Risk of suicide and accidental death among subjects visiting a doctor because of mental disorder: A matched case-control study in Finnish farmers

Background: Various mental disorders, especially depression, precede suicide. According to some authors, also victims of accidental death in many cases have suffered from mental problems, in most former studies the study design has been retrospective. In this prospective study the risk of suicide or accidental death among patients visiting a primary health care doctor was evaluated. Subjects and methods: 20 suicides, 24 accidental deaths and 176 controls (four matched controls for each case) were included in a cohort comprising 3,172 male farmers who were followed up for 13 yr, Results: Generally speaking, persons visiting a doctor because of some mental problem had a clearly increased risk of committing suicide: odds ratio (OR)=5.6; 95% confidence limit (CL): 1.7, 18.5. The corresponding OR for accidental deaths is 1.5 (95% CL, 1.1, 2.1) Alcohol abuse was the most usual mental disorder preceding suicide (OR=13.2, 95% CL: 1.4, 121) and accidental death (OR=10.9; 95% CL: 1.3, 91.4). Visits to the doctor because of depression preceded suicide in 5 of 20 cases. Not one of 80 controls of suicide cases had visited a doctor because of depression during the follow-up, so it was not possible to calculate the OR. Those having used psychotropical drugs during the follow-up had a 14.5-fold risk (95% CL: 3.1, 68.3) of dying from suicide and 3.8-fold risk (95% CL: 1.3, 10.3) of dying accidentally. Conclusions: Alcohol abuse is the most usual mental disorder associated with accidental death. Suicide is often preceded by alcoholism or depression.