Nilsson Sandra F, Laursen Thomas M, Erlangsen Annette, Hawton Keith, Nordentoft Merete, Fazel Seena
Copenhagen Research Center for Mental Health-CORE, Copenhagen University Hospital-Mental Health Services, Copenhagen, Denmark.
The National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.
Lancet Public Health. 2025 Jul;10(7):e559-e567. doi: 10.1016/S2468-2667(25)00100-8.
Homelessness is associated with adverse outcomes, but associations with suicide and self-harm require careful examination. We examined risks of suicidal behaviours in people experiencing homelessness compared with the general population, and the contribution of psychiatric disorders.
Nationwide, register-based data on people living in Denmark between Jan 1, 1999, and Dec 31, 2020, born between 1945 and 2006 and aged 15-76 years, were analysed. Homelessness was measured as any homelessness or current homelessness and previous homelessness. Outcomes were first self-harm episode and death by suicide. We estimated adjusted mortality rate ratios (aMRRs) and adjusted incidence rate ratios (aIRRs) in Poisson regression and probabilities of outcomes. Analyses were stratified by sex and adjusted for sociodemographic factors and psychiatric disorders.
Among 5 188 284 residents, 56 663 (1·1%) had at least one episode of homelessness, accounting for 570 986 person-years. Within 10 years of first homeless shelter contact, 1·3% (95% CI 1·2-1·4%) of males and 0·9% (0·7-1·0%) of females had died by suicide and 9·2% (8·9-9·6%) of males and 9·9% (9·4-10·5%) of females self-harmed. Homelessness was associated with an elevated rate of suicide (males aMRR 2·2 [2·0-2·4]; females 3·8 [3·2-4·5]) and self-harm (males 3·5 [3·4-3·6]; females 3·3 [3·1-3·5]) compared with no homelessness. Current homelessness compared with no homelessness was associated with elevated adjusted suicide rates (males 3·7 [3·1-4·5]; females 8·0 [5·5-11·6]), which were higher than for previous homelessness (males 2·0 [1·8-2·2]; females 3·4 [2·8-4·1]). Psychiatric disorders added further risk of suicidality among people experiencing homelessness compared with no psychiatric disorder and no homelessness (males 19·9 [18·1-22·0]; too few cases for females). Self-harm in people experiencing homelessness increased risk of dying by suicide (males 7·4 [6·5-8·5]; females 17·7 [14·4-21·7]).
Individuals experiencing homelessness have elevated risks of self-harm and suicide, particularly those who are currently homeless. An episode of self-harm and psychiatric disorders are important indicators of suicide in this vulnerable group. Findings highlight a need for improving assessment and intervention.
Independent Research Fund Denmark and NIHR Oxford Health Biomedical Research Centre.
无家可归与不良后果相关，但与自杀和自我伤害的关联需要仔细研究。我们研究了无家可归者与一般人群相比的自杀行为风险，以及精神障碍的影响。
对1999年1月1日至2020年12月31日期间居住在丹麦、出生于1945年至2006年、年龄在15 - 76岁之间的人群进行基于全国登记数据的分析。无家可归的衡量标准为任何形式的无家可归或当前无家可归以及既往无家可归情况。结局指标为首次自我伤害事件和自杀死亡。我们在泊松回归中估计了调整后的死亡率比（aMRRs）和调整后的发病率比（aIRRs）以及结局的概率。分析按性别分层，并对社会人口学因素和精神障碍进行了调整。
在5188284名居民中，56663人（1.1%）至少有一次无家可归经历，共计570986人年。在首次接触无家可归者收容所后的10年内，1.3%（95%CI 1.2 - 1.4%）的男性和0.9%（0.7 - 1.0%）的女性自杀死亡，9.2%（8.9 - 9.6%）的男性和9.9%（9.4 - 10.5%）的女性有过自我伤害行为。与无家可归者相比，无家可归与自杀率升高（男性aMRR 2.2 [2.0 - 2.4]；女性3.8 [3.2 - 4.5]）和自我伤害率升高（男性3.5 [3.4 - 3.6]；女性3.3 [3.1 - 3.5]）相关。与无家可归相比而言，当前无家可归与调整后的自杀率升高相关（男性3.7 [3.1 - 4.5]；女性8.0 [5.5 - 11.6]），高于既往无家可归者（男性2.0 [1.8 - 2.2]；女性3.4 [2.8 -4.1]）。与无精神障碍且无家可归者相比，精神障碍会增加无家可归者的自杀风险（男性19.9 [18.1 - 22.0]；女性病例数过少）。无家可归者的自我伤害会增加自杀死亡风险（男性7.4 [6.5 - 8.5]；女性17.7 [14.4 - 21.7]）。
无家可归者自我伤害和自杀风险升高，尤其是当前无家可归者。自我伤害事件和精神障碍是这一弱势群体自杀的重要指标。研究结果凸显了改善评估和干预的必要性。
丹麦独立研究基金和英国国家卫生研究院牛津健康生物医学研究中心。
