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Combined influence of serious mental illness and criminal offending on suicide risk in younger adults

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

We conducted a national epidemiological study to determine how mental illness and criminal offending combine to influence suicide risk in younger adults.

Methods

Using completely interlinked registers, we generated a nested case–control study from the cohort of all Danish people born 1965 and onwards. We identified 2,384 suicides aged 15–41 years during 1981–2006, and 56,016 age and sex-matched living controls. We examined all criminal charges from 1980, and all psychiatric admissions from 1969 and outpatient episodes from 1995. Exposure odds ratios were estimated using conditional logistic regression models.

Results

A quarter of male and 17 % of female suicides had histories of both criminal justice system contact and secondary care psychiatric treatment, with a marked elevation in risk seen compared with having neither risk factor: male odds ratio (OR) 34.0, 95 % confidence interval (CI) 29.1–39.6; female OR 72.7, CI 49.4–107.1. Among those treated for psychiatric illness, contact with the criminal justice system predicted higher risk: male OR 1.4, CI 1.1–1.7; female OR 1.7, CI 1.1–2.4, although these effects were attenuated and became non-significant with adjustment for socio-demographic risk factors. In men, risk was especially high if first criminal justice system contact occurred before first psychiatric treatment episode, and if these two challenging life events coalesced within a year of each other.

Conclusion

These younger age adults should be monitored carefully for signs of suicidal behaviour. The need for well coordinated multiagency care is indicated, and a broad range of psychiatric illnesses should be considered carefully when assessing their suicide risk.

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Acknowledgments

The investigation was funded by an American Foundation for Suicide Prevention (New York, USA) and by the Stanley Medical Research Institute (Maryland, USA). The authors are also grateful to the expertise of Dr. Esben Agerbo, National Centre for Research-based Research, University of Aarhus, Denmark in generating the nested case–control dataset for the study.

Conflict of interest

Louis Appleby is National Clinical Director for Health and Criminal Justice, England, and he was formally National Clinical Director for Mental Health, England, when this study was conducted. None of the other authors have any competing interests to declare.

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Authors and Affiliations

  1. Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Oxford Road, Manchester, M13 9PL, UK

    Roger T. Webb, Louis Appleby & Jenny Shaw

  2. National Centre for Register-based Research, University of Aarhus, Taasingegade 1, 8000, Aarhus C, Denmark

    Ping Qin, Hanne Stevens & Preben Bo Mortensen

Authors
  1. Roger T. Webb
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  2. Ping Qin
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  3. Hanne Stevens
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  4. Louis Appleby
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  5. Jenny Shaw
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  6. Preben Bo Mortensen
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Corresponding author

Correspondence to Roger T. Webb.

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Webb, R.T., Qin, P., Stevens, H. et al. Combined influence of serious mental illness and criminal offending on suicide risk in younger adults. Soc Psychiatry Psychiatr Epidemiol 48, 49–57 (2013). https://doi.org/10.1007/s00127-012-0517-6

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  • DOI: https://doi.org/10.1007/s00127-012-0517-6

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