Financial Stressors and Risk of Suicidal Behavior in a Swedish National Cohort.

Abstract

Although financial stressors are implicated as risk factors for suicidal behavior, these associations might be confounded by other factors. Furthermore, a move toward high-risk subgroup definition is necessary. The authors used Swedish national registry data to examine the associations between receipt of social welfare, unemployment benefits, or early retirement (N = 627,745-2,260,753) with suicidal behavior in Cox proportional hazards models. They applied co-relative models to improve causal inference, and examined interactions with aggregate genetic risk for suicidality. All three exposures were associated with elevated suicidal behavior risk. Initial hazard ratios for suicide attempt ranged from 1.37-3.86, were similar for suicide death, and declined after controlling for psychopathology and time elapsed after exposure. Age at registration differentially impacted risk of suicidal behavior. Aggregate genetic liability for suicidality was associated with risk, but its effect was not moderated by financial stress. Financial stressors are associated with suicidal behavior risk even after controlling for psychopathology. Associations are attributable in part to familial confounding, though a potentially causal pathway was observed in most cases. Suicidality risk varied as a function of sex and age at exposure; these findings could be used to identify subgroups at high risk who warrant targeted prevention.