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LaMontagne AD, Åberg M, Blomqvist S, Glozier N, Greiner BA, Gullestrup J, Harvey SB, Kyron MJ, Madsen IEH, Hanson LM, Maheen H, Mustard C, Niedhammer I, Rugulies R, Smith PM, Taouk Y, Waters S, Witt K, King TL. Work-related suicide: Evolving understandings of etiology & intervention. Am J Ind Med 2024; 67:679-695. [PMID: 38853462 DOI: 10.1002/ajim.23624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024]
Abstract
Previously published analyses of suicide case investigations suggest that work or working conditions contribute to 10%-13% of suicide deaths. Yet, the way in which work may increase suicide risk is an underdeveloped area of epidemiologic research. In this Commentary, we propose a definition of work-related suicide from an occupational health and safety perspective, and review the case investigation-based and epidemiologic evidence on work-related causes of suicide. We identified six broad categories of potential work-related causes of suicide, which are: (1) workplace chemical, physical, and psychosocial exposures; (2) exposure to trauma on the job; (3) access to means of suicide through work; (4) exposure to high-stigma work environments; (5) exposure to normative environments promoting extreme orientation to work; and (6) adverse experiences arising from work-related injury or illness. We summarise current evidence in a schema of potential work-related causes that can also be applied in workplace risk assessment and suicide case investigations. There are numerous implications of these findings for policy and practice. Various principle- and evidence-based workplace intervention strategies for suicide prevention exist, some of which have been shown to improve suicide-prevention literacy, reduce stigma, enhance helping behaviours, and in some instances maybe even reduce suicide rates. Prevailing practice in workplace suicide prevention, however, overly emphasises individual- and illness-directed interventions, with little attention directed to addressing the working conditions that may increase suicide risk. We conclude that a stronger emphasis on improving working conditions will be required for workplace suicide prevention to reach its full preventive potential.
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Affiliation(s)
- Anthony D LaMontagne
- Institute for Health Transformation & School of Health & Social Development, Deakin University, Geelong, Victoria, Australia
| | - Maria Åberg
- School of Public Health and Community Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Sandra Blomqvist
- Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Nick Glozier
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | | | - Jorgen Gullestrup
- Institute for Health Transformation & School of Health & Social Development, Deakin University, Geelong, Victoria, Australia
| | - Samuel B Harvey
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
| | - Michael J Kyron
- Suicide Prevention and Resilience Research Center (SPARRC), School of Psychological Science, Perth, Western Australia, Australia
| | - Ida E H Madsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
- National Institute of Public Health, Copenhagen, Denmark
| | - Linda Magnusson Hanson
- Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Humaira Maheen
- Centre for Health Policy, Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Isabelle Niedhammer
- Institut National de la Santé et de la Recherche Médicale (INSERM), Univ Angers, Angers, France
| | - Reiner Rugulies
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Peter M Smith
- Instutute for Work & Health, Toronto, Ontario, Canada
| | - Yamna Taouk
- Centre for Health Policy, Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Waters
- School of Languages, Cultures and Societies, University of Leeds, Leeds, UK
| | - Katrina Witt
- Orygen Centre for Youth Mental Health, Parkville, Victoria, Australia
| | - Tania L King
- Centre for Health Policy, Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria, Australia
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Greiner BA, Arensman AE. The role of work in suicidal behavior - uncovering priorities for research and prevention. Scand J Work Environ Health 2022; 48:419-424. [PMID: 35904099 PMCID: PMC9888435 DOI: 10.5271/sjweh.4051] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Birgit A Greiner
- School of Public Health, University College Cork, Ireland,
Correspondence to: Birgit A Greiner, School of Public Health, University College Cork, Ireland. []
| | - and Ella Arensman
- School of Public Health, University College Cork, Ireland,National Suicide Research Foundation, University College Cork, Ireland,Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
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3
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Ludvigsson JF, Svedberg P, Olén O, Bruze G, Neovius M. The longitudinal integrated database for health insurance and labour market studies (LISA) and its use in medical research. Eur J Epidemiol 2019; 34:423-437. [PMID: 30929112 PMCID: PMC6451717 DOI: 10.1007/s10654-019-00511-8] [Citation(s) in RCA: 602] [Impact Index Per Article: 120.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/12/2019] [Indexed: 12/17/2022]
Abstract
Education, income, and occupation are factors known to affect health and disease. In this review we describe the Swedish Longitudinal Integrated Database for Health Insurance and Labour Market Studies (LISA, Longitudinell Integrationsdatabas för Sjukförsäkrings- och Arbetsmarknadsstudier). LISA covers the adult Swedish population aged ≥ 16 years registered on December 31 each year since 1990 (since 2010 individuals aged ≥ 15 years). The database was launched in response to rising levels of sick leave in the country. Participation in Swedish government-administered registers such as LISA is compulsory, and hence selection bias is minimized. The LISA database allows researchers to identify individuals who do not work because of injury, disease, or rehabilitation. It contains data on sick leave and disability pension based on calendar year. LISA also includes information on unemployment benefits, disposable income, social welfare payments, civil status, and migration. During 2000–2017, an average of 97,000 individuals immigrated to Sweden each year. This corresponds to about 1% of the Swedish population (10 million people in 2017). Data on occupation have a completeness of 95%. Income data consist primarily of income from employment, capital, and allowances, including parental allowance. In Sweden, work force participation is around 80% (2017: overall: 79.1%; men 80.3% and women 77.9%). Education data are available in > 98% of all individuals aged 25–64 years, with an estimated accuracy for highest attained level of education of 85%. Some information on civil status, income, education, and employment before 1990 can be obtained through the Population and Housing Census data (FoB, Folk- och bostadsräkningen).
