Suicide and unintentional injury mortality among homeless people: a Danish nationwide register-based cohort study

• Published in: European journal of public health 2014-02, Vol.24 (1), p.50-56
• Main Authors: Feodor Nilsson, Sandra, Hjorthøj, Carsten Rygaard, Erlangsen, Annette, Nordentoft, Merete
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Cohort analysis; Denmark; Denmark - epidemiology; Drug Abuse; Drug use; Drugs; Female; History; Homeless people; Homeless Persons - psychology; Homeless Persons - statistics & numerical data; Homelessness; Humans; Injuries; Longitudinal Studies; Male; Males; Men; Middle Aged; Mortality; Mortality Rates; Registries; Risk; Risk assessment; Risk Factors; Schizophrenia; Schizophrenia - mortality; Self-Injurious Behavior - mortality; Sex Factors; Substance-Related Disorders - mortality; Suicide; Suicide - statistics & numerical data; Suicides & suicide attempts; Women; Young Adult
• ISSN: 1101-1262; 1464-360X
• DOI: 10.1093/eurpub/ckt025

Homeless people have elevated mortality, especially due to external causes. We aimed to examine suicide and unintentional injury mortality levels and identify predictors in the homeless population. A nationwide, register-based cohort study of homeless people aged 16 years and older was carried out using the Danish Homeless Register, 1999-2008. In all, 32 010 homeless people (70.5% men) were observed. For men, the mortality rate was 174.4 [95% confidence interval (CI) = 150.6-198.1] per 100 000 person-years for suicide and 463.3 (95% CI = 424.6-502.0) for unintentional injury. For women, the corresponding rates were 111.4 (95% CI = 81.7-141.1) for suicide and 241.4 (95% CI = 197.6-285.1) for unintentional injury. Schizophrenia spectrum, affective, personality and substance use disorders were strongly associated with increased risk of suicide; the highest risk estimates were found for schizophrenia spectrum disorders among both men [hazard ratio (HR) = 3.1, 95% CI = 2.0-4.9] and women (HR = 15.5, 95% CI = 4.5-54.0). Alcohol and drug use disorders were predictors of death by unintentional injury for both men and women, whereas schizophrenia spectrum disorders and personality disorders were only significant predictors among men; the highest risk estimates were found for drug use disorders among men (HR = 2.2, 95% CI = 1.8-2.8) and women (HR = 3.1, 95% CI = 1.8-5.4). A history of psychiatric admission and emergency room contact were predictors for dying by suicide and unintentional injury. People in the homeless shelter population with a history of a psychiatric disorder constitute a high-risk group regarding the elevated suicide and unintentional injury mortality.