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Studies on the individual gender-specific risk and familial co-aggregation of suicidal behaviour in autism spectrum disorder (ASD) are lacking.
We conducted a matched case-cohort study applying conditional logistic regression models on 54 168 individuals recorded in 1987–2013 with ASD in Swedish national registers: ASD without ID n = 43 570 (out of which n = 19035, 43.69% with ADHD); ASD + ID n = 10 598 (out of which n = 2894 individuals, 27.31% with ADHD), and 270 840 controls, as well as 347 155 relatives of individuals with ASD and 1 735 775 control relatives.
The risk for suicidal behaviours [reported as odds ratio OR (95% confidence interval CI)] was most increased in the ASD without ID group with comorbid ADHD [suicide attempt 7.25 (6.79–7.73); most severe attempts i.e. requiring inpatient stay 12.37 (11.33–13.52); suicide 13.09 (8.54–20.08)]. The risk was also increased in ASD + ID group [all suicide attempts 2.60 (2.31–2.92); inpatient only 3.45 (2.96–4.02); suicide 2.31 (1.16–4.57)]. Females with ASD without ID had generally higher risk for suicidal behaviours than males, while both genders had highest risk in the case of comorbid ADHD [females, suicide attempts 10.27 (9.27–11.37); inpatient only 13.42 (11.87–15.18); suicide 14.26 (6.03–33.72); males, suicide attempts 5.55 (5.10–6.05); inpatient only 11.33 (9.98–12.86); suicide 12.72 (7.77–20.82)]. Adjustment for psychiatric comorbidity attenuated the risk estimates. In comparison to controls, relatives of individuals with ASD also had an increased risk of suicidal behaviour.
Clinicians treating patients with ASD should be vigilant for suicidal behaviour and consider treatment of psychiatric comorbidity.
Self-harm among young adults is a common and increasing phenomenon in many parts of the world. The long-term prognosis after self-harm at young age is inadequately known. We aimed to estimate the risk of mental illness and suicide in adult life after self-harm in young adulthood and to identify prognostic factors for adverse outcome.
We conducted a national population-based matched case-cohort study. Patients aged 18-24 years (n = 13 731) hospitalized after self-harm between 1990 and 2003 and unexposed individuals of the same age (n = 137 310 ) were followed until December 2009. Outcomes were suicide, psychiatric hospitalization and psychotropic medication in short-term (1-5 years) and long-term (>5 years) follow-up.
Self-harm implied an increased relative risk of suicide during follow-up [hazard ratio (HR) 16.4, 95% confidence interval (CI) 12.9–20.9). At long-term follow-up, 20.3% had psychiatric hospitalizations and 51.1% psychotropic medications, most commonly antidepressants and anxiolytics. There was a six-fold risk of psychiatric hospitalization (HR 6.3, 95% CI 5.8–6.8) and almost three-fold risk of psychotropic medication (HR 2.8, 95% CI 2.7–3.0) in long-term follow-up. Mental disorder at baseline, especially a psychotic disorder, and a family history of suicide were associated with adverse outcome among self-harm patients.
We found highly increased risks of future mental illness and suicide among young adults after self-harm. A history of a mental disorder was an important indicator of long-term adverse outcome. Clinicians should consider the substantially increased risk of suicide among self-harm patients with psychotic disorders.
Social workers report high levels of stress and have an increased risk for hospitalisation with mental diagnoses. However, it is not known whether the risk of work disability with mental diagnoses is higher among social workers compared with other human service professionals. We analysed trends in work disability (sickness absence and disability pension) with mental diagnoses and return to work (RTW) in 2005–2012 among social workers in Finland and Sweden, comparing with such trends in preschool teachers, special education teachers and psychologists.
Records of work disability (>14 days) with mental diagnoses (ICD-10 codes F00–F99) from nationwide health registers were linked to two prospective cohort projects: the Finnish Public Sector study, years 2005–2011 and the Insurance Medicine All Sweden database, years 2005–2012. The Finnish sample comprised 4849 employees and the Swedish 119 219 employees covering four occupations: social workers (Finland 1155/Sweden 23 704), preschool teachers (2419/74 785), special education teachers (832/14 004) and psychologists (443/6726). The reference occupations were comparable regarding educational level. Risk of work disability was analysed with negative binomial regression and RTW with Cox proportional hazards.
