ImportanceAccording to the World Health Organization, more than 700 000 individuals worldwide die by suicide each year. Medical conditions likely increase the risk of suicide.ObjectiveTo (1) provide age- and sex-specific pairwise estimates of the risk of suicide across a comprehensive range of medical conditions, (2) investigate whether there is a dose-response–like relationship at play (ie, the higher the disability burden due to medical morbidity, the higher the risk of suicide), and (3) determine if the risk of suicide with medical conditions is particularly pronounced among those who had mental disorder preceding the medical conditions.Design, Setting, and ParticipantsThis cohort study was an observational study of population-based data for all individuals living in Denmark at some point between 2000 and 2020. The data analysis took place from September 2023 to May 2024.ExposuresThirty-one specific medical conditions as well as prior mental disorder.Main Outcomes and MeasuresThe main outcome was suicide. Associations between the 31 specific medical conditions, nested within 9 categories, and suicide were examined via Poisson regression, yielding incidence rate ratios (IRRs). Subsequent analyses included an interaction term to assess whether a previous hospital-treated mental disorder modified the associations. Finally, the association between the disability burden of medical conditions and suicide was examined for those with and without prior mental disorder, respectively.ResultsA total of 6 635 857 individuals (3 337 613 females and 3 298 244 males) were included in the analyses of the associations between medical conditions and suicide. Except for endocrine disorders, all categories of medical conditions were associated with a statistically significant increased risk of suicide (which was most pronounced for gastrointestinal conditions [IRR, 1.7; 95% CI,1.5-1.8], cancer [IRR, 1.5; 95% CI, 1.4-1.6], and hematological conditions [IRR, 1.5; 95% CI, 1.3-1.6]). Interaction between mental disorder and individual medical conditions did not seem to play a major role for suicide risk. For those without but not for those with mental disorder, there was a dose-response–like relationship between the disability burden of medical conditions and suicide.Conclusions and RelevanceMedical conditions are generally associated with increased risk of suicide in a dose-response–like manner. Individuals with hospital-treated mental disorder appear to be at such elevated risk of suicide that additional disability associated with medical conditions has little impact in this regard.

中文翻译：

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不同医疗条件下的自杀风险和既往精神障碍的作用


重要性根据世界卫生组织的数据，全世界每年有超过 700 000 人死于自杀。医疗状况可能会增加自杀的风险。目的 （1） 提供针对年龄和性别的自杀风险的成对估计，（2） 调查是否存在类似剂量反应的关系在起作用（即，由于医学发病率导致的残疾负担越高，自杀风险越高），以及 （3） 确定在疾病之前患有精神障碍的人中，有医疗状况的自杀风险是否特别明显。设计、设置和参与者这项队列研究是一项观察性研究，对 2000 年至 2020 年间居住在丹麦的所有个人的基于人群的数据进行研究。数据分析于 2023 年 9 月至 2024 年 5 月进行。主要结局和措施主要结局是自杀。通过泊松回归检查嵌套在 9 个类别中的 31 种特定医疗状况与自杀之间的关联，得出发病率比 （IRR）。随后的分析包括一个交互项，以评估先前医院治疗的精神障碍是否改变了这些关联。最后，分别检查了既往有和没有精神障碍的人的医疗状况的残疾负担与自杀之间的关联。结果共纳入 6 635 857 例 （女性 3 337 613 例，男性 3 298 244 例） 参与疾病与自杀之间的关联分析。 除内分泌疾病外，所有类别的疾病都与自杀风险增加相关，具有统计学意义（胃肠道疾病 [IRR，1.7;95% CI，1.5-1.8]、癌症 [IRR，1.5;95% CI，1.4-1.6] 和血液病 [IRR，1.5;95% CI，1.3-1.6] 最为明显）。精神障碍和个体医疗状况之间的相互作用似乎对自杀风险没有主要影响。对于那些没有精神障碍但不是精神障碍的人，医疗状况的残疾负担与自杀之间存在类似剂量反应的关系。结论和相关性医疗条件通常以类似剂量反应的方式与自杀风险增加相关。患有医院治疗的精神障碍的人自杀的风险似乎如此之高，以至于与医疗条件相关的额外残疾在这方面几乎没有影响。