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(J H W Tischbein 1805) Suicide among men Bo Runeson Dep Clin Neuroscience Karolinska Institute
(J H W Tischbein 1805)
Suicide among men
Bo RunesonDep Clin NeuroscienceKarolinska Institute
Suicide in Stockholm County and Sweden per 100 000 inhabitants
15 years and older 1980–2006
0
10
20
30
40
50
60
198019
8119
8219
8319
8419
8519
8619
8719
8819
8919
9019
9119
9219
9319
9419
9519
9619
9719
9819
9920
0020
0120
0220
0320
0420
0520
06Suicid
es p
er 100 0
00 inhabitants
Men, Stockholm Women, Stockholm
Men, Sweden Women, Sweden
Decreasing rates of suicide in Swedish men
……..and in Denmark
but not in the youngest age groups
………nor in the very oldest age group
Suicide and prescription of antidepressants
Suicide in Swedish countiesaverage rate 1999-2003, per 100 000 inhabitants (SoS)
Suicide attempts in Swedish countiesaverage rate 1999-2003, inpatients per 100 000 inhabitants (SoS)
Suicide in urban and rural areas ?
Suicide Suicide attempt
Men Women Men Women
Metropolitain area 35.2 17.2 98.1 150.8Suburban area 24.9 12.0 80.6 131.2Large town 30.3 13.0 84.2 132.6Commuting community 31.8 11.7 76.0 115.1Rural community 41.6 7.8 72.0 111.4
Sweden 31.5 12.5 83.6 129.5
(SoS)
Method of suicide in men and women
Poisoning
Hanging
Drowning
Shooting
Cutting
Jumping from height
Other
Number of suicides according to method in ages above 15 years of age2003. Per cent.
WomenMen
Male suicide
� Historically more varying rates� Reflects changes in society
� More sensitive to somatic diseases� More sensitive to bereavement of spouse and to suicide in family
� Do not retain social networks
� Less inclined to seek psychiatric help
Family clustering?
Runeson & Åsberg Am J Psychiatry 2003A family history of suicide predicted suicide independent of severe mental disorder
(Brent & Mann2006)
Two
familial
path-
ways
Rate of depression among suicide victimsshare of suicides in an area
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Males Females Youth <30 Elderly >65
No depression
Depression
(Beskow -79) (Åsgård -90) (Runeson -89) (Waern –02)
Substance abuse/dependenceshare of suicides in an area
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Males Females Youth <30 Elderly
>65
Substance abuse
(Beskow -79) (Åsgård -90) (Runeson -89) (Waern -99)
Male depression
Comorbidity (schizophrenia and alcoholism)
15-32 years33-44 years
45-77 years
Men
Women0
10
20
30
40
50
(Heilä -99)
Suicide after suicide attemptA cohort followed for 37 years
(Suominen et la 2004)
Time in years
2520151050
Cumulative survival from suicide
1,0
0,9
0,8
0,7
0,6
Schizophrenia (n = 388)
Bipolar disorder (n = 379)
Personality disorder (n = 645)
Depressive disorder (n = 1607)
Alcohol abuse/dependence (n = 2005)
No psychiatric diagnosis (n = 12 724)
Males
Prognosis after suicide attempt is related to diagnosis!(Tidemalm, Långström, Lichtenstein, Runeson, unpubl)
ControlsAlcohol abuse/depDepression
Personality dis
Bipolar disorderSchizophrenia
Males
Suicide according to education and sex
High level Median level Low levelof education of education of education
Occupation and suiciden=3195, age and sexadjusted suicides
Medical doctor 2.73
No occupation 2.47
Nurse 2.04
Unskilled worker 1.99
Painter 1.73
Cook 1.72
Plumber 1.52
Carpenter 1.49
Driver 1.35
Cleaner 1.35
Farmer 1.17
Primary school teacher 1
Motor mechanic 1.00
Business man 0.93
Police 0.85
Shop assistant 0.79
Technician 0.70
Military 0.51
Architect 0.44
Engineer 0.44
(Agerbo et al 2007)
1.171.571.021.59Farmer
1.251.750.961.73Painter
0.520.570.430.44Architect
0.560.660.560.70Technician
1111Teacher
1.151.580.971.72Cook
1.151.720.921.99Unskilled worker
2.282.302.112.04Nurse
1.061.710.882.47No occupation
3.403.033.312.73Medical doctor
Adjusted for all and civil status
Adjusted for admission in psychiatric care
Adjusted for income and
employment
RR
(Ron Mueck 2000)
SuicideAvailable methods
Resistance towards seeking help
Depression
Substance abuse
Genetic or early environmental factors
Personality traits
Model for male suicide
Precipitating factors:Separation, loss of position
Demographic factors
(Johan Heinrich Füssli 1779)
Prevention?
Adequate suicide risk assessment
Optimal treatment of mental disorder
Continuity and quality in follow-up of treatment
