Greater suicide risk amongst rich people with mental illness

Risk of suicide in relation to income level in people admitted to hospital with mental illness: nested case-control study

Commentary: Suicide and income - is the risk greater in rich people who develop serious mental illness?

Rich people with a history of mental illness are at greater risk of committing suicide than their lower income counterparts, according to a study in this week's BMJ. These unexpected findings are at odds with the general pattern of suicide risk associated with poverty.

Researchers in Denmark analysed data on 811 people who had committed suicide between 1982 and 1994. Each person who had committed suicide was matched with approximately 100 people of the same age and sex who were alive on the date of the suicide, and information on income, history of mental illness, and marital status was added. In contrast to findings in the general population, the suicide risk for patients admitted to hospital with a mental illness fell significantly with decreasing income.

Greater stigma associated with mental illness among rich people may explain these findings, say the authors. In Denmark, there are no private psychiatric hospitals. Perhaps patients from higher income groups are less likely to be admitted to hospital, they add.

Further studies, which take into account the severity of illness, are needed to fully explain these patterns of risk, warns David Gunnell in an accompanying commentary. The greater resources available to richer patients may enable them to avoid admission to hospital. Equally, less severe illness in high income groups may be treated in private clinics. Thus, patients from high income groups who are admitted to public hospitals may have more severe mental illness than patients from lower income groups.

Contacts:

[Paper] E Agerbo, Research Fellow, National Center for Register-based Research, University of Aarhus, Denmark Email: ea@ncrr.au.dk

[Commentary] David Gunnell, Department of Social Medicine, University of Bristol, UK Email: D.J.Gunnell@bristol.ac.uk