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Suicide and occupation: the impact of socio-economic, demographic and psychiatric differences

Published online by Cambridge University Press:  20 April 2007

ESBEN AGERBO ,
DAVID GUNNELL ,
JENS PETER BONDE ,
PREBEN BO MORTENSEN  and
MERETE NORDENTOFT
ESBEN AGERBO*
Affiliation:
National Centre for Register-based Research, University of Aarhus, Aarhus C, Denmark
DAVID GUNNELL
Affiliation:
Department of Social Medicine, University of Bristol, Bristol, UK
JENS PETER BONDE
Affiliation:
Department of Occupational Medicine, Aarhus University Hospital, Aarhus C, Denmark
PREBEN BO MORTENSEN
Affiliation:
National Centre for Register-based Research, University of Aarhus, Aarhus C, Denmark
MERETE NORDENTOFT
Affiliation:
Bispebjerg Hospital, Department of Psychiatry, Copenhagen NV, Denmark
*
*Address for correspondence: Esben Agerbo, M.Sc., National Centre for Register-based Research, University of Aarhus, Taasingegade1, DK-8000 Aarhus C, Denmark. (Email: ea@ncrr.dk)
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Abstract

Background

To explore the risk of suicide associated with occupation while evaluating the impact of socio-economic, demographic and psychiatric differences.

Method

A nested case–control study with 3195 suicides and 63 900 matched controls. Information on causes of death, occupation, psychiatric admission, marital status and socio-economic factors was obtained from routine registers.

Results

Across the 55 occupations investigated, the risk of suicide ranged from 2·73 [95% confidence interval (CI) 1·77–4·22] among doctors to 0·44 (95% CI 0·27–0·72) among architects and engineers compared with primary school teachers. With the exception of doctors and nurses, most of the excess risk of suicide associated with particular occupations is explained by the social and economic characteristics of people in those occupations. Much, but not all, of the excess risk in doctors and nurses is due to their increased use of self-poisoning, a method for which they have the knowledge to use effectively. Occupation has little association with suicide among people who suffer from a psychiatric illness, except for doctors, where the excess risk is 3·62 (p=0·007).

Conclusions

Most of the considerable variation in suicide risk across occupations is explained by socio-economic factors, except for doctors and nurses. Apart from in doctors, the risk of suicide has little association with occupation among people who suffer from a psychiatric illness. Restriction of access to lethal means is an important strategy in suicide prevention.

Type
Original Article
Information
Psychological Medicine , Volume 37 , Issue 8 , August 2007 , pp. 1131 - 1140
Copyright
Copyright © Cambridge University Press 2007

