The association between adjustment disorder diagnosed at psychiatric treatment facilities and completed suicide

Figures & data

Table 1 Characteristics of suicide cases and controls, Denmark 1994–2006

	Cases (n = 9612)	Controls (n = 199,306)
Gender
Male	6837 (71%)	142,865 (72%)
Female	2775 (29%)	56,441 (28%)
Age group
15–34 years	1701 (18%)	42,627 (21%)
35–54 years	3608 (38%)	93,703 (47%)
55–74 years	2818 (29%)	51,176 (26%)
75–90 years	1485 (15%)	11,800 (5.9%)
Marital status
Married	3121 (32%)	107,758 (54%)
Cohabitating	823 (8.0%)	25,130 (13%)
Single	5569 (58%)	64,471 (32%)
Unmarried minor	99 (1.0%)	1947 (1.0%)
Income
Lowest income quartile	4014 (42%)	49,322 (25%)
Second income quartile	2242 (23%)	50,011 (25%)
Third income quartile	1786 (19%)	49,952 (25%)
Highest income quartile	1570 (16%)	50,021 (25%)
Adjustment disorder	728 (7.6%)	1040 (0.52%)
Other psychiatric diagnoses
Depression	1713 (18%)	2542 (1.3%)
Substance abuse	1024 (11%)	2686 (1.4%)
Anxiety disorders	352 (3.7%)	1309 (0.66%)

Table 2 Bias analysis exploring the effects of imperfect nondifferential sensitivity of psychiatric disorders on the association between adjustment disorder and suicidea

	Adjustment disorder Odds ratio
Adjusted for depression (uncorrected)	7.5
Depression sensitivity = 0.5   Depression specificity = 1.0	4.9
Depression sensitivity = 0.7   Depression specificity = 1.0	6.2
Depression sensitivity = 0.9   Depression specificity = 1.0	7.1
Adjusted for substance abuse (uncorrected)	11
Substance abuse sensitivity = 0.5   Substance abuse specificity = 1.0	7.8
Substance abuse sensitivity = 0.7   Substance abuse specificity = 1.0	9.2
Substance abuse sensitivity = 0.9   Substance abuse specificity = 1.0	10
Adjusted for anxiety disorders (uncorrected)	14
Anxiety disorders sensitivity = 0.5   Anxiety disorders specificity = 1.0	12
Anxiety disorders sensitivity = 0.7   Anxiety disorders specificity = 1.0	13
Anxiety disorders sensitivity = 0.9   Anxiety disorders specificity = 1.0	14

Notes:

a We set all specificity equal to 1.0, because the probability that a person truly without these disorders would be treated at a psychiatric facility with a diagnosis of these disorders is near zero.

Table 3 Bias analysis exploring the effects of differential imperfect sensitivity of psychiatric disorders on association between adjustment disorder and suicidea

	Adjustment disorder Odds ratio
Adjusted for depression (uncorrected)	7.5
Depression sensitivity cases = 0.92; controls = 0.5   Depression specificity = 1.0	4.9
Adjusted for substance abuse (uncorrected)	11
Substance abuse sensitivity cases = 0.92; controls = 0.5   Substance abuse specificity = 1.0	7.8
Adjusted for anxiety disorders (uncorrected)	14
Anxiety disorder sensitivity cases = 0.92; controls = 0.5   Anxiety disorder specificity = 1.0	12

Notes:

a We set all specificity equal to 1.0, because the probability that a person truly without these disorders would be treated at a psychiatric facility with a diagnosis of these disorders is near zero.

Table

	ICD-8 Code (1981–1993)	ICD-10 Code (1994–2006)
Adjustment disorder	–	F43.2
Depression
Depressive episodes	296, 300.4	F32
Recurrent depressive disorder	296, 300.4	F33
Dysthymia	300.4	F34.1
Substance abuse
Mental/behavioral disorders due to use of alcohol	291, 303	F10
Mental/behavioral disorders due to use of drugs	294, 304	F11–F19
Anxiety disorders
Other anxiety disorders	300	F40
Phobic anxiety disorders	300.2	F41
Obsessive–compulsive disorder	300.3	F42
Completed suicide	–	X60–X84

Abbreviation: ICD, International Classification of Disease.