Association between spousal suicide and mental, physical, and social health outcomes a longitudinal and nationwide register-based study

Annette Erlangsen, Bo Runeson, James M. Bolton, Holly Wilcox, Julie L. Forman, Jesper Krogh, M. Katherine Shear, Merete Nordentoft, Yeates Conwell

Research output: Contribution to journalArticle

Abstract

Importance Bereavement after spousal suicide has been linked to mental disorders; however, a comprehensive assessment of the effect of spousal suicide is needed. OBJECTIVE To determine whether bereavement after spousal suicide was linked to an excessive risk of mental, physical, and social health outcomes when compared with the general population and spouses bereaved by other manners. DESIGN, SETTING, AND PARTICIPANTS This nationwide, register-based cohort study conducted in Denmark of 6.7 million individuals aged 18 years and older from 1980 to 2014 covered more than 136 million person-years and compared people bereaved by spousal suicide with the general population and people bereaved by other manners of death. Incidence rate ratios were calculated using Poisson regressions while adjusting for sociodemographic characteristics and the presence of mental and physical disorders. MAIN OUTCOMES AND MEASURES Mental disorders (any disorder, mood, posttraumatic stress disorder, anxiety, alcohol use disorders, drug use disorders, and self-harm); physical disorders (cancers, diabetes, sleep disorder, cardiovascular diseases, chronic lower respiratory tract diseases, liver cirrhosis, and spinal disc herniation); causes of mortality (all-cause, natural, unintentional, suicide, and homicide); social health outcomes; and health care use. RESULTS The total study population included 3 491 939 men, 4814 of whom were bereaved by spousal suicide, and 3 514 959 women, 10 793 of whom were bereaved by spousal suicide. Spouses bereaved by a partner's suicide had higher risks of developing mental disorders within 5 years of the loss (men: incidence rate ratio, 1.8; 95% CI, 1.6-2.0; women: incidence rate ratio, 1.7; 95% CI, 1.6-1.8) than the general population. Elevated risks for developing physical disorders, such as cirrhosis and sleep disorders, were also noted as well as the use of more municipal support, sick leave benefits, and disability pension funds than the general population. Compared with spouses bereaved by other manners of death, those bereaved by suicide had higher risks for developing mental disorders (men: incidence rate ratio, 1.7; 95% CI, 1.5-1.9; women: incidence rate ratio, 2.0; 95% CI, 1.9-2.2), suicidal behaviors, mortality, and municipal support. Additionally, a higher level of mental health care use was noted. CONCLUSIONS AND RELEVANCE Exposure to suicide is stressful and affects the bereaved spouse on a broad range of outcomes. The excess risks of mental, physical, and social health outcomes highlight a need for more support directed toward spouses bereaved by suicide.

Original languageEnglish (US)
Pages (from-to)456-464
Number of pages9
JournalJAMA Psychiatry
Volume74
Issue number5
DOIs
StatePublished - May 1 2017

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Suicide
Health
Spouses
Mental Disorders
Incidence
Bereavement
Population
Delivery of Health Care
Respiratory Tract Diseases
Pensions
Sick Leave
Mortality
Homicide
Financial Management
Denmark
Post-Traumatic Stress Disorders
Mood Disorders
Liver Cirrhosis
Health Status
Substance-Related Disorders

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Association between spousal suicide and mental, physical, and social health outcomes a longitudinal and nationwide register-based study. / Erlangsen, Annette; Runeson, Bo; Bolton, James M.; Wilcox, Holly; Forman, Julie L.; Krogh, Jesper; Katherine Shear, M.; Nordentoft, Merete; Conwell, Yeates.

In: JAMA Psychiatry, Vol. 74, No. 5, 01.05.2017, p. 456-464.

