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Agerbo reports a nested case-control study of all (n = 9011) Danish midlife suicides (25–60 years of age) 1982–97.1 He investigated sex specific midlife suicide risks associated with spousal psychiatric admission, spouse or child bereavement by suicide or other causes of death, and several sociodemographic factors. There is a wealth of original findings from this impressive population based register study. Particularly, increased suicide risks were seen after spousal psychiatric admission or spousal or child death, especially after spousal suicide. Several points of criticism regarding certain study premises and the interpretation of study findings are discussed here. In what follows, I will focus on five points: firstly, the age range restriction; secondly, the psychiatric admission criterion; thirdly, the environmental interpretations of certain findings; fourthly, the implications of assortative mating; and fifthly, the evidence for sex specific suicide risks. An attempt is made to place this study’s findings in the context of present information on the epidemiology of suicide. Furthermore, brief comments on the relevance of the study findings and on new research or methodology needed to overcome the present limitation of the knowledge in this area are given.
Firstly, the range restriction in age (25–60 years) clearly restricts the generalisability of this study: it does not capture total (lifetime) suicide mortality. Internationally, in most Western industrialised nations, there is a noticeable positive age relation of suicide risk that furthermore is more pronounced for men than for women. Consider the Danish suicide rates of the elderly population (aged 65 years or over), as available from the European Health for All database (http:/www.euro.who.int/hfadb): during the study period (1982–97), yearly male suicide rates were …