Næss Erik Oftedahl, Mehlum Lars, Qin Ping
National Center for Suicide Research and Prevention, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Sognsvannsveien 21, N-0372, Oslo, Norway.
SSM Popul Health. 2021 Jun 20;15:100853. doi: 10.1016/j.ssmph.2021.100853. eCollection 2021 Sep.
Research has shown that people who have never been married, divorced, or widowed are at an increased risk of suicide compared with those who are married, but we have little knowledge as to how this elevated risk is modified by socioeconomic factors, and little research has studied the risk among persons enduring a marital separation. This study addressed these issues with individual-level data from Norwegian national registers. All suicide cases in people above 18 years that took place in the period 1992-2012 (n = 11 051) were compared with living controls (185 685) matched on sex and age via a nested case control design, and suicide risk associated with marital status was assessed with conditional logistic regression. The results showed that, compared with a status of being married, suicide risk was highly associated with a status of being never married, separated, divorced, or widowed, even after adjustment for income-level, educational attainment, centrality of residence, and immigration status. The strongest effect was seen for a separated status; compared to the married, separated persons were fully 6.06 times more apt to die by suicide, and the effect was strongest in the 30 days following a separation. The observed significant associations remained but differed in strength by sex and age, and there were significant deviations by personal socioeconomic status. Most notably, the increased risk was higher for never-married persons with low educational attainment or income. However, most interaction effects (10/16) did not yield significant results. In conclusion, suicide risk is strongly associated with a single status of any form with the highest risk during a marital separation, but the increased risk varies in strength according to individual-level factors. The stress and loss of support induced by marital dissolution are important contributing risk factors for suicide, and persons with low income may be especially vulnerable.
研究表明，与已婚人士相比，从未结婚、离异或丧偶的人自杀风险更高，但我们对社会经济因素如何改变这种升高的风险知之甚少，而且很少有研究关注处于分居状态的人的自杀风险。本研究利用挪威国家登记处的个体层面数据解决了这些问题。通过巢式病例对照设计，将1992年至2012年期间发生的18岁以上人群的所有自杀病例（n = 11051）与按性别和年龄匹配的在世对照（185685人）进行比较，并通过条件逻辑回归评估与婚姻状况相关的自杀风险。结果显示，即使在对收入水平、教育程度、居住中心性和移民身份进行调整后，与已婚状态相比，自杀风险与从未结婚、分居、离异或丧偶状态高度相关。分居状态的影响最为强烈；与已婚者相比，分居者自杀死亡的可能性足足高出6.06倍，且这种影响在分居后的30天内最为强烈。观察到的显著关联依然存在，但在性别和年龄方面强度有所不同，并且在个人社会经济地位方面存在显著差异。最值得注意的是，教育程度或收入较低的未婚者自杀风险增加得更高。然而，大多数交互作用效应（10/16）并未产生显著结果。总之，自杀风险与任何形式的单身状态密切相关，其中婚姻分居期间风险最高，但增加的风险强度因个体层面因素而异。婚姻解体所带来的压力和支持的丧失是自杀的重要促成风险因素，低收入人群可能尤其脆弱。
