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Suicide among persons who entered same-sex and opposite-sex marriage in Denmark and Sweden, 1989–2016: a binational, register-based cohort study
  1. Annette Erlangsen1,2,3,
  2. Sven Drefahl4,
  3. Ann Haas5,
  4. Charlotte Bjorkenstam6,7,
  5. Merete Nordentoft1,8,
  6. Gunnar Andersson4
  1. 1 Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
  2. 2 Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3 Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
  4. 4 Stockholm University Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
  5. 5 Department of Health Sciences, Lehman College, City University of New York, New York City, New York, USA
  6. 6 Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  7. 7 Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
  8. 8 Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Dr Annette Erlangsen, Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, DK-1900 Hellerup, Denmark; Annette.Erlangsen{at}


Background People belonging to sexual minority groups have higher levels of suicidality than heterosexuals. However, findings regarding suicide death are sparse. Using unique national data from two countries, we investigated whether individuals entering a same-sex marriage (SSM), a proxy group of sexual minority individuals, had higher suicide rates than those entering opposite-sex marriage (OSM).

Methods A cohort study of all males and females who entered an SSM (n=28 649) or OSM (n=3 918 617) in Denmark and Sweden during 1989–2016 was conducted. Incidence rate ratios (IRRs) for suicide were calculated using adjusted Poisson regression models.

Results In total, 97 suicides occurred among individuals who had entered an SSM compared with 6074 among those who entered an OSM, corresponding to an adjusted IRR of 2.3 (95% CI 1.9 to 2.8). For people who entered SSM, a 46% decline was noted over time from an IRR of 2.8 (95% CI 1.9 to 4.0) during 1989–2002 to 1.5 (95% CI 1.2 to 1.9) during 2003–2016. The excess suicide mortality was present in all age groups but most pronounced among younger individuals aged 18–34 years of age (IRR 2.7, 95% CI 1.5 to 4.8) and females (IRR 2.7, 95% CI 1.8 to 3.9).

Conclusion This large register-based study found higher suicide rates among individuals who entered an SSM, compared with those who entered an OSM. A lower suicide rate was noted for individuals in SSMs in recent years. More research is needed to identify the unique suicide risk and protective factors for sexual minority people.

  • suicide
  • suicidal behaviour
  • sexual minorities
  • register data
  • Denmark
  • Sweden, same-sex marriage

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  • Contributors All authors were actively involved in planning the study and engaged in discussing ongoing progress of analyses and interpretation of findings. AE, SD and GA were in charge of the data management and analyses with feedback from AH, MN and CB. AE drafted and revised the manuscript based on comments provided by all authors. All authors approved the final version of the report. AE and GA are the final guarantors of the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The research project was approved by the Danish and Swedish Data Protection Agencies.

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

  • Data availability statement No data are available.

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