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References

REFERENCES

Agerbo, E. (2003). Unemployment and suicide. Journal of Epidemiology and Community Health 57, 560–561.CrossRefGoogle ScholarPubMed
Agerbo, E. (2005 a). Effect of psychiatric illness and labour market status on suicide: a healthy worker effect? Journal of Epidemiology and Community Health 59, 598–602.Google Scholar
Agerbo, E. (2005 b). Midlife suicide risk, partner's psychiatric illness, spouse and child bereavement by suicide or other modes of death: a gender specific study. Journal of Epidemiology and Community Health 59, 407–412.Google Scholar
Agerbo, E., Byrne, Eaton W. W. & Mortensen, P. B. (2004). Marital and labor market status in the long run in schizophrenia. Archives of General Psychiatry 61, 28–33.Google Scholar
Agerbo, E., Mortensen, P. B., Eriksson, T., Qin, P. & Westergaard-Nielsen, N. (2001). Risk of suicide in relation to income level in people admitted to hospital with mental illness: nested case–control study. British Medical Journal 322, 334–335.Google Scholar
Agerbo, E., Qin, P. & Mortensen, P. B. (2006). Psychiatric illness, socioeconomic status, and marital status in people committing suicide: a matched case-sibling-control study. Journal of Epidemiology and Community Health 60, 776–781.Google Scholar
Alexander, R. E. (2001). Stress-related suicide by dentists and other health care workers. Fact or folklore? Journal of the American Dental Association 132, 786–794.Google Scholar
Altman, D. G. & Royston, P. (2000). What do we mean by validating a prognostic model? Statistics in Medicine 19, 453–473.Google Scholar
Bedeian, A. G. (1982). Suicide and occupation: a review. Journal of Vocational Behavior 21, 206–223.Google Scholar
Boxer, P. A., Burnett, C. & Swanson, N. (1995). Suicide and occupation: a review of the literature. Journal of Occupational and Environmental Medicine 37, 442–452.Google Scholar
Bross, I. D. & Bross, N. S. (1987). Do atomic veterans have excess cancer? New results correcting for the healthy soldier bias. American Journal of Epidemiology 126, 1042–1050.Google Scholar
Center, C., Davis, M., Detre, T., Ford, D. E., Hansbrough, W., Hendin, H., Laszlo, J., Litts, D. A., Mann, J., Mansky, P. A., Michels, R., Miles, S. H., Proujansky, R., Reynolds, C. F. III & Silverman, M. M. (2003). Confronting depression and suicide in physicians: a consensus statement. Journal of the American Medical Association 289, 3161–3166.CrossRefGoogle ScholarPubMed
Clayton, D. & Hills, M. (1996). Statistical Models in Epidemiology. Oxford University Press: Oxford.Google Scholar
Danish National Board of Health (1992). Causes of Death in Denmark 1990 [in Danish]. Danish National Board of Health: Copenhagen.Google Scholar
Greenland, S. (1989). Modeling and variable selection in epidemiologic analysis. American Journal Public Health 79, 340–349.CrossRefGoogle ScholarPubMed
Hamermesh, D. S. & Soss, N. M. (1974). An economic theory of suicide. Journal of Political Economy 82, 83–98.Google Scholar
Hawton, K. (2005). Restriction of access to methods of suicide as a means of suicide prevention. In Prevention and Treatment of Suicidal Behaviour: From Science to Practice (ed. Hawton, K.), pp. 279–291. Oxford University Press: Oxford.CrossRefGoogle Scholar
Hawton, K. & Vislisel, L. (1999). Suicide in nurses. Suicide and Life-threatening Behavior 29, 86–95.CrossRefGoogle ScholarPubMed
Hem, E., Berg, A. M. & Ekeberg, A. O. (2001). Suicide in police – a critical review. Suicide and Life-threatening Behavior 31, 224–233.CrossRefGoogle ScholarPubMed
ILO (1990). International Standard Classification of Occupations: ISCO-88. International Labor Office: Geneva.Google Scholar
Kelly, S. & Bunting, J. (1998). Trends in suicide in England and Wales, 1982–96. Population Trends 92, 29–41.Google Scholar
Kelly, S., Charlton, J. & Jenkins, R. (1995). Suicide deaths in England and Wales, 1982–92: the contribution of occupation and geography. Population Trends 80, 16–25.Google Scholar
King, G. & Zeng, L. (2002). Estimating risk and rate levels, ratios and differences in case–control studies. Statistics in Medicine 21, 1409–1427.Google Scholar
Kposowa, A. J. (1999). Suicide mortality in the United States: differentials by industrial and occupational groups. American Journal of Industrial Medicine 36, 645–652.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
Kreitman, N., Carstairs, V. & Duffy, J. (1991). Association of age and social class with suicide among men in Great Britain. Journal of Epidemiology and Community Health 45, 195–202.Google Scholar
Li, C. Y. & Sung, F. C. (1999). A review of the healthy worker effect in occupational epidemiology. Occupational Medicine (Oxford, England) 49, 225–229.Google Scholar