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Affiliation(s)
- Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. .,Department of Paediatrics, Örebro University Hospital, Örebro, Sweden. .,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building 2, City Hospital, Nottingham, UK. .,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - Pia Svedberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ola Olén
- Clinical Epidemiology Unit, Department of Medicine Stockholm, Karolinska Institutet, Stockholm, Sweden
| | - Gustaf Bruze
- Clinical Epidemiology Unit, Department of Medicine Stockholm, Karolinska Institutet, Stockholm, Sweden
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine Stockholm, Karolinska Institutet, Stockholm, Sweden
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4
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Course and characteristics of work disability 3 years before and after lumbar spine decompression surgery- a national population-based study. Sci Rep 2018; 8:11811. [PMID: 30087405 PMCID: PMC6081436 DOI: 10.1038/s41598-018-30211-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/17/2018] [Indexed: 11/17/2022] Open
Abstract
Despite decompression surgery being a widespread intervention for patients with dorsopathies (i.e. back pain) affecting the lumbar spine, the scientific knowledge on patterns and characteristics of work disability before and after the surgery is limited. Sickness absence (SA) and disability pension (DP) were examined three years before and after surgery in 8558 patients aged 25–60 years who underwent lumbar spine decompression surgery in Sweden. They were compared to individuals with diagnosed dorsopathies but no surgery and individuals from the general population as matched comparison groups. According to Group Based Trajectory models, in patients with decompression surgery, 39% had low levels of SA/DP during the entire study period and 15% started with low levels of SA/DP, which increased in the year before, and declined to almost zero in the second year after surgery. Three trajectory groups (12%, 17%, and 18%) started at different levels of SA/DP, which increased in the years before, and declined in the third year after surgery. The trajectory groups in the comparison groups showed lower levels of work disability. Sex, education, and the use of antidepressants and analgesics the year before surgery played an important role to explain the variance of trajectory groups in patients with surgery.
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Wang M, Helgesson M, Rahman S, Niederkrotenthaler T, Mittendorfer-Rutz E. Trajectories and characteristics of functional impairment before and after suicide attempt in young adults - a nationwide register-based cohort study. BMC Psychiatry 2017; 17:393. [PMID: 29221477 PMCID: PMC5723036 DOI: 10.1186/s12888-017-1567-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/30/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Despite high rates of youth suicide attempt, little is known about patterns of functional impairment in terms of sickness absence and disability pension (SA/DP) before and after an attempt. The aim was to identify SA/DP trajectories among young adults with or without suicide attempt and to describe associations of socio-demographic and clinical factors with such trajectories. METHODS This is a population-based cohort study of 5385 individuals aged 25-40 years with a first suicide attempt during 2007-2009. One control for each case without suicide attempt was matched by socio-demographic factors. Trajectories of annual SA/DP months over an eight-year period were analysed by group-based trajectory modelling. Associations between socio-demographic and clinical factors with trajectory groups were estimated by chi2-test and multinomial logistic regression. RESULTS Two groups of suicide attempters had low SA/DP levels over time (62%). One group had constantly high SA/DP levels (16%). The remaining two groups had increased SA/DP initially, which then decreased at different time points. Socio-demographic and clinical factors were associated with different trajectories (R2 = 0.44). Suicide attempters with low levels of SA/DP were likely to be unemployed whereas a larger proportion of those with high levels of SA/DP had psychiatric health care before the suicide attempt, particularly due to schizophrenia and non-affective psychoses or personality disorders. CONCLUSIONS Young suicide attempters even with no/low levels of SA/DP were likely to be marginalised at the labour market. Schizophrenia/non-affective psychoses and personality disorders were important clinical factors for differentiating the levels of SA/DP among young suicide attempters.
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Affiliation(s)
- Mo Wang
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE 171 77, Stockholm, Sweden.
