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Cited by 79Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseInjury Epidemiology and Prevention

A continuum of premature death. Meta-analysis of competing mortality in the psychosocially vulnerable

Neeleman, J·2001·International Journal of Epidemiology
DOI 10.1093/ije/30.1.154
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Abstract

BACKGROUND: Suicide may be an extreme expression of liability to death of any type. If true, suicide risk factors should also increase other mortality, and, given exposure, excess risk should be higher for suicide than for other mortality. METHODS: Of 304 publications identified in Index Medicus (1966-June 1988) by the string (suicide) and (mortality or death) and (accidental or natural), 24 reported total and cause-specific mortality associated with exposure to 16 established suicide risk factors; reference scanning yielded 122 more. These 146 publications reported on 163 cohorts (total subjects = 1179 126) mortality. Meta-analysis gave random effects standardized mortality ratios (SMR) for natural, accidental and suicidal death, stratified over the 16 risk groups. RESULTS: Overall, SMR were 8.6 (95% CI : 7.1-10.4) for suicide, 3.4 (95% CI : 2.9-4.0) for accidental and 2.1 (95% CI : 1.9-2.3) for natural death. Compatible with the first hypothesis, in most groups, mortality of any type was raised. Supporting the second hypothesis, excesses increased from lowest for natural death to highest for suicide. This trend was most pronounced following deliberate self-harm, intermediate in substance abusers, and weakest, but present, in bereaved and low social class cohorts and reversed in smokers and epileptic people. CONCLUSIONS: Many suicide risks apply to any type of premature death, whilst also retaining some specificity for suicide. Primary prevention, targeting such generic risk factors, will not only reduce rates of suicide but also of other types of death. Conversely, when prevention focuses on specific outcomes-such as suicide-only, other types of mortality may increase.

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  • Comparing suicide cases with controls who have died by other external causes such as accidents may generate smaller or no differences between groups because of overlapping risk factors and because prematurely deceased controls may be at increased risk of suicide themselves.

    “Comparing suicide cases with controls who have died by other external causes such as accidents may generate smaller or no differences between groups because of overlapping risk factors19 and because prematurely deceased controls may be at increased risk of suicide themselves.4”

    From Risk factors for suicide in adults: systematic review and meta-analysis of psychological autopsy studies (2022) · cites this paper as [19]

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Research works printed but not linked: 8

  1. Beskow J, Jenkins R, Kingdon D, Retterstol N, Sartorius N. Suicide prevention strategies across Europe. Eur Psychiatry 1996;11:203.
  2. Schmidt W, De Lint J. Mortality experiences of male and female alcoholics. Q J Stud Alcohol 1969;30:112-18.
  3. Sharp S, Sterne J. Meta-analysis. Stata Tech Bull 1997;38:9-14.
  4. Costello RM, Parsons-Manders P, Schnieder SL. Alcohol mortality-a twelve year follow-up. Am J Drug Alcohol Abuse 1978;5:199-210.
  5. Steptoe A. The links between stress and illness. J Psychosom Res 1991;35:633-44. 103
  6. Engstrom A, Adamsson C, Allebeck P, Rydberg U. Mortality in patients with substance abuse: a follow up in Stockholm Country. Int J Addict 1991;26:91-106. 134
  7. Musto DF, Ramos MR. A follow-up of the New Haven Morphine Maintenance Clinic of 1920. N Engl J Med 1981;304:1071-77. 136
  8. O'Donnel J. A follow-up of narcotic addicts. Am J Orthopsychiatry 1964;34:948-54. 137

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Authors
Neeleman, J.
Affiliations
University of Groningen (NL)
Corresponding author
Neeleman, J
Venue
International Journal of Epidemiology
Publisher
Oxford University Press (OUP)
Published
2001-02
Volume
30
Issue
1
Pages
154-162
ISSN
  • 0300-5771 (ISSN-L)
  • 1464-3685
DOI
10.1093/ije/30.1.154
OpenAlex
W2166908833
Cited by
79
References
192
Citations by year
2026: 1 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 3 · 2020: 4 · 2019: 6 · 2018: 2 · 2017: 5 · 2016: 5 · 2015: 1 · 2014: 7 · 2013: 4 · 2012: 6
FWCI
0.72
Type
journal article
Language
en
Open access
closed
Locations
  • International Journal of Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Injury Epidemiology and Prevention
Keywords
suicide, premature mortality, competing risk of death, suicide risk factors, standardized mortality ratio, accidental death, natural death, self-harm, substance abuse, bereavement, social class, smoking, epilepsy, psychosocial vulnerability, suicide prevention
MeSH terms
Humans, Risk Factors, Suicide

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