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Risk of Suicide After Diagnosis of Severe Physical Health Conditions: A Cohort Study

14 Pages Posted: 16 Jun 2022

See all articles by Vahe Nafilyan

Vahe Nafilyan

Government of the United Kingdom - Health Analysis and Life Events Division

Jasper Morgan

Government of the United Kingdom - Health Analysis and Life Events Division

David Mais

Government of the United Kingdom - Health Analysis and Life Events Division

Katherine Sleeman

King’s College London - Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation

Asim Butt

Government of the United Kingdom - Office for National Statistics; Government of the United Kingdom - Health Analysis and Life Events Division

Isobel Ward

Government of the United Kingdom - Office for National Statistics; Government of the United Kingdom - Health Analysis and Life Events Division

James Tucker

Government of the United Kingdom - Office for National Statistics; Government of the United Kingdom - Health Analysis and Life Events Division

Louis Appleby

University of Manchester - National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH)

Myer Glickman

Government of the United Kingdom - Office for National Statistics; Government of the United Kingdom - Health Analysis and Life Events Division

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Abstract

Background: The diagnosis of a severe physical health condition can cause psychological distress and lead to severe depression. The association between severe physical health conditions and risk of suicide and how the risk of suicide changes in the months following diagnosis, are not clear.

Methods: We estimated whether diagnosis of severe physical health conditions is associated with an increase in risk of death by suicide using a dataset based on the 2011 Census linked to hospital records and death registration records covering 47,354,696 people alive on 1 Jan 2017 in England. Patients diagnosed with low-survival cancers, chronic ischaemic heart disease, chronic obstructive pulmonary disease, and degenerative neurological condition were matched to individuals using socio-demographic characteristics from the Census. We estimated the cumulative incidence of death by suicide occurring between 1 January 2017 and 31 December 2021 (registered by 31 December 2021) in patients and matched controls.

Findings: Diagnosis of severe conditions was associated with an increased risk of dying by suicide. One year after diagnosis, the rate of suicide was 22.2 (95% confidence intervals: 11.1 to 33.3) per 100,000 low-survival cancer patients compared to 9.1 (4.6 to 13.6) per 100,000 matched controls. For COPD patients, the one-year suicide rate was 23.6 (20.0 to 27.2) per 100,000 COPD patients (matched controls: 9.7, 7.6 to 11.7), for ischaemic heart disease 16.4 (14.1 to 18.8) per 100,000 patients (matched controls: 8.5, 6.9 to 10.0), for degenerative neurological conditions 107.7 (23.3 to 192.1) per 100,000 patients. The increase in risk was more pronounced in the first six months after diagnosis or first treatment.

Interpretation: Further research is needed to understand the drivers of suicide in patients diagnosed with severe conditions. Identification of treatable mental illness following diagnosis of severe physical health conditions is essential.

Funding: Office for National Statistics

Declaration of Interest: None to declare.

Ethical Approval: This study was ethically self-assessed against the ethical principles of the National Statistician's Data Ethics Advisory Committee (NSDEC) using NSDEC's ethics self-assessment tool. We engaged with the UK Statistics Authority Data Ethics team and it was decided that ethical approval was not required.

Keywords: suicide, severe illness

Suggested Citation

Nafilyan, Vahe and Morgan, Jasper and Mais, David and Sleeman, Katherine and Butt, Asim and Ward, Isobel and Tucker, James and Appleby, Louis and Glickman, Myer, Risk of Suicide After Diagnosis of Severe Physical Health Conditions: A Cohort Study. Available at SSRN: https://ssrn.com/abstract=4138283 or http://dx.doi.org/10.2139/ssrn.4138283

Vahe Nafilyan (Contact Author)

Government of the United Kingdom - Health Analysis and Life Events Division ( email )

United Kingdom

Jasper Morgan

Government of the United Kingdom - Health Analysis and Life Events Division ( email )

David Mais

Government of the United Kingdom - Health Analysis and Life Events Division ( email )

Katherine Sleeman

King’s College London - Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation ( email )

United Kingdom

Asim Butt

Government of the United Kingdom - Office for National Statistics ( email )

London, SW1A 2AA
United Kingdom

Government of the United Kingdom - Health Analysis and Life Events Division ( email )

Isobel Ward

Government of the United Kingdom - Office for National Statistics ( email )

London, SW1A 2AA
United Kingdom

Government of the United Kingdom - Health Analysis and Life Events Division ( email )

James Tucker

Government of the United Kingdom - Office for National Statistics ( email )

London, SW1A 2AA
United Kingdom

Government of the United Kingdom - Health Analysis and Life Events Division ( email )

Louis Appleby

University of Manchester - National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) ( email )

2nd Floor Jean McFarlane Building
Oxford Road
Manchester, M13 9PL
United Kingdom

Myer Glickman

Government of the United Kingdom - Office for National Statistics ( email )

Government of the United Kingdom - Health Analysis and Life Events Division ( email )

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