Abstract

Background: Some small studies reported high risk of suicide after surgical treatment for peptic ulcer. Our aim was to explore the risk of suicide in hospitalized gastric ulcer and duodenal ulcer patients separately among operated and unopearated cohorts.

Methods: Retrospective cohorts of 163,579 unoperated 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 hospitalization, or operation for the surgery cohort, until death, any cancer, emigration, or December 31, 2003. Standardized mortality ratios (SMRs) were calculated using rates from the age, sex and calendar period-matched Swedish population. Poisson regression produced adjusted relative risk estimates among operated and unoperated patients.

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

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