Proportion of suicides in Denmark attributable to bereavement by the suicide of a first-degree relative or partner: Nested case–control study

Alexandra Pitman, Keltie McDonald, Yanakan Logeswaran, Gemma Lewis, Julie Cerel, Annette Erlangsen

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Objective: To provide the first estimates of the risk of suicide after bereavement by the suicide of any first-degree relative and the proportion of suicides in Denmark attributable to suicide bereavement. Methods: We conducted a nationwide nested case–control study defining cases as all Danish-born individuals who died by suicide in Denmark between 01 January 1980 and 31 December 2016 (n = 32,248), age-matched to four living controls. Using three exposure categories (bereavement by the suicide of a relative [parent, offspring, sibling, and spouse/cohabitee]; non-suicide bereavement; no bereavement) and conditional logistic regression adjusted for pre-specified covariates we estimated the odds of exposure to suicide bereavement in cases versus controls. We tested whether associations differed for men and women, estimated the population attributable fraction (PAF) of suicides in our population at risk that could be attributed to a first-degree relative's suicide loss, and estimated the attributable fraction among the exposed (AFe). Results: Suicide bereavement was associated with an increased odds of suicide when compared with no bereavement (ORadj2 = 2.90, 95% CI: 2.46–3.40) or non-suicide bereavement (ORadj2 = 1.48, 95% CI: 1.25–1.74). There was no evidence to support any interaction with sex. PAF (0.69%; 95% CI: 0.62%–0.77%) and AFe (60.12%; 95% CI: 53.19%–66.03%) estimates suggested that in Denmark 0.69% of suicides, and 60% of suicides among suicide-bereaved relatives, could be prevented if it was possible to address all factors increasing suicide risk in suicide-bereaved relatives. Conclusion: Suicide bereavement in relatives and partners contributes to at least one in 145 suicides in Denmark.

Original languageEnglish
Pages (from-to)529-539
Number of pages11
JournalActa Psychiatrica Scandinavica
Volume146
Issue number6
DOIs
StatePublished - Dec 2022

Bibliographical note

Funding Information:
This work was supported by a grant from the American Foundation for Suicide Prevention (SRG‐0‐111‐17). Alexandra Pitman and Gemma Lewis re also supported by the National Institute for Health Research (NIHR) University College London Hospital (UCLH) Biomedical Research Centre (BRC). The funder was not involved in the design or conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Only Keltie McDonald, Alexandra Pitman, Yanakan Logeswaran, Annette Erlangsen had access to the raw data. The corresponding author had full access to all data used in the study, and final responsibility for the decision to submit for publication. a

Publisher Copyright:
© 2022 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.

Keywords

  • bereavement
  • case–control studies
  • population attributable fraction
  • registries
  • suicide

ASJC Scopus subject areas

  • Psychiatry and Mental health

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