| | - Magnus Helgesson
- 0000 0004 1937 0626grid.4714.6Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE 171 77 Stockholm, Sweden
| | - Syed Rahman
- 0000 0004 1937 0626grid.4714.6Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE 171 77 Stockholm, Sweden
| | - Thomas Niederkrotenthaler
- 0000 0000 9259 8492grid.22937.3dCenter for Public Health, Department of Social and Preventive Medicine, Medical University Vienna, Vienna, Austria
| | - Ellenor Mittendorfer-Rutz
- 0000 0004 1937 0626grid.4714.6Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE 171 77 Stockholm, Sweden
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6
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Buji RI, Abdul Murad NA, Chan LF, Maniam T, Mohd Shahrir MS, Rozita M, Shamsul AS, Mohamad Hussain R, Abdullah N, Jamal R, Nik Jaafar NR. Suicidal ideation in systemic lupus erythematosus: NR2A gene polymorphism, clinical and psychosocial factors. Lupus 2017; 27:744-752. [PMID: 29161964 DOI: 10.1177/0961203317742711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Systemic lupus erythematosus (SLE) patients are a high-risk population for suicide. Glutamatergic neurosystem genes have been implicated in the neurobiology of depression in SLE and suicidal behaviour in general. However, the role of glutamate receptor gene polymorphisms in suicidal behaviour among SLE patients remains unclear in the context of established clinical and psychosocial factors. We aimed to investigate the association of NR2A gene polymorphism with suicidal ideation in SLE while accounting for the interaction between clinical and psychosocial factors. Methods A total of 130 SLE patients were assessed for mood disorders (MINI International Neuropsychiatric Interview), severity of depression (Patient Health Questionnaire-9), suicidal behaviour (Columbia-Suicide Severity Rating Scale), socio-occupational functioning (Work and Social Adjustment Scale), recent life events (Social Readjustment Rating Scale) and lupus disease activity (SELENA-SLE Disease Activity Index). Eighty-six out of the 130 study participants consented for NR2A genotyping. Results Multivariable logistic regression showed nominal significance for the interaction effect between the NR2A rs2072450 AC genotype and higher severity of socio-occupational impairment with lifetime suicidal ideation in SLE patients ( p = 0.038, odds ratio = 1.364, 95% confidence interval = 1.018-1.827). However, only the association between lifetime mood disorder and lifetime suicidal ideation remained significant after Bonferroni correction ( p < 0.001, odds ratio = 33.834, 95% confidence interval = 7.624-150.138). Conclusions Lifetime mood disorder emerged as a more significant factor for suicidal ideation in SLE compared with NR2A gene polymorphism main and interaction effects. Clinical implications include identification and treatment of mood disorders as an early intervention for suicidal behaviour in SLE. More adequately-powered gene-environment interaction studies are required in the future to clarify the role of glutamate receptor gene polymorphisms in the risk stratification of suicidal behaviour among SLE patients.
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Affiliation(s)
- R I Buji
- 1 Hospital Mesra Bukit Padang, Kota Kinabalu, Sabah, Malaysia
| | - N A Abdul Murad
- 2 UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur, Malaysia
| | - L F Chan
- 3 Department of Psychiatry, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - T Maniam
- 3 Department of Psychiatry, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia.,7 Mind Faculty, Mont Kiara, Kuala Lumpur, Malaysia
| | - M S Mohd Shahrir
- 4 Department of Medicine, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - M Rozita
- 4 Department of Medicine, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - A S Shamsul
- 2 UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur, Malaysia.,5 Department of Community Health, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - R Mohamad Hussain
- 2 UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur, Malaysia
| | - N Abdullah
- 2 UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur, Malaysia
| | - R Jamal
- 2 UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur, Malaysia.,6 Department of Pediatrics, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - N R Nik Jaafar
- 3 Department of Psychiatry, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
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7
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Wang M, Vaez M, Dorner TE, Tiihonen J, Voss M, Ivert T, Mittendorfer-Rutz E. Trajectories and characteristics of work disability before and after acute myocardial infarction. Heart 2017; 104:340-348. [PMID: 28864716 DOI: 10.1136/heartjnl-2017-311950] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Scientific knowledge on work disability in terms of sickness absence and disability pension (SA/DP) among patients with acute myocardial infarction (AMI) is scarce. The study aimed to investigate trajectories of SA/DP among individuals with or without AMI and examined the associations between sociodemographic, morbidity and coronary revascularisation characteristics with such trajectories among patients with AMI. METHODS This is a population-based cohort study of 10 255 individuals aged 30-60 years who had a first AMI during 2008-2010 and were alive 30 days after AMI. Each case was matched by sociodemographics to one control without AMI. Trajectories of annual SA/DP months over a 6-year period for cases and controls were analysed by group-based trajectory modelling. Associations of characteristics with trajectory groups were estimated by Χ2 test and multinomial logistic regression. RESULTS The majority of patients (59%) had slightly increased annual levels of SA/DP (1 month) at the time of AMI, which returned to no SA/DP 2 years after the event. One group (4%) had increasing SA/DP months preceding and after AMI. Three groups showed constant SA/DP months on low (14%), medium (9%) and high (15%) levels. Sex, unemployment, education, musculoskeletal disorders and prescription of antidepressants were the strongest factors discriminating the SA/DP trajectories (R2difference=0.02-0.03, p<0.01). CONCLUSIONS The majority of patients with AMI have a good outcome in terms of low levels of work disability within 2 years after AMI. Patterns of SA/DP before AMI, sex, socioeconomic status as well as comorbid musculoskeletal and mental disorders provide crucial clinical information on work disability after AMI.
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Affiliation(s)
- Mo Wang
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Ernst Dorner
- Department for Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
| | - Margaretha Voss
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department for Analysis and Forecast, Swedish Social Insurance Agency, Stockholm, Sweden
| | - Torbjörn Ivert
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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