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Risk of suicide among operated and non-operated patients hospitalised for peptic ulcers
  1. S Bahmanyar1,2,
  2. P Sparén3,
  3. E Mittendorfer Rutz4,
  4. C M Hultman3,5
  1. 1
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden
  2. 2
    Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
  3. 3
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  4. 4
    Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  5. 5
    Department of Neuroscience, Psychiatry, Ulleråker, Uppsala University, Sweden
  1. Correspondence to Dr S Bahmanyar, Clinical Epidemiology Unit, Department of Medicine, Karolinska Hospital, M9:01, 171 76, Stockholm, Sweden; Shahram.bahmanyar{at}


Background: Some small studies have reported high risk of suicide after surgical treatment for peptic ulcer. The aim of the present study was to explore the risk of suicide in hospitalised gastric ulcer and duodenal ulcer patients separately among operated and non-operated cohorts.

Methods: Retrospective cohorts of 163 579 non-operated patients with gastric ulcer or duodenal ulcer and 28 112 patients with surgical treatment for ulcer, recorded in the Swedish Inpatient Register since 1965, were followed from the first hospitalisation, or operation for the surgery cohort, until death, any cancer, emigration, or 31 December 2003. Standardised mortality ratios (SMRs) were calculated, and Poisson regression produced adjusted relative risk estimates among operated and non-operated patients.

Results: Non-operated patients hospitalised for peptic ulcer showed a 70% excess risk of suicide (SMR 1.7, 95% CI 1.6 to 1.9) and those who underwent operation had a 60% increased risk (SMR 1.6, 95% CI 1.4 to 1.8). The risk of suicide was very high during the first year after hospitalisation (SMR 4.0, 95% CI 3.4 to 4.7) and more marked among women, patients under 70 and patients hospitalised without complications of ulcer. Both gastric ulcer and duodenal ulcer patients had high risk of suicide completion.

Conclusion: Hospitalised patients with gastric ulcer or duodenal ulcer have an increased risk of suicide regardless of surgical treatment. These patients, especially women, are at very high risk during the first year after first hospitalisation/operation. The evaluation and management of suicidal thoughts in patients in medical settings should be further considered.

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  • Funding The study was made possible by a grant from Karolinska Institutet, Sweden

  • Competing interests None.

  • Ethics approval Karolinska Institutet regional ethics committee.

  • Provenance and Peer review Not commissioned; externally peer reviewed.