UCL Division of Psychiatry, University College London (UCL), London, UK.
Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK.
Epidemiol Psychiatr Sci. 2023 Aug 8;32:e53. doi: 10.1017/S2045796023000653.
To investigate mechanisms of suicide risk in people bereaved by suicide, prompted by observations that bereaved people experience higher levels of distress around dates of emotional significance. We hypothesised that suicide-bereaved first-degree relatives and partners experience an increased risk of self-harm and suicide around dates of (i) anniversaries of the death and (ii) the deceased's birthday, compared with intervening periods.
We conducted a self-controlled case series study using national register data on all individuals living in Denmark from 1 January 1980 to 31 December 2016 and who were bereaved by the suicide of a first-degree relative or partner (spouse or cohabitee) during that period, and who had the outcome (any episode of self-harm or suicide) within 5 years and 6 weeks of the bereavement. We compared relative incidence of suicidal behaviour in (i) the first 30 days after bereavement and (ii) in the aggregated exposed periods (6 weeks either side of death anniversaries; 6 weeks either side of the deceased's birthdays) to the reference (aggregated unexposed intervening periods). As an indirect comparison, we repeated these models in people bereaved by other causes.
We found no evidence of an elevated risk of suicidal behaviour during periods around anniversaries of a death or the deceased's birthdays in people bereaved by suicide (adjusted incidence rate ratio [IRR] = 1.00; 95% confidence interval [CI] = 0.87-1.16) or other causes (IRR = 1.04; 95% CI = 1.00-1.08) compared with intervening periods. Rates were elevated in the 30 days immediately after bereavement by other causes (IRR: 1.95, 95% CI: 1.77-2.22).
Although people bereaved by suicide are at elevated risk of self-harm and suicide, our findings do not suggest that this risk is heightened around emotionally significant anniversaries. Bereavement care should be accessible at all points after a traumatic loss as needs will differ over the grief trajectory.
通过观察到丧亲者在情感重要日期周围经历更高水平的痛苦，来研究自杀风险的机制。我们假设，与介入期相比，自杀丧亲的一级亲属和伴侣在以下日期（i）去世周年纪念日和（ii）死者生日时，更有可能遭受自我伤害和自杀的风险。
我们使用 1980 年 1 月 1 日至 2016 年 12 月 31 日期间丹麦所有一级亲属或伴侣（配偶或同居者）因自杀而丧亲的个人的全国登记数据，进行了一项自我对照病例系列研究，并在丧亲后 5 年零 6 周内发生了自杀行为（任何一次自我伤害或自杀）。我们将（i）丧亲后 30 天内和（ii）在死亡周年纪念日前后的 6 周内（死者生日前后的 6 周）的自杀行为的相对发生率与参考值（合并未暴露的介入期）进行比较。作为间接比较，我们在因其他原因丧亲的人群中重复了这些模型。
我们发现，在自杀丧亲者或其他原因丧亲者中，没有证据表明在死者周年纪念日或死者生日前后的时间段内自杀行为的风险增加（调整后的发病率比[IRR] = 1.00；95%置信区间[CI] = 0.87-1.16）或其他原因（IRR = 1.04；95%CI = 1.00-1.08）与介入期相比。其他原因导致的丧亲后 30 天内的死亡率升高（IRR：1.95，95%CI：1.77-2.22）。
尽管自杀丧亲者自我伤害和自杀的风险较高，但我们的研究结果表明，这种风险不会在情感重要的周年纪念日升高。丧亲后的悲痛轨迹不同，需要提供随时可及的丧亲关怀。
Zotero 插件