Research output: Contribution to journalArticle

Erlangsen, A, Runeson, B, Bolton, JM, Wilcox, H, Forman, JL, Krogh, J, Katherine Shear, M, Nordentoft, M & Conwell, Y 2017, 'Association between spousal suicide and mental, physical, and social health outcomes a longitudinal and nationwide register-based study', JAMA Psychiatry, vol. 74, no. 5, pp. 456-464. https://doi.org/10.1001/jamapsychiatry.2017.0226
Erlangsen, Annette ; Runeson, Bo ; Bolton, James M. ; Wilcox, Holly ; Forman, Julie L. ; Krogh, Jesper ; Katherine Shear, M. ; Nordentoft, Merete ; Conwell, Yeates. / Association between spousal suicide and mental, physical, and social health outcomes a longitudinal and nationwide register-based study. In: JAMA Psychiatry. 2017 ; Vol. 74, No. 5. pp. 456-464.
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abstract = "Importance Bereavement after spousal suicide has been linked to mental disorders; however, a comprehensive assessment of the effect of spousal suicide is needed. OBJECTIVE To determine whether bereavement after spousal suicide was linked to an excessive risk of mental, physical, and social health outcomes when compared with the general population and spouses bereaved by other manners. DESIGN, SETTING, AND PARTICIPANTS This nationwide, register-based cohort study conducted in Denmark of 6.7 million individuals aged 18 years and older from 1980 to 2014 covered more than 136 million person-years and compared people bereaved by spousal suicide with the general population and people bereaved by other manners of death. Incidence rate ratios were calculated using Poisson regressions while adjusting for sociodemographic characteristics and the presence of mental and physical disorders. MAIN OUTCOMES AND MEASURES Mental disorders (any disorder, mood, posttraumatic stress disorder, anxiety, alcohol use disorders, drug use disorders, and self-harm); physical disorders (cancers, diabetes, sleep disorder, cardiovascular diseases, chronic lower respiratory tract diseases, liver cirrhosis, and spinal disc herniation); causes of mortality (all-cause, natural, unintentional, suicide, and homicide); social health outcomes; and health care use. RESULTS The total study population included 3 491 939 men, 4814 of whom were bereaved by spousal suicide, and 3 514 959 women, 10 793 of whom were bereaved by spousal suicide. Spouses bereaved by a partner's suicide had higher risks of developing mental disorders within 5 years of the loss (men: incidence rate ratio, 1.8; 95{\%} CI, 1.6-2.0; women: incidence rate ratio, 1.7; 95{\%} CI, 1.6-1.8) than the general population. Elevated risks for developing physical disorders, such as cirrhosis and sleep disorders, were also noted as well as the use of more municipal support, sick leave benefits, and disability pension funds than the general population. Compared with spouses bereaved by other manners of death, those bereaved by suicide had higher risks for developing mental disorders (men: incidence rate ratio, 1.7; 95{\%} CI, 1.5-1.9; women: incidence rate ratio, 2.0; 95{\%} CI, 1.9-2.2), suicidal behaviors, mortality, and municipal support. Additionally, a higher level of mental health care use was noted. CONCLUSIONS AND RELEVANCE Exposure to suicide is stressful and affects the bereaved spouse on a broad range of outcomes. The excess risks of mental, physical, and social health outcomes highlight a need for more support directed toward spouses bereaved by suicide.",
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N2 - Importance Bereavement after spousal suicide has been linked to mental disorders; however, a comprehensive assessment of the effect of spousal suicide is needed. OBJECTIVE To determine whether bereavement after spousal suicide was linked to an excessive risk of mental, physical, and social health outcomes when compared with the general population and spouses bereaved by other manners. DESIGN, SETTING, AND PARTICIPANTS This nationwide, register-based cohort study conducted in Denmark of 6.7 million individuals aged 18 years and older from 1980 to 2014 covered more than 136 million person-years and compared people bereaved by spousal suicide with the general population and people bereaved by other manners of death. Incidence rate ratios were calculated using Poisson regressions while adjusting for sociodemographic characteristics and the presence of mental and physical disorders. MAIN OUTCOMES AND MEASURES Mental disorders (any disorder, mood, posttraumatic stress disorder, anxiety, alcohol use disorders, drug use disorders, and self-harm); physical disorders (cancers, diabetes, sleep disorder, cardiovascular diseases, chronic lower respiratory tract diseases, liver cirrhosis, and spinal disc herniation); causes of mortality (all-cause, natural, unintentional, suicide, and homicide); social health outcomes; and health care use. RESULTS The total study population included 3 491 939 men, 4814 of whom were bereaved by spousal suicide, and 3 514 959 women, 10 793 of whom were bereaved by spousal suicide. Spouses bereaved by a partner's suicide had higher risks of developing mental disorders within 5 years of the loss (men: incidence rate ratio, 1.8; 95% CI, 1.6-2.0; women: incidence rate ratio, 1.7; 95% CI, 1.6-1.8) than the general population. Elevated risks for developing physical disorders, such as cirrhosis and sleep disorders, were also noted as well as the use of more municipal support, sick leave benefits, and disability pension funds than the general population. Compared with spouses bereaved by other manners of death, those bereaved by suicide had higher risks for developing mental disorders (men: incidence rate ratio, 1.7; 95% CI, 1.5-1.9; women: incidence rate ratio, 2.0; 95% CI, 1.9-2.2), suicidal behaviors, mortality, and municipal support. Additionally, a higher level of mental health care use was noted. CONCLUSIONS AND RELEVANCE Exposure to suicide is stressful and affects the bereaved spouse on a broad range of outcomes. The excess risks of mental, physical, and social health outcomes highlight a need for more support directed toward spouses bereaved by suicide.

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