Bo Runeson DepClinNeuroscience Karolinska Institute · PDF fileTime in years 0 5 10 15 20 25 Cumulative survival from suicide 1,0 0,9 0,8 0,7 0,6 Schizophrenia (n = 388) Bipolar disorder

(J H W Tischbein 1805)

Suicide among men

Bo RunesonDep Clin NeuroscienceKarolinska Institute

Suicide in Stockholm County and Sweden per 100 000 inhabitants

15 years and older 1980–2006

0

10

20

30

40

50

60

198019

8119

8219

8319

8419

8519

8619

8719

8819

8919

9019

9119

9219

9319

9419

9519

9619

9719

9819

9920

0020

0120

0220

0320

0420

0520

06Suicid

es p

er 100 0

00 inhabitants

Men, Stockholm Women, Stockholm

Men, Sweden Women, Sweden

Decreasing rates of suicide in Swedish men

……..and in Denmark

but not in the youngest age groups

………nor in the very oldest age group

Suicide and prescription of antidepressants

Suicide in Swedish countiesaverage rate 1999-2003, per 100 000 inhabitants (SoS)

Suicide attempts in Swedish countiesaverage rate 1999-2003, inpatients per 100 000 inhabitants (SoS)

Suicide in urban and rural areas ?

Suicide Suicide attempt

Men Women Men Women

Metropolitain area 35.2 17.2 98.1 150.8Suburban area 24.9 12.0 80.6 131.2Large town 30.3 13.0 84.2 132.6Commuting community 31.8 11.7 76.0 115.1Rural community 41.6 7.8 72.0 111.4

Sweden 31.5 12.5 83.6 129.5

(SoS)

Method of suicide in men and women

Poisoning

Hanging

Drowning

Shooting

Cutting

Jumping from height

Other

Number of suicides according to method in ages above 15 years of age2003. Per cent.

WomenMen

Male suicide

� Historically more varying rates� Reflects changes in society

� More sensitive to somatic diseases� More sensitive to bereavement of spouse and to suicide in family

� Do not retain social networks

� Less inclined to seek psychiatric help

Family clustering?

Runeson & Åsberg Am J Psychiatry 2003A family history of suicide predicted suicide independent of severe mental disorder

(Brent & Mann2006)

Two

familial

path-

ways

Rate of depression among suicide victimsshare of suicides in an area

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Males Females Youth <30 Elderly >65

No depression

Depression

(Beskow -79) (Åsgård -90) (Runeson -89) (Waern –02)

Substance abuse/dependenceshare of suicides in an area

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Males Females Youth <30 Elderly

>65

Substance abuse

(Beskow -79) (Åsgård -90) (Runeson -89) (Waern -99)

Male depression

Comorbidity (schizophrenia and alcoholism)

15-32 years33-44 years

45-77 years

Men

Women0

10

20

30

40

50

(Heilä -99)

Suicide after suicide attemptA cohort followed for 37 years

(Suominen et la 2004)

Time in years

2520151050

Cumulative survival from suicide

1,0

0,9

0,8

0,7

0,6

Schizophrenia (n = 388)

Bipolar disorder (n = 379)

Personality disorder (n = 645)

Depressive disorder (n = 1607)

Alcohol abuse/dependence (n = 2005)

No psychiatric diagnosis (n = 12 724)

Males

Prognosis after suicide attempt is related to diagnosis!(Tidemalm, Långström, Lichtenstein, Runeson, unpubl)

ControlsAlcohol abuse/depDepression

Personality dis

Bipolar disorderSchizophrenia

Males

Suicide according to education and sex

High level Median level Low levelof education of education of education

Occupation and suiciden=3195, age and sexadjusted suicides

Medical doctor 2.73

No occupation 2.47

Nurse 2.04

Unskilled worker 1.99

Painter 1.73

Cook 1.72

Plumber 1.52

Carpenter 1.49

Driver 1.35

Cleaner 1.35

Farmer 1.17

Primary school teacher 1

Motor mechanic 1.00

Business man 0.93

Police 0.85

Shop assistant 0.79

Technician 0.70

Military 0.51

Architect 0.44

Engineer 0.44

(Agerbo et al 2007)

1.171.571.021.59Farmer

1.251.750.961.73Painter

0.520.570.430.44Architect

0.560.660.560.70Technician

1111Teacher

1.151.580.971.72Cook

1.151.720.921.99Unskilled worker

2.282.302.112.04Nurse

1.061.710.882.47No occupation

3.403.033.312.73Medical doctor

Adjusted for all and civil status

Adjusted for admission in psychiatric care

Adjusted for income and

employment

RR

(Ron Mueck 2000)

SuicideAvailable methods

Resistance towards seeking help

Depression

Substance abuse

Genetic or early environmental factors

Personality traits

Model for male suicide

Precipitating factors:Separation, loss of position

Demographic factors

(Johan Heinrich Füssli 1779)

Prevention?

Adequate suicide risk assessment

Optimal treatment of mental disorder

Continuity and quality in follow-up of treatment