Sick-leave measures, socio-demographic factors and health care as risk indicators for suicidal behavior in patients with depressive disorders - a nationwide prospective cohort study in Sweden

Background: Studies based on large data sets investigating a wide range of risk indicators on suicidal behavior in patients with depressive disorders are sparse. This study aimed to examine the association of sick-leave measured in different ways on one hand and socio-demographics, medication, and health care on the other hand with suicide attempt and suicide among patients with depressive disorders. Methods: This is a population-based prospective cohort study using nationwide register data. All individuals who lived in Sweden 31.12.2004, then aged 16-64 years, and had psychiatric in- or outpatient care due to depressive disorders in 2005 were included (N=21,096). Univariate and multivariate hazard ratios (HR) and 95% Confidence Intervals (Cl) with regard to suicide attempt and suicide during 2006-2010 were estimated by Cox regression. Results: Those with new sick-leave spells, full-time spells, spells due to mental diagnoses and exceeding one year and those having > 1 sick-leave spells had a higher risk of suicide attempt. Female sex, young age, lower education, living alone, prescription of antidepressants and anxiolytics, inpatient health care, and suicide attempts resulted in higher HRs of suicide attempt in the multivariate analyses (range of HRs 1.17-3.28). Male sex, combined antidepressant and anxiolytic prescription, mental inpatient health care, and suicide attempts predicted subsequent suicide (range of HRs 1.84-3.33). Limitations: Focus on specialized health care limited generalization. Conclusions: Sickness absence, social-demographics, and medical determinants were associated with suicidal behavior. These risk indicators should be considered when monitoring individuals with depressive disorders and assessing suicide risk. (C) 2014 Elsevier By. All rights reserved,