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Cited by 160Suicide and Self-Harm StudiesWorkplace Health and Well-beingOccupational Health and Burnout

Stress and suicide in the Nurses' health study

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Feskanich, D, Hastrup, J L, Marshall, J R, Colditz, G A, Stampfer, M J, Willett, W C, Kawachi, I·2002·Journal of Epidemiology and Community Health
DOI 10.1136/jech.56.2.95PMC PMC1732078
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Abstract

Study objectives: Although stress is thought to be a risk factor for suicide, most research has been retrospective or has focused on attempted suicides or suicide ideation. This study examined prospectively the associations between self perceived stress, diazepam use, and death from suicide among adult women. Design: A cohort study was conducted with 14 years of follow up. Stress at home and at work were assessed by questionnaire and scored on a four point scale: minimal, light, moderate, or severe. Setting: Eleven states within the United States. Participants: Female nurses (n=94 110) who were 36 to 61 years of age when they answered questions on stress and diazepam use in 1982. Results: During 1 272 000 person years of observation 73 suicides were identified. After adjustment for age, smoking, coffee consumption, alcohol intake, and marital status, the relation between self reported stress and suicide remained U shaped. Compared with the light home and work stress categories, which had the lowest incidences of suicide, risks were increased among women reporting either severe (relative risk (RR) = 3.7, 95% confidence intervals (CI) 1.7 to 8.3) or minimal (RR=2.1, 95% CI 1.0 to 4.5) home stress and either severe (RR=1.9, 95% CI 0.8 to 4.7) or minimal (RR=2.4, 95% CI 0.9 to 6.1) work stress. When responses to home and work stress were combined, there was an almost fivefold increase in risk of suicide among women in the high stress category. Risk of suicide was over eightfold among women reporting high stress or diazepam use compared with those reporting low stress and no diazepam use. Conclusions: The relation between self reported stress and suicide seems to be U shaped among adult women. The excess risk for those reporting minimal stress may reflect denial or undiagnosed depression or an association with some other unmeasured risk factor for suicide.

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  • Several studies have reported temporal associations between the onset of an acute stress experience and suicide attempts or death by suicide.

    “Indeed, several studies have reported temporal associations between the onset of an acute stress experience and suicide attempts or death by suicide (Feskanich et al., 2002; Gradus et al., 2010).”

    From Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks (2023) · cites this paper as Feskanich et al., 2002

    The Results report an association between self-reported home stress and subsequent suicide deaths, supporting a temporal association between stress and death by suicide. But the Discussion says the study measured stress ratings rather than recent stressful events, and the Key points state that it had no data on suicide attempts. It therefore does not establish an association with the onset of an acute stress experience. (LLM, conf=0.88)

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  • Numerous studies have reported associations between life stress and suicide ideation or attempts.

    “Numerous studies have reported associations between life stress and suicide ideation or attempts (e.g., Coope et al., 2015; Feskanich et al., 2002; Gradus et al., 2010; Liu et al., 2019; Stewart et al., 2019; Wang et al., 2015).”

    From Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks (2023) · cites this paper as Feskanich et al., 2002

    The Abstract reports that high perceived stress has been observed in people with early suicidal thoughts, so the paper does discuss an association relevant to ideation. But its own study examined death from suicide, not ideation or attempts; the Key points state that it had no data on attempted suicides. It therefore does not support citing this study as one that reported an association with those outcomes. (LLM, conf=0.86)

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Authors
Feskanich, D., Hastrup, J. L., Marshall, J. R., Colditz, G. A., Stampfer, M. J., Willett, W. C., & Kawachi, I.
Affiliations
  • Brigham and Women's Hospital (US)
  • University at Buffalo, State University of New York (US)
Corresponding author
Feskanich, D
ORCID
Venue
Journal of Epidemiology and Community Health
Publisher
BMJ
Published
2002-02
Volume
56
Issue
2
Pages
95-98
ISSN
  • 0141-7681 (ISSN-L)
  • 0143-005X
  • 1470-2738
DOI
10.1136/jech.56.2.95
PMC
PMC1732078
OpenAlex
W2104235224
Semantic Scholar
1f361ca3265c40b57a8226510bc7fc814cff7489
Cited by
160
References
23
Citations by year
2026: 2 · 2025: 7 · 2024: 7 · 2023: 14 · 2022: 5 · 2021: 9 · 2020: 4 · 2019: 6 · 2018: 13 · 2017: 6 · 2016: 11 · 2015: 13 · 2014: 6 · 2013: 9 · 2012: 8
FWCI
3.97
Type
journal article
Language
en
Open access
Locations
  • Journal of Epidemiology & Community Health (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
  • Brigham and Women's Hospital
  • University of Arizona Cancer Center
  • National Institutes of Health
  • University at Buffalo
  • National Heart, Lung, and Blood Institute (HL34594, R01HL034594)
  • National Cancer Institute (CA-40356)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
  • Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
Keywords
suicide, self-reported stress, home stress, occupational stress, women, nurses, U-shaped relationship, depression, suicide risk factors
MeSH terms
Adult, Diazepam, Female, Humans, Middle Aged, Nurses, Occupational Diseases, Prospective Studies, Surveys and Questionnaires, Risk Factors, Self Disclosure, State Medicine, Stress, Psychological, Suicide, Anti-Anxiety Agents, United States, Cohort Studies, Workplace

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