults (946 women, 560 men) examined in 1971-2, 1976-7, 1992-3, and 2000-1.
Main outcome measures Sexual intercourse, attitudes to sexuality in later life, sexual dysfunctions, and marital satisfaction.
Results From 1971 to 2000 the proportion of 70 year olds reporting sexual intercourse increased among all groups: married men from 52% to 68% (P=0.002), married women from 38% to 56% (P=0.001), unmarried men from 30% to 54% (P=0.016), and unmarried women from 0.8% to 12% (P<0.001). Men and women from later birth cohorts reported higher satisfaction with sexuality, fewer sexual dysfunctions, and more positive attitudes to sexuality in later life than those from earlier birth cohorts. A larger proportion of men (57% v 40%, P<0.001) and women (52% v 35%, P<0.001) reported very happy relationships in 2000-1 compared with those in 1971-2. Sexual debut before age 20 increased in both sexes: in men from 52% to 77% (P<0.001) and in women from 19% to 64% (P<0.001).
Conclusion Self reported quantity and quality of sexual experiences among Swedish 70 year olds has improved over a 30 year period.
doi:10.1136/bmj.a279
PMCID: PMC2483873  PMID: 18614505
13.  Mental health literacy and attitudes in a Swedish community sample – Investigating the role of personal experience of mental health care 
BMC Public Health  2008;8:8.
Background
Mental ill health is a common condition in the general population, yet only about half of those with a mental disorder have treatment contact. Personal experience may affect attitudes, which in turn influence the help-seeking process. This study investigated differences in mental health literacy and attitudes among mentally healthy persons and in persons with symptoms of mental illness with and without treatment contact.
Method
A postal screening questionnaire was sent to a random sample of the general population aged 20–64 in the county of Skaraborg, Sweden in order to ascertain mental health status and history of treatment contact; 3538 responded (49%). Face-to-face interviews were carried out in random sub samples of mentally healthy persons (n = 128) and in mentally ill persons with (n = 125) and without (n = 105) mental health care contact. Mental health literacy and attitudes to treatment were assessed using questions based on a vignette depicting a person with depression. Past month mental disorder was diagnosed according to the Schedule for Clinical Assessment in Neuropsychiatry (SCAN).
Results
Two thirds failed to recognize depression in a vignette; recognition was equally poor in mentally healthy persons and in persons with symptoms of mental illness with and without treatment contact. In response to an open-ended question concerning appropriate interventions, one third suggested counselling and only one percent proposed antidepressant treatment. Again, proportions were similar in all groups. Persons with a history of mental health contact more often suggested that a GP would provide the best form of help. When presented with a list of possible interventions, those with a history of mental health contact were more positive to medical interventions such as antidepressants, hypnotics, and inpatient psychiatric treatment. When asked about the prognosis for the condition described in the vignette, persons with treatment contact were less likely to believe in full recovery without intervention; mentally ill without treatment contact were more optimistic.
Conclusion
Mental health literacy, specially concerning attitudes towards interventions is associated with personal history of mental health care.
doi:10.1186/1471-2458-8-8
PMCID: PMC2254613  PMID: 18184424
14.  Secular trends in self reported sexual activity and satisfaction in Swedish 70 year olds: cross sectional survey of four populations, 1971-2001 
Objective To study secular trends in self reported sexual behaviour among 70 year olds.
Design Cross sectional survey.
Settings Four samples representative of the general population in Gothenburg, Sweden.
Participants 1506 adults (946 women, 560 men) examined in 1971-2, 1976-7, 1992-3, and 2000-1.
Main outcome measures Sexual intercourse, attitudes to sexuality in later life, sexual dysfunctions, and marital satisfaction.