Liu, T. & Waterbor, J. W. (1994). Comparison of suicide rates among industrial groups. American Journal of Industrial Medicine 25, 197–203.CrossRefGoogle ScholarPubMed
Lostao, L., Joiner, T. E. Jr., Lester, D., Regidor, E., Atach, P. & Sandin, B. (2006). Social inequalities in suicide mortality: Spain and France, 1980–1982 and 1988–1990. Suicide and Life-threatening Behavior 36, 113–119.Google Scholar
Lunn, M. & McNeil, D. (1995). Applying Cox regression to competing risks. Biometrics 51, 524–532.Google Scholar
MacKinnon, D. P., Krull, J. L. & Lockwood, C. M. (2000). Equivalence of the mediation, confounding and suppression effect. Prevention Science 1, 173–181.CrossRefGoogle ScholarPubMed
Malig, C. (1996). The Civil Registration System in Denmark. IIVRS Technical Paper no. 66. International Institute for Vital Registration and Statistics: Bethesda, MD, USA.Google Scholar
Malmberg, A., Simkin, S. & Hawton, K. (1999). Suicide in farmers. British Journal of Psychiatry 175, 103–105.CrossRefGoogle ScholarPubMed
Maris, R. W. (2002). Suicide. Lancet 360, 319–326.Google Scholar
Mellanby, R. J. (2005). Incidence of suicide in the veterinary profession in England and Wales. The Veterinary Record 157, 415–417.CrossRefGoogle ScholarPubMed
Munk-Jorgensen, P. & Mortensen, P. B. (1997). The Danish Psychiatric Central Register. Danish Medical Bulletin 44, 82–84.Google ScholarPubMed
Newman, S. C. (2001). Biostatistical Methods in Epidemiology. John Wiley & Sons: New York.Google Scholar
Notkola, V. J., Martikainen, P. & Leino, P. I. (1993). Time trends in mortality in forestry and construction workers in Finland 1970–85 and impact of adjustment for socioeconomic variables. Journal of Epidemiology and Community Health 47, 186–191.Google Scholar
Platt, S. & Hawton, K. (2000). Suicidal behaviour and the labour market. In The International Handbook of Suicide and Attempted Suicide (ed. Hawton, K. and van Heeringen, K.), pp. 309–384. John Wiley & Sons: New York.Google Scholar
Robins, J. M., Hernan, M. A. & Brumback, B. (2000). Marginal structural models and causal inference in epidemiology. Epidemiology 11, 550–560.Google Scholar
Rothberg, J. M., Bartone, P. T., Holloway, H. C. & Marlowe, D. H. (1990). Life and death in the US Army. In Corpore sano. Journal of the American Medical Association 264, 2241–2244.Google Scholar
Rothman, K. J. & Greenland, S. (1998). Modern Epidemiology. Lippincott Williams & Wilkins: Philadelphia.Google Scholar
Schernhammer, E. (2005). Taking their own lives – the high rate of physician suicide. New England Journal of Medicine 352, 2473–2476.Google Scholar
Schernhammer, E. S. & Colditz, G. A. (2004). Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). American Journal of Psychiatry 161, 2295–2302.Google Scholar
Schwartz, E. (1987). Proportionate mortality ratio analysis of automobile mechanics and gasoline service station workers in New Hampshire. American Journal of Industrial Medicine 12, 91–99.CrossRefGoogle ScholarPubMed
Stack, S. (1996). Gender and suicide risk among artists: a multivariate analysis. Suicide and Life-threatening Behavior 26, 374–379.Google Scholar
Stack, S. (2001). Occupation and suicide. Social Science Quarterly 82, 384–396.CrossRefGoogle Scholar
Stack, S. (2004). Suicide among social workers: a research note. Archives of Suicide Research 8, 379–388.CrossRefGoogle ScholarPubMed
Stark, C., Belbin, A., Hopkins, P., Gibbs, D., Hay, A. & Gunnell, D. (2006). Male suicide and occupation in Scotland. Health Statistics Quarterly 29, 26–29.Google Scholar
Statistics Denmark (1991). The Integrated Database for Longitudinal Labour Market Research [in Danish]. Statistics Denmark Press: Copenhagen.Google Scholar
Statistics Denmark (1996). DISCO-88. Statistics Denmark's Standard Classification of Occupations. Statistics Denmark: Copenhagen.Google Scholar
Tohen, M., Bromet, E., Murphy, J. M. & Tsuang, M. T. (2000). Psychiatric epidemiology. Harvard Review of Psychiatry 8, 111–125.CrossRefGoogle ScholarPubMed
WHO (1967). Manual of the International Classification of Diseases (ICD-8). World Health Organization: Geneva.Google Scholar
WHO (1992). The ICD-10 Classification of Mental and Behavioral Disorders. World Health Organization: Geneva.Google Scholar
Wieclaw, J., Agerbo, E., Mortensen, P. B. & Bonde, J. P. (2005). Occupational risk of affective and stress-related disorders in the Danish workforce. Scandinavian Journal of Work, Environment and Health 31, 343–351.Google Scholar
Wieclaw, J., Agerbo, E., Mortensen, P. B. & Bonde, J. P. (2006). Risk of affective and stress related disorders among employees in human service professions. Occupational and Environmental Medicine 63, 314–319.Google Scholar