Investigating risk of self-harm and suicide on anniversaries after bereavement by suicide and other causes: a Danish population-based self-controlled case series study
Abstract Aims To investigate mechanisms of suicide risk in people bereaved by suicide, prompted by observations that bereaved people experience higher levels of distress around dates of emotional significance. We hypothesised that suicide-bereaved first-degree relatives and partners experience an in...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2023-01-01
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| Series: | Epidemiology and Psychiatric Sciences |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2045796023000653/type/journal_article |
| _version_ | 1827874703824388096 |
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| author | Alexandra Pitman Yanakan Logeswaran Keltie McDonald Julie Cerel Gemma Lewis Annette Erlangsen |
| author_facet | Alexandra Pitman Yanakan Logeswaran Keltie McDonald Julie Cerel Gemma Lewis Annette Erlangsen |
| author_sort | Alexandra Pitman |
| collection | DOAJ |
| description | Abstract
Aims
To investigate mechanisms of suicide risk in people bereaved by suicide, prompted by observations that bereaved people experience higher levels of distress around dates of emotional significance. We hypothesised that suicide-bereaved first-degree relatives and partners experience an increased risk of self-harm and suicide around dates of (i) anniversaries of the death and (ii) the deceased’s birthday, compared with intervening periods.
Methods
We conducted a self-controlled case series study using national register data on all individuals living in Denmark from 1 January 1980 to 31 December 2016 and who were bereaved by the suicide of a first-degree relative or partner (spouse or cohabitee) during that period, and who had the outcome (any episode of self-harm or suicide) within 5 years and 6 weeks of the bereavement. We compared relative incidence of suicidal behaviour in (i) the first 30 days after bereavement and (ii) in the aggregated exposed periods (6 weeks either side of death anniversaries; 6 weeks either side of the deceased’s birthdays) to the reference (aggregated unexposed intervening periods). As an indirect comparison, we repeated these models in people bereaved by other causes.
Results
We found no evidence of an elevated risk of suicidal behaviour during periods around anniversaries of a death or the deceased’s birthdays in people bereaved by suicide (adjusted incidence rate ratio [IRRadj] = 1.00; 95% confidence interval [CI] = 0.87–1.16) or other causes (IRRadj = 1.04; 95% CI = 1.00–1.08) compared with intervening periods. Rates were elevated in the 30 days immediately after bereavement by other causes (IRRadj: 1.95, 95% CI: 1.77–2.22).
Conclusions
Although people bereaved by suicide are at elevated risk of self-harm and suicide, our findings do not suggest that this risk is heightened around emotionally significant anniversaries. Bereavement care should be accessible at all points after a traumatic loss as needs will differ over the grief trajectory.
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| first_indexed | 2024-03-12T16:55:36Z |
| format | Article |
| id | doaj.art-61a7f30a5d3a4edda8c9f716c8c0d34c |
| institution | Directory Open Access Journal |
| issn | 2045-7960 2045-7979 |
| language | English |
| last_indexed | 2024-03-12T16:55:36Z |
| publishDate | 2023-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Epidemiology and Psychiatric Sciences |
| spelling | doaj.art-61a7f30a5d3a4edda8c9f716c8c0d34c2023-08-08T07:28:38ZengCambridge University PressEpidemiology and Psychiatric Sciences2045-79602045-79792023-01-013210.1017/S2045796023000653Investigating risk of self-harm and suicide on anniversaries after bereavement by suicide and other causes: a Danish population-based self-controlled case series studyAlexandra Pitman0https://orcid.org/0000-0002-9742-1359Yanakan Logeswaran1https://orcid.org/0000-0002-8310-8767Keltie McDonald2Julie Cerel3Gemma Lewis4Annette Erlangsen5UCL Division of Psychiatry, University College London (UCL), London, UK Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UKUCL Division of Psychiatry, University College London (UCL), London, UKUCL Division of Psychiatry, University College London (UCL), London, UKCollege of Social Work, University of Kentucky, Lexington, KY, USAUCL Division of Psychiatry, University College London (UCL), London, UKDanish Research Institute for Suicide Prevention, Psychiatric Centre Copenhagen, Hellerup, Copenhagen, Denmark Copenhagen Research Centre for Mental Health, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Hellerup, Copenhagen, Denmark Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, AustraliaAbstract Aims To investigate mechanisms of suicide risk in people bereaved by suicide, prompted by observations that bereaved people experience higher levels of distress around dates of emotional significance. We hypothesised that suicide-bereaved first-degree relatives and partners experience an increased risk of self-harm and suicide around dates of (i) anniversaries of the death and (ii) the deceased’s birthday, compared with intervening periods. Methods We conducted a self-controlled case series study using national register data on all individuals living in Denmark from 1 January 1980 to 31 December 2016 and who were bereaved by the suicide of a first-degree relative or partner (spouse or cohabitee) during that period, and who had the outcome (any episode of self-harm or suicide) within 5 years and 6 weeks of the bereavement. We compared relative incidence of suicidal behaviour in (i) the first 30 days after bereavement and (ii) in the aggregated exposed periods (6 weeks either side of death anniversaries; 6 weeks either side of the deceased’s birthdays) to the reference (aggregated unexposed intervening periods). As an indirect comparison, we repeated these models in people bereaved by other causes. Results We found no evidence of an elevated risk of suicidal behaviour during periods around anniversaries of a death or the deceased’s birthdays in people bereaved by suicide (adjusted incidence rate ratio [IRRadj] = 1.00; 95% confidence interval [CI] = 0.87–1.16) or other causes (IRRadj = 1.04; 95% CI = 1.00–1.08) compared with intervening periods. Rates were elevated in the 30 days immediately after bereavement by other causes (IRRadj: 1.95, 95% CI: 1.77–2.22). Conclusions Although people bereaved by suicide are at elevated risk of self-harm and suicide, our findings do not suggest that this risk is heightened around emotionally significant anniversaries. Bereavement care should be accessible at all points after a traumatic loss as needs will differ over the grief trajectory. https://www.cambridge.org/core/product/identifier/S2045796023000653/type/journal_articleanniversaries and special eventsattempted suicidebereavementsuicidetime factors |
| spellingShingle | Alexandra Pitman Yanakan Logeswaran Keltie McDonald Julie Cerel Gemma Lewis Annette Erlangsen Investigating risk of self-harm and suicide on anniversaries after bereavement by suicide and other causes: a Danish population-based self-controlled case series study Epidemiology and Psychiatric Sciences anniversaries and special events attempted suicide bereavement suicide time factors |
| title | Investigating risk of self-harm and suicide on anniversaries after bereavement by suicide and other causes: a Danish population-based self-controlled case series study |
| title_full | Investigating risk of self-harm and suicide on anniversaries after bereavement by suicide and other causes: a Danish population-based self-controlled case series study |
| title_fullStr | Investigating risk of self-harm and suicide on anniversaries after bereavement by suicide and other causes: a Danish population-based self-controlled case series study |
| title_full_unstemmed | Investigating risk of self-harm and suicide on anniversaries after bereavement by suicide and other causes: a Danish population-based self-controlled case series study |
| title_short | Investigating risk of self-harm and suicide on anniversaries after bereavement by suicide and other causes: a Danish population-based self-controlled case series study |
| title_sort | investigating risk of self harm and suicide on anniversaries after bereavement by suicide and other causes a danish population based self controlled case series study |
| topic | anniversaries and special events attempted suicide bereavement suicide time factors |
| url | https://www.cambridge.org/core/product/identifier/S2045796023000653/type/journal_article |
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