Social workers in Finland and Sweden had a higher risk of work disability with mental diagnoses compared with preschool teachers and special education teachers (rate ratios (RR) 1.43–1.91), after adjustment for age and sex. In Sweden, but not in Finland, social workers also had higher work disability risk than psychologists (RR 1.52; 95% confidence interval 1.28–1.81). In Sweden, in the final model special education teachers had a 9% higher probability RTW than social workers. In Sweden, in the final model the risks for work disability with depression diagnoses and stress-related disorder diagnoses were similar to the risk with all mental diagnoses (RR 1.40–1.77), and the probability of RTW was 6% higher in preschool teachers after work disability with depression diagnoses and 9% higher in special education teachers after work disability with stress-related disorder diagnoses compared with social workers.
Social workers appear to be at a greater risk of work disability with mental diagnoses compared with other human service professionals in Finland and Sweden. It remains to be studied whether the higher risk is due to selection of vulnerable employees to social work or the effect of work-related stress in social work. Further studies should focus on these mechanisms and the risk of work disability with mental diagnoses among human service professionals.
The aim of this study was to analyse a possible synergistic effect between back pain and common mental disorders (CMDs) in relation to future disability pension (DP).
All 4 823 069 individuals aged 16–64 years, living in Sweden in December 2004, not pensioned in 2005 and without ongoing sickness absence at the turn of 2004/2005 formed the cohort of this register-based study. Hazard ratios (HRs) and 95% confidence intervals (CIs) for DP (2006–2010) were estimated. Exposure variables were back pain (M54) (sickness absence or inpatient or specialized outpatient care in 2005) and CMD (F40-F48) [sickness absence or inpatient or specialized outpatient care or antidepressants (N06a) in 2005].
HRs for DP were 4.03 (95% CI 3.87–4.21) and 3.86 (95% CI 3.68–4.04) in women and men with back pain. HRs for DP in women and men with CMD were 4.98 (95% CI 4.88–5.08) and 6.05 (95% CI 5.90–6.21). In women and men with both conditions, HRs for DP were 15.62 (95% CI 14.40–16.94) and 19.84 (95% CI 17.94–21.94). In women, synergy index, relative excess risk due to interaction, and attributable proportion were 1.24 (95% CI 1.13–1.36), 0.18 (95% CI 0.11–0.25), and 2.08 (95% CI 1.09–3.06). The corresponding figures for men were 1.45 (95% CI 1.29–1.62), 0.29 (95% CI 0.22–0.36), and 4.21 (95% CI 2.71–5.70).
Co-morbidity of back pain and CMD is associated with a higher risk of DP than either individual condition, when added up, which has possible clinical implications to prevent further disability and exclusion from the labour market.
The aim of the present study was to investigate trajectories of suicide attempt risks before and after granting of disability pension in young people.
The analytic sample consisted of all persons 16–30 years old and living in Sweden who were granted a disability pension in the years 1995–1997; 2000–2002 as well as 2005–2006 (n = 26 624). Crude risks and adjusted odds ratios for suicide attempt were computed for the 9-year window around the year of disability pension receipt by repeated-measures logistic regressions.
The risk of suicide attempt was found to increase continuously up to the year preceding the granting of disability pension in young people, after which the risk declined. These trajectories were similar for women and men and for disability pension due to mental and somatic diagnoses. Still, the multivariate odds ratios for suicide attempts for women and for disability pension due to mental disorders were 2.5- and 3.8-fold increased compared with the odds ratios for men and disability pension due to somatic disorders, respectively. Trajectories of suicide attempts differed for young individuals granted a disability pension during 2005–2006 compared with those granted during 1995–1997 and 2000–2002.
We found an increasing risk of suicide attempt up until the granting of a disability pension in young individuals, after which the risk decreased. It is of clinical importance to monitor suicide attempt risk among young people waiting for the granting of a disability pension.
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