Late-adolescent risk factors for suicide and self-harm in middle-aged men: explorative prospective population-based study

Br J Psychiatry. 2020 Jul;217(1):370-376. doi: 10.1192/bjp.2019.243.

Abstract

Background: Recent reports show alarmingly high rates of suicide in middle-aged men, yet there are few long-term prospective studies that focus on suicidal behaviour in men in this age group.

Aims: To prospectively explore associations of potential risk factors at age 18 with suicide and self-harm in middle-aged men.

Method: A population-based Swedish longitudinal cohort study of male conscripts with no history of self-harm at enlistment in 1968-1989 (n = 987 583). Conscription examinations included measures of cognitive performance, stress resilience, psychiatric diagnoses, body mass index (BMI), cardiovascular fitness and muscle strength. Suicides and self-harm at age 45-65 years were identified in the National Hospital Register and Swedish Cause of Death Register. Risks were calculated using Cox proportional hazards models.

Results: Low stress resilience (cause-specific hazard ratio CHR = 2.31, 95% CI 1.95-2.74), low cognitive ability (CHR = 2.01, 95% CI 1.71-2.37) as well as psychiatric disorders and low cardiovascular fitness in late adolescence were associated with increased risk for suicide in middle-aged men. Similar risk estimates were obtained for self-harm. In addition, high and low BMI as well as low muscle strength were associated with increased risk of self-harm. Associations also remained significant after exclusion of men with self-harm before age 45.

Conclusions: This prospective study provides life-course perspective support that psychological and physical characteristics in late adolescence may have long-lasting consequences for suicidal behaviour in middle-aged men, a very large population at heightened risk of suicide.

Keywords: Suicide; cohort; epidemiology; risk assessment; self-harm.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Self-Injurious Behavior* / epidemiology
  • Suicide* / statistics & numerical data
  • Sweden / epidemiology
  • Young Adult