Economic hardship as an independent risk factor for suicidality in individuals with gambling disorder

Economic hardship as an independent risk factor for suicidality in individuals with gambling disorder | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Economic hardship as an independent risk factor for suicidality in individuals with gambling disorder Signe Åberg, Philip Staaf, Anders Håkansson This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7474708/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Gambling disorder is an important problem around the world and is linked to self-harm and suicides which are more common in people with gambling disorders than in people without. Economic hardship is believed to be a risk factor for self-harm in people with gambling disorder and is also common among people with gambling disorder. Therefore, the aim of this study was to investigate economic hardship, defined here as social welfare payments, as a possible risk factor for suicide in people with a gambling disorder. Methods This case-control study contained data from registers including 3592 people with gambling disorder, compared to a total of 7184 age- and gender-matched controls, all with an age of 18 or older. These groups were used to analyze the association between suicide/suicide attempts and social welfare payments and adjust this risk to other possible risk factors. Lastly, a comparison was made between potential suicides/suicides attempts in regard to when in time the individuals received social welfare payments and compare the prevalence of psychiatric disorders, age and gender with the different outcomes. Results The OR for suicide or suicide attempts when receiving social welfare payments, in the group with a gambling disorder, was 1.94 (CI 95%, 1.64–2.30). However, this risk was even greater among the control group with an OR of 3.14 (CI 95%, 2.34–4.20). Adjusted to other risk factors, both psychiatric disorders and being diagnosed with gambling disorder seemed to be a greater risk for suicide/suicide attempts. Conclusions In conclusion, even though social welfare payments seemed to be a risk factor for suicide in the gambling disorder group, the risk was greater within the control group and other risk factors than social welfare payments appeared to play a bigger part when it comes to suicides/suicide attempts. The generally increased risk of suicidal behaviour in people with over-indebtedness is confirmed. Gambling disorder Suicidality Economic hardship Over-indebtedness Background Gambling is used to describe wagering with the hopes of winning something, but with an uncertain outcome ( 1 ). Gambling is globally widespread, and it is estimated that 46.2% of adults in the world have gambled in some form in the past 12 months. It is more common among men than women in the world, with a gambling rate of 49.1% and 37.4%, respectively ( 2 ). Gambling may come with negative effects on people’s lives, their families, and their financial status ( 2 ). In WHO’s international classification of disorders (ICD-10), gambling disorder (still named pathological gambling in that diagnostic system) has the diagnostic code F63.0 ( 3 ). The transition time from a person’s onset of gambling until the onset of problematic gambling, is correlated with a more severe and chronic gambling disorder, at least in males ( 4 ). The diagnosis described in the Diagnostic and Statistical Manual of Mental Disorder, Fifth edition (DSM-5) of the American Psychiatric Association ( 5 ), is referred to as gambling disorder (GD). Gambling disorder (GD) can be defined as recurrent gambling with negative consequences, increased tolerance, and withdrawal effects and difficulties when attempting to quit or cut down on gambling. Pathological gambling, an older name of the diagnosis, was described as an impulse control disorder, but GD is now reclassified as an addictive disorder due to its similarities to alcohol and drug use disorders ( 1 ). Approximately 1.4% of adults worldwide are estimated to have a gambling problem ( 2 ). In the setting studied here, Sweden, about 1.3% have problematic gambling, and the risk for problematic gambling appears to be especially high for people who start to gamble with money before they turn 18, or related to life events, such as losing your job, having a deteriorating housing situation and receiving sickness compensation ( 6 ). It has been shown that people who are gambling on online casinos are experiencing the most severe problems ( 2 ). Gambling is a worldwide entity which continues to grow. It is estimated that all forms of commercial gambling as an industry will reach a profit of 700 billion US