Results From 1971 to 2000 the proportion of 70 year olds reporting sexual intercourse increased among all groups: married men from 52% to 68% (P=0.002), married women from 38% to 56% (P=0.001), unmarried men from 30% to 54% (P=0.016), and unmarried women from 0.8% to 12% (P<0.001). Men and women from later birth cohorts reported higher satisfaction with sexuality, fewer sexual dysfunctions, and more positive attitudes to sexuality in later life than those from earlier birth cohorts. A larger proportion of men (57% v 40%, P<0.001) and women (52% v 35%, P<0.001) reported very happy relationships in 2000-1 compared with those in 1971-2. Sexual debut before age 20 increased in both sexes: in men from 52% to 77% (P<0.001) and in women from 19% to 64% (P<0.001).
Conclusion Self reported quantity and quality of sexual experiences among Swedish 70 year olds has improved over a 30 year period.
doi:10.1136/bmj.a279
PMCID: PMC2483873  PMID: 18614505
15.  Evaluation of the quality of drug therapy among elderly patients in nursing homes 
Objective
To evaluate drug therapy quality among elderly nursing home residents. Secondary aims were to compare quality in young and old elderly and to determine whether number of prescribers affected quality of drug therapy.
Design
A cross-sectional population-based register study.
Setting
Nursing home residents in the Gothenburg area using the multi-dose system (e.g. patients who get their drugs machine dispensed into one unit for each dose occasion, a service offered by the National Corporation of Pharmacies).
Subjects
All nursing home residents aged 65 years and older.
Main outcome measures
The quality of drug therapy assessed using five quality indicators for the elderly recently introduced by the Swedish National Board of Health and Welfare; number of prescribed drugs per resident.
Results
Over 70% of residents had one or more potentially inappropriate prescription. Younger nursing home residents (65–79 years) had significantly (p < 0.001) lower quality of drug therapy than older residents (80 + ). The average number of prescribing physicians per resident was high at almost four per resident. An increasing number of prescribers per resident was associated with a higher number of drugs prescribed and a lower quality of drug therapy.
Conclusion
Computerized quality assurance systems can provide support for healthcare providers. Quality indicators should be modified to give maximum support for users.
doi:10.1080/02813430600991980
PMCID: PMC3389457  PMID: 17354153
Drugs; elderly; family practice; nursing home; prescribing; quality indicators
16.  Burden of illness and suicide in elderly people: case-control study 
BMJ : British Medical Journal  2002;324(7350):1355.
Objectives
To study the association between physical illness and suicide in elderly people.
Design
Case-control with illness determined from interviews with relatives of people who committed suicide and with control participants and from medical records.
Setting
Gothenburg and two surrounding counties (210 703 people aged 65 years and over).
Participants
Consecutive records of people who had committed suicide and had undergone forensic examination (46 men, 39 women) and living control participants from the tax register (84 men, 69 women).
Main outcome measures
Physical illness rated in 13 organ systems according to the cumulative illness rating scale-geriatrics; serious physical illness (organ category score 3 or 4); overall score for burden of physical illness.
Results
Visual impairment (odds ratio 7.0, 95% confidence interval 2.3 to 21.4), neurological disorders (3.8, 1.5 to 9.4), and malignant disease (3.4, 1.2 to 9.8) were associated with increased risk for suicide. Serious physical illness in any organ category was an independent risk factor for suicide in the multivariate regression model (6.4, 2.0 to 20.0). When the sexes were analysed separately, serious physical illness was associated with suicide in men (4.2, 1.8 to 9.5) as was high burden of physical illness (2.8, 1.2 to 6.5). Such associations were not seen in women, possibly because of the small sample size.
Conclusions
Visual impairment, neurological disorders, and malignant disease were independently associated with increased risk of suicide in elderly people. Serious physical illness may be a stronger risk factor for suicide in men than in women.
What is already known on this topicPhysical illness is a common antecedent to suicide in elderly people, though prevalence figures vary widely from 34% to 94%The risk of suicide associated with physical illness is unclear because there are few controlled studiesA recent report noted serious physical illness in 56% of those who committed suicide compared with 16% of a control groupWhat this study addsVisual impairment, neurological disorder, and malignant disease were all independently associated with suicide in elderly peopleBoth serious physical illness and high overall burden of illness are stronger risk factors in men than in women
PMCID: PMC115206  PMID: 12052799

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