Suicide risk and suicide method in patients with personality disorders

• Published in: Journal of psychiatric research 2016-12, Vol.83, p.29-36
• Main Authors: Björkenstam, Charlotte, Ekselius, Lisa, Berlin, Marie, Gerdin, Bengt, Björkenstam, Emma
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Distribution; Cause of Death; Comorbidity; Female; Humans; Longitudinal Studies; Male; Medicin och hälsovetenskap; Mental Disorders - epidemiology; Middle Aged; Personality disorder; Personality Disorders - epidemiology; Personality Disorders - psychology; Psychiatry; Register; Retrospective Studies; Risk Factors; Self-Injurious Behavior - epidemiology; Suicide; Suicide - psychology; Suicide - statistics & numerical data; Suicide method; Sweden; Young Adult
• ISSN: 0022-3956; 1879-1379; 1879-1379
• DOI: 10.1016/j.jpsychires.2016.08.008

Abstract Objective The influence of psychopathology on suicide method has revealed different distributions among different psychiatric disorders. However, evidence is still scarce. We hypothesized that having a diagnosis of personality disorder (PD) affect the suicide method, and that different PD clusters would influence the suicide method in different ways. In addition, we hypothesized that the presence of psychiatric and somatic co-morbidity also affects the suicide method. Method We examined 25,217 individuals aged 15–64 who had been hospitalized in Sweden with a main diagnosis of PD the years 1987–2013 (N = 25,217). The patients were followed from the date of first discharge until death or until the end of the follow-up period, i.e. December 31, 2013, for a total of 323,508.8 person-years, with a mean follow up time of 11.7 years. The SMR, i.e. the ratio between the observed number of suicides and the expected number of suicides, was used as a measure of risk. Results Overall PD, different PD-clusters, and comorbidity influenced the suicide method. Hanging evidenced highest SMR in female PD patients (SMR 34.2 (95% CI: 29.3–39.8)), as compared to non-PD patients and jumping among male PD patients (SMR 24.8 (95% CI: 18.3–33.6)), as compared to non PD-patients. Furthermore, the elevated suicide risk was related to both psychiatric and somatic comorbidity. Conclusion The increased suicide risk was unevenly distributed with respect to suicide method and type of PD. However, these differences were only moderate and greatly overshadowed by the overall excess suicide risk in having PD. Any attempt from society to decrease the suicide rate in persons with PD must take these characteristics into account.