This may result in an underestimation of the full extent of the association between COPD and subsequent suicide risk. Similarly, a contact with psychiatric hospitals and Nutlin-3a Mdm2 inhibitor specialist clinics was used as a proxy for psychiatric illness, which represents more severe psychiatric conditions, possibly leading to an underestimation of psychiatric problems. On the other hand, the data used for the study have been collected systematically and routinely without any purpose of fulfilling a particular interest
of research, which reduces plausible bias due to recall of information and ensures the precision of the data. At the same time, the study is based on the entire national population of a country where hospital treatments for physical and psychiatric illness are free of charge, which eliminates possible bias induced by a selection of access to healthcare by personal socioeconomic status. The large size of included participants also provides us opportunities to search insights on effect differences by, for example, sex and age as well as psychiatric history with reasonable statistical power. Conclusions The present study demonstrates a substantially increased risk of suicide among patients previously hospitalised for COPD
compared with individuals without such a history. The relative risk increases with frequency of hospitalisations and recency of the most recent hospitalisation for COPD treatment. The observed effect was more prominent in women, in patients above 60 years old and in individuals without a psychiatric history. The findings underline the importance of assessment of suicide risk in patients with COPD and the need of close collaboration between clinicians and clinic units with responsibilities of somatic and psychiatric treatment. Supplementary Material Author’s manuscript: Click here to view.(1.9M, pdf) Reviewer comments: Click here to view.(155K, pdf) Footnotes Contributors: PQ conceptualised and designed the study and analysed the
data. JMCS reviewed the literature, organised the writing and wrote the initial drafts. PQ and JMCS finalised the manuscript. JMCS, CFC, MO and PQ contributed the analysis and interpretation of the data, revised critically for important GSK-3 intellectual content and approved the final version to be published. Funding: This project was partly supported by the Danish Sygekassernes Helsefonden (Danish Health Insurance Research foundation; 2009B063). Competing interests: None. Ethics approval: The study has been approved by the Data Protection Agency in Denmark. Provenance and peer review: Not commissioned; externally peer reviewed. Data sharing statement: No additional data are available. Statistical code and further explanation about the data set can be provided from the corresponding author on request.
An estimated 60 000–134 000 undocumented migrants (UMs) live in the Netherlands.