dollars by the year 2028. This digitalization has expanded the gambling market, especially in low- and middle-income countries ( 7 ). Suicide continues to be a major public health issue and a common cause of death in many settings. In Sweden, during 2023, 1328 people were claimed dead due to intentional self-harm ( 8 ), classified as ICD-10 X60-X84 intentional self-harm ( 9 ). Additionally, 289 deaths were reported as suspected suicides, but with uncertain intent ( 8 ), referred to as the ICD-10 codes Y10-34 ( 9 ). The most common method used in these cases were poisoning and hanging, but the choice of method differed between men and women. Among men, hanging, poisoning and usage of firearms were all common, meanwhile women almost never used firearms ( 8 ). Women are more likely to have suicide ideations and to commit suicide attempts, while men have a higher suicide mortality, typically referred to as the gender paradox of suicide ( 10 ). Financial indebtedness, such as an eviction ( 11 ), has also been shown to be a risk factor of suicide ( 12 ). People with GD have been described to have a significantly higher risk of overall mortality and a much greater risk of suicide than the rest of the population ( 11 ). In addition to the risk increase related to indebtedness per se ( 12 ), individuals with GD often experience a lower quality of life, and health and relationship problems ( 13 ). Previous studies have shown that substance use disorders and other psychiatric comorbidities, such as anxiety, depression and personality disorders, are associated with a higher incidence of intentional self-harm among individuals with GD ( 14 ). In addition to this, studies have shown that the odds ratio of suicide and suicide attempts among people with GD is higher among people who also suffer from alcohol use disorders and among women ( 15 ). In a cohort study made in Norway, an increased risk of suicide in people with GD compared to the general population was seen. In the GD population, suicide was the most common cause of death. Compared with other psychiatric disorders, such as mood disorder, substance use disorder, alcohol dependence or psychotic disorder, there was a lower risk of suicide among individuals with GD ( 16 ). People with GD often experience economic challenges as a symptom of their disease. Therefore, it is reasonable to believe that being a recipient of social welfare payments (SWP) may be associated with GD. This makes it important to investigate the role of SWP in the elevated risk of suicide in GD. Even though intentional self-harm was more common in GD when receiving SWP ( 14 ), it has not yet been studied whether this group that received SWP have a higher risk of actually committing suicide. This study aims to investigate the relationship between SWP and suicide, in individuals with GD and in matched controls, with the following specific research questions: 1) Is economic hardship, defined as receiving SWP, a risk factor for suicide and suicide attempt in people with GD and is there an association when psychiatric disorders, age and gender are taken into account? 2) Is there a difference between when in time the SWP was received compared to the suicide/suicide attempt, in regard to other psychiatric disorders, age and gender? Methods This study was a case-control study, with 3689 individuals diagnosed with gambling disorder (F63.0) and a randomly selected control group, with two controls matched personally with each of the GD group individuals with respect to age, gender and municipality of residence, and who had never been diagnosed with GD. This led to a total of 11067 individuals in the study population. Individuals under 18 years of age were excluded, primarily due to the different preconditions for receiving SWP. This excluded 291 individuals in total, which lead to a study population of 10776 individuals (3592 cases and 7184 controls). Social welfare payments (SWP) are provided to cover food, medical expenses and clothes among other things that are seen as life necessities. SWP are usually not provided if the individual has economic assets ( 17 ). The data was extracted from the Longitudinal Integrated Database for Health Insurances and Labour market studies (LISA-register) from Statistics of Sweden, Death cause register and Swedish national patient register for inpatient and outpatient care. Social welfare payments were retrieved from the LISA-register. The Death cause register contained the diagnostic codes for all individuals who passed away. ICD10 codes X60-84 for intentional self-harm and Y10-34 for event of undetermined intent were considered to represent suicidal behavior. To select people with GD (diagnostic code F63.0), the Swedish national patient register for inpatient and outpatient care was used. This register was also used to identify psychiatric comorbidities. All the registers included data from 2005 through 2019. IBM SPSS Statistic Data Editor Version 29.0.2 was used for all statistical testing. Chi2-tests were used to compare prevalence of SWP, the prevalence of suicide by ICD10 codes X60-84, and the prevalence of suicide by either X60-84 or Y10-34 in the GD group and the control group, respectively. In order to discover any differences in committing suicide while receiving SWP in the GD group versus in the control group, another Chi2-test was carried out, and thereafter, a logistic regression was carried out, adjusting the risk factors to one another. The risk factors investigated in this study were having GD or not, ever having received SWP or not, having a psychiatric comorbidity, gender and age. Having a psychiatric comorbidity included everyone with a chapter F diagnosis other than F63.0 (GD). Age was grouped into people younger than 20, 20–29, 30–39, 40–49, 50–59, 60–69 and 70 years or more. Since all individuals under 18 years were excluded in this study, the group younger than 20 years only contained people 18–20 years old. Finally, a final Chi2-test was used to compare when the suicide/suicide attempt (altogether grouped as suicidal behavior, SB) occurred in relation to the year of receiving SWP. All individuals were divided into four different groups; one group which did not have a suicide attempt/suicide ( No SB ), one group who displayed suicidal behavior before receiving SWP ( SB before SWP ), one group which displayed suicidal behavior the same year or after receiving SWP ( SB during/after ) and the last group which displayed suicidal behavior but did not receive SWP ( SB without SWP ). If someone displayed suicidal behavior more than once during the study period, the first year of a suicide attempt was put in relation to receiving SWP. The same was applied for individuals who had received SWP during more than one year. The prevalence of psychatric comorbidities, gender differences and age differences were examined in these groups. Results Prevalence of suicide among people with GD and controls are described and compared with each other in Table 1 . The GD group had a higher prevalence of SWP compared to the control group. In the GD group, there were 1441 individuals who had social support before they were diagnosed with GD, 201 individuals who were diagnosed first and received SWP later on, and 202 individuals who were diagnosed and received their first SWP during the same year. Table 1 Prevalence of intentional self-harm (X60-84) as a cause of death, combined prevalence of intentional self-harm (X60-84) and event of uncertain intent (Y10-34) as causes of death, and prevalence of SWP in the GD group and in the matched control group. GD (n, %) Control (n, %) Total Cause of death X60-84 42 (30.9%) 13 (14.3%) 55 Other causes 94 (69.1%) 78 (85.7%) 172 Total 136 (100%) 91 (100%) 227 * Cause of death X60-84 or Y10-34 52 (38.2%) 14 (15.4%) 66 Other causes 84 (61.8%) 77 (84.6%) 160 Total 136 (100%) 91 (100%) 227 ** SWP present or not SWP present 1844 (51.3%) 1285 (17.9%) 3129 SWP not present 1748 (48.7%) 5899 (82.1%) Total 3592 (100%) 7184 (100%) 10776 ** Pearson Chi-Square shows p = 0.004* and p < 0.001**. In the GD group, there were 52 individuals who passed away from suicide (X60-84 or Y10-34), with 28 of them having a prior suicide attempt. In the control group, there were 14 individuals who passed away from suicide (X60-84 or Y10-34), with 5 of them having a prior suicide attempt. In total there were 891 individuals who had a suicide attempt, 703 of them having a GD diagnosis and 188 were controls. In total, 407 of them had a suicide attempt after receiving SWP and 127 had a suicide attempt before receiving SWP (Table 1 ). No significant association could be seen between people receiving SWP or not at any point during the period of 2005–2019, and the occurrence of fatal suicide, neither in total or in the separate GD group, nor in the separate control group (Table 2 ). Regarding the broader concept of suicidal behavior (fatal suicide or non-fatal suicide attempt), a significant association could be seen between having received SWP and the occurrence of suicidal behaviour, both in the GD group separately, in the control group separately, and in total (Table 3 ). Table 2 Prevalence of SWP in the population who committed suicide (X60-84 or Y10-34), in both the GD-group and the control group. GD/Control SWP present SWP not present Total (100%) p-value GD Suicide 21 (40.4%) 31 (59.6%) 52 Not suicide 1823 (51.5%) 1717 (48.5%) 3540 0.111 Control Suicide 2 (14.3%) 12 (85.7%) 14 Not suicide 1283 (21.8%) 5887 (82.1%) 7170 0.725 Total Suicide 23 (34.8%) 43 (65.2%) 66 Not suicide 3106 (29.0%) 7604 (71.0%) 10710 0.297 Pearson Chi-square test was used. Table 3 Chi-square test with both suicide by, and suicide attempts with the X60-84 or Y10-34. This test does not take into account when in time you received SWP in relation to the attempt. GD/Control SWP present SWP not present Total p-value GD Suicide or attempt 467 (64.2%) 260 (35.8%) 727 No suicide/attempt 1377 (48.1%) 1488 (51.9%) 2865 p < 0.001 Control Suicide or attempt 78 (39.6%) 119 (60.4%) 197 No suicide/attempt 1207 (17.3%) 5780 (82.7%) 6987 p < 0.001 Total Suicide or attempt 545 (59.0%) 379 (41%) 924 No suicide/attempt 2584 (26.2%) 7268 (73.8%) 9852 p < 0.001 A logistic regression analysis showed that factors associated wither suicidal behavior (suicide or suicide attempts) were the presence of another psychiatric diagnosis (other than F63.0), having a GD diagnosis, having SWP present, or being female, whereas increasing age was not an independent risk factor (Table 4 ). Table 4 Logistic regression analysis, comparing different risk factors for suicide and/or suicide attempts (X60-84 or Y10-34). OR CI (95%) p-value GD/control 2.43 2.00-2.94 < 0.001 Other psychiatric diagnosis 8.87 6.89–11.41 < 0.001 SWP present 1.61 1.38–1.87 < 0.001 Gender (female) 1.60 1.36–1.89 < 0.001 Age (rising) 0.97 0.91–1.03 0.287 The time perspective, i.e. when in time individuals received their SWP in relation to their suicide or suicide attempt, is described in Table 5 , which shows that there were statistically significant differences with respect to psychiatric diagnosis and gender, both within the GD group and within the control group. A linear-by-linear comparison concerning psychiatric diagnosis was also significant both in the GD group and in the control group, whereas the gender differences between the time-related groups were seen only within the GD group. Comparing the same groups with regards to their gender, in both GD and controls, there was an association between being a female and having a suicide attempt before receiving SWP. The test was statistically significant in both the GD and the control group. However, a linear-by-linear comparison was only significant in the GD group and in total. Table 5 Chi-square test comparing individuals who had suicidal behavior (SB), defined as having a suicide attempt or committed suicide (X60-84 or Y10-34) in different time aspects. Comparing individuals with SB without any SWP, individuals who had SB before receiving SWP, individuals who received SWP before/the same year as having SB and individuals who had no SB, in regard to having a psychiatric comorbidity (another psychiatric diagnosis other than F63.0) and gender. GD/control Other psychiatric diagnosis No other psychiatric diagnosis Total (100%) GD SB without SWP 244 (93.1%) 18 (6.9%) 262 SB before SWP 104 (97.2%) 3 (2.8%) 107 SB during/after SWP 354 (98.9%) 4 (1.1%) 358 No SB 2223 (77.6%) 642 (22.4%) 2865 ** ⁺ Control SB without SWP 62 (52.1%) 57 (47.9%) 119 SB before SWP 18 (90.0% 2 (10.0%) 20 SB during/after SWP 50 (86.2%) 8 (13.8%) 58 No SB 1011 (14.4%) 5976 (85.5%) 6987 ** ⁺ Total SB without SWP 306 (80.3%) 75 (19.7%) 381 SB before SWP 122 (96.1%) 5 (3.9%) 127 SB during/after SWP 404 (97.1%) 12 (2.9%) 416 No SB 3234 (32.8%) 6618 (67.2%) 9852 ** ⁺ Male Female Total GD SB without SWP 190 (72.5%) 72 (27.5%) 262 SB before SWP 64 (59.8%) 43 (40.2%) 107 SB during/after SWP 237 (66.2%) 121 (33.8%) 358 No SB 2300 (80.3%) 565 (19.7%) 2865 ** ⁺ Control SB without SWP 85 (71.4%) 34 (28.6%) 119 SB before SWP 12 (60.0%) 8 (40.0%) 20 SB during/after SWP 50 (86.2%) 8 (13.8%) 58 No SB 5434 (77.8%) 1553 (22.2%) 6987 * Total SB without SWP 275 (72.2%) 106 (27.8%) 381 SB before SWP 76 (59.8%) 51 (40.2%) 127 SB during/after SWP 287 (69.0%) 129 (31.0%) 416 No SB 7734 (78.5%) 2118 (21.5%) 9852 ** ⁺ Pearson Chi-square test shows p = 0.033* and p < 0.001**. Linear-by-linear p < 0.001⁺. Both in the GD and the control group, there were a significant association between age and the different time prespective between SB and SWP. However, when looking at the total dataset, there were no significant differences regarding age (Table 6 ). Table 6 Chi-square test comparing different age-intervals with individuals who had SB without any SWP, individuals who had SB before receiving SWP, individuals who received SWP before/the same year as SB and individuals who had no SB. Suicide or suicide attempt by X64-80 or Y10-34 defines SB. GD Age SB without SWP SB before SWP SB during/after SWP No SB p-value < 20 7 (6.7%) 7 (6.7%) 4 (3.8%) 87 (82.9%) 20–29 77 (7.1%) 34 (3.1%) 112 (10.3%) 865 (79.5%) 30–39 76 (6.6%) 31 (2.7%) 102 (8.9%) 943 (81.9%) 40–49 56 (7.8%) 22 (3.1%) 78 (10.8%) 563 (78.3%) 50–59 28 (7.0%) 10 (2.5%) 54 (13.5%) 308 (77.0%) 60–69 13 (13.1%) 2 (2.0%) 5 (5.1%) 79 (79.8%) > 70 5 (17.2%) 1 (3.4%) 3 (10.3%) 20 (69.0%) 0.030 Control Age SB without SWP SB before SWP SB during/after SWP No SB p-value < 20 7 (3.3%) 0 (0.0%) 2 (1.0%) 201 (95.7%) 20–29 40 (1.8%) 9 (0.4%) 29 (1.3%) 2098 (96.4%) 30–39 35 (1.5%) 3 (0.1%) 19 (0.8%) 2247 (97.5%) 40–49 17 (1.2%) 4 (0.3%) 7 (0.5%) 1410 (98.1%) 50–59 16 (2.0%) 3 (0.4%) 1 (0.1%) 780 (97.5%) 60–69 4 (2.0%) 1 (0.5%) 0 (0.0%) 193 (97.5%) > 70 0 (0.0%) 0 (0.0%) 0 (0.0%) 58 (100%) 0.049 Total Age SB without SWP SB before SWP SB during/after SWP No SB p-value < 20 14 (4.4%) 7 (2.2%) 6 (1.9%) 288 (91.4%) 20–29 117 (3.6%) 43 (1.3%) 141 (4.3%) 2963 (90.8%) 30–39 111 (3.2%) 34 (1.0%) 121 (3.5%) 3190 (92.3%) 40–49 73 (3.4%) 26 (1.2%) 85 (3.9%) 1973 (91.5%) 50–59 44 (3.7%) 13 (1.1%) 55 (4.6%) 1088 (90.7%) 60–69 17 (5.7%) 3 (1.0%) 5 (1.7%) 272 (91.6%) > 70 5 (5.7%) 1 (1.1%) 3 (3.4%) 78 (89.7%) 0.158 Discussion Firstly, this study derives from a case-control data material where individuals diagnosed with a gambling disorder are at higher risk of suicidal behaviour than people who are not, as shown previously in research from the same data sources ( 18 ). The same is shown when considering mortality by suicide and by events of uncertain intent as the same outcome. This corresponds well with previously published studies in this area, also describing an increased mortality rate by suicide in people with GD ( 13 ). Furthermore, receiving SWP, as an indicator of economic hardship, was also more frequent in people with GD than it was in the control group, just as previously suggested ( 14 ). However, there was no significant connection between receiving SWP and committing suicide. In contrast, when looking at the broader concept of suicidal behavior, defined as suicide and suicide attempts, a significant connection between SWP and suicidality could be seen. The group that received SWP had a higher rate of suicidality compared to the people not receiving SWP. Surprisingly, this association was stronger in controls than in individuals with GD. This result indicates that SWP may not be the main contributor to the reason for the increased risk of suicide or suicidality in individuals with GD, and that the relative risk of self-harm when in economic hardship may be greater in people without a GD. A possible explanation for this may be the fact that psychiatric comorbidities are very common in people with gambling disorders ( 19 ) and have a heavy impact on their risk of self-harm. Psychiatric disorders could therefore be more impactful than economic hardship among people with GD, but also, in patients with GD, other factors than the economic hardship, such as the addictive disorder itself, may play the largest part in the risk increase for suicidal behavior. Even having the diagnosis of GD as such seems to be a greater risk factor than the economic hardship experienced in people with SWP. This is an important discovery and may guide future research in gambling-related suicide. When it comes to differences between male and female, the biggest difference was seen in people having a suicide attempt/suicide after receiving SWP, with a smaller male-to-female ratio in the control group than in the GD group. When looking at the GD and the control group together, there was an association between being male gender and never having a suicide attempt/suicide, which correlates well with previous studies suggesting that suicide attempts are more common in women than in men ( 10 ). Since the suicide attempt group is much larger than the suicide group in this study, suicide attempts had a heavier impact on the results. A relatively large group with a GD diagnosis that received SWP after having a suicide attempt, an association that does not necessarily mean that the suicide attempt leads to financial problems, as the reception of SWP may be the result of a longer time period of financial difficulties before SWP is actually applied for or granted. It would be of interest to investigate this further with more in-depth, individual interview study designs, to get a better understanding of the financial situation in these individuals and in the possible association between suicide attempts and SWP in these individuals. Another aspect is that there were a few individuals who had a suicide attempt, then received SWP and later committed suicide. It is beyond the scope of the present study to analyze whether, in these individuals, their financial status had an impact on their complete suicide or not. This makes this group difficult to analyze, since it probably both contains individuals whose financial status impacted their suicidality, and individuals where economic hardship did not have an impact on the suicide attempt. One limitation with the current study is that not all who have financial problems receive SWP. In case of a faster development of GD, it may be more likely that an individual has not yet applied for or not yet received SWP, even though they are acutely struggeling with a financial crisis which could have an impact on their possible suicidality. It is difficult to avoid this limitation, and SWP can still be seen as a good indicator of long-term financial difficulties, although it cannot definitely determine who is suffering from financial difficulties and who is not. Another limitation with the study is that it is not possible to know if SWP indicates financial problems at the exact time of the suicide/suicide attempt. For example, if they received SWP and a few years later had a suicide attempt, they could have been in an improved financial situation by then. Here, the choice was made to interpret all reception of SWP as an indicator of a present or recent (and still relevant) financial problem. An unavoidable limitation is that the data used in this study only covers the years 2005–2019. This presents a couple of limits. Firstly, it cannot considered what happened before 2005. For example, people may have received SWP in 2004 and no other time and will therefore be categorized in the group not receiving SWP during the study period. Another possible limitation time brings to this study is that gambling is increasing and evolving through the years. Gambling in 2005 does not look the same as it did in 2019 with the considerable digitalization of gambling ( 7 ). In the same way, gambling might have evolved even more since 2019, and this warrants further study of gambling in relation to over-indebtedness and suicidal behaviour in more recent years. Conclusions In conclusion, even though receiving SWP appeared to contribute significantly to a higher risk of suicide and suicidality in individuals with GD, the same association, and even with a stronger statistical association, was seen in controls. Other risk factors such as psychiatric comorbidities seem to have a higher correlation with suicidal behaviour than did SWP. This knowledge is important for clinicians to be able to identify risk factors for suicide in GD and be able to intervene in time. Declarations Human ethics and consent to participate declaration The study was approved by the Swedish Ethical Review Authority (Uppsala, Sweden), decision number 2019-01559. The study was conducted according to the Declaration of Helsinki. As this is a deidentified national register study, and in accordance with the ethical permission of the Swedish Ethical Review Authority, no informed consent was required from the included individuals, whose identity was unknown to the researchers. Clinical trial number: not applicable. Funding The study was carried out without any project-specific funding, but it was made possible thanks to the last author’s overall research funding from the state-owned gambling operator of Sweden (AB Svenska Spel) and from the regional health care organization (Region Skåne). Consent for publication Not applicable. No individual data are published. Availability of data and materials The data that support the findings of this study are available from the Swedish Board of Health and Welfare, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the Swedish Board of Health and Welfare and from the Swedish Ethical Review Authority. References Potenza MN, Balodis IM, Derevensky J, Grant JE, Petry NM, Verdejo-Garcia A, et al. Gambling disorder. 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Available from: https://www.socialstyrelsen.se/kunskapsstod-och-regler/omraden/ekonomiskt-bistand/ekonomiskt-bistand-for-privatpersoner/. Kidane A, Karlsson A, Håkansson A. Suicide and attempted suicide in gambling disorder – results from a nationwide case-control study. Psychiatry Res 2025;348:116476. Dowling NA, Cowlishaw S, Jackson AC, Merkouris SS, Francis KL, Christensen DR. Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis. Aust N Z J Psychiatry. 2015;49(6):519-39. Additional Declarations Competing interest reported. The last author has funding from the state-owned gambling operator of Sweden (AB Svenska Spel), and, outside of the present work, from the research council of Svenska Spel and from the research council of the Swedish alcohol monopoly, Systembolaget. None of these organisations were involved in or affected the present research projects or publication in any way. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7474708","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":525049942,"identity":"f9a91e59-8325-4124-94f9-ce858d7a59ae","order_by":0,"name":"Signe Åberg","email":"","orcid":"","institution":"Lund University","correspondingAuthor":false,"prefix":"","firstName":"Signe","middleName":"","lastName":"Åberg","suffix":""},{"id":525049945,"identity":"20391fdc-4f47-4c72-a962-8c531f60d7a2","order_by":1,"name":"Philip Staaf","email":"","orcid":"","institution":"Lund University","correspondingAuthor":false,"prefix":"","firstName":"Philip","middleName":"","lastName":"Staaf","suffix":""},{"id":525049948,"identity":"b2ffb418-ae84-4403-a772-cc736b5eef72","order_by":2,"name":"Anders Håkansson","email":"data:image/png;base64,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","orcid":"","institution":"Lund University","correspondingAuthor":true,"prefix":"","firstName":"Anders","middleName":"","lastName":"Håkansson","suffix":""}],"badges":[],"createdAt":"2025-08-27 21:19:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7474708/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7474708/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93042352,"identity":"da6416af-d3cb-433d-ba84-c8ed4027c5b5","added_by":"auto","created_at":"2025-10-08 12:30:56","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":59041,"visible":true,"origin":"","legend":"","description":"","filename":"bergStaafHkanssonmanuscriptwithamendment250910.docx","url":"https://assets-eu.researchsquare.com/files/rs-7474708/v1/d98aea5272058c719b94b831.docx"},{"id":93042349,"identity":"8b35fabf-bdb3-4926-a29c-671a6cabf26c","added_by":"auto","created_at":"2025-10-08 12:30:56","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6348,"visible":true,"origin":"","legend":"","description":"","filename":"64a30bf8bd234bd5b1ae53c2581dd5a0.json","url":"https://assets-eu.researchsquare.com/files/rs-7474708/v1/cac1af52fbd0ac4923515695.json"},{"id":93042354,"identity":"d7bfa23d-4c25-406a-bfa6-02e8c812fd05","added_by":"auto","created_at":"2025-10-08 12:30:56","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":97538,"visible":true,"origin":"","legend":"","description":"","filename":"64a30bf8bd234bd5b1ae53c2581dd5a01enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7474708/v1/822d9c3bc6b67dfae17d643d.xml"},{"id":93043176,"identity":"d647e2bd-1de9-4e5a-877c-42f7715ac48e","added_by":"auto","created_at":"2025-10-08 12:38:56","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":94191,"visible":true,"origin":"","legend":"","description":"","filename":"64a30bf8bd234bd5b1ae53c2581dd5a01structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7474708/v1/bc58212aa1aa65193c80ce20.xml"},{"id":93042357,"identity":"4f2acaa7-cb97-4957-9f4d-b00ef88c61c2","added_by":"auto","created_at":"2025-10-08 12:30:56","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":101216,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7474708/v1/f84ee5901e9e504253d9b6d6.html"},{"id":93043556,"identity":"8c20d93b-6a9e-46ae-845f-c0cc0629346a","added_by":"auto","created_at":"2025-10-08 12:46:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":834326,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7474708/v1/c10bde12-d53b-4d17-b79f-e7f07c404c0a.pdf"}],"financialInterests":"Competing interest reported. The last author has funding from the state-owned gambling operator of Sweden (AB Svenska Spel), and, outside of the present work, from the research council of Svenska Spel and from the research council of the Swedish alcohol monopoly, Systembolaget. None of these organisations were involved in or affected the present research projects or publication in any way.","formattedTitle":"Economic hardship as an independent risk factor for suicidality in individuals with gambling disorder","fulltext":[{"header":"Background","content":"\u003cp\u003eGambling is used to describe wagering with the hopes of winning something, but with an uncertain outcome (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Gambling is globally widespread, and it is estimated that 46.2% of adults in the world have gambled in some form in the past 12 months. It is more common among men than women in the world, with a gambling rate of 49.1% and 37.4%, respectively (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Gambling may come with negative effects on people\u0026rsquo;s lives, their families, and their financial status (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In WHO\u0026rsquo;s international classification of disorders (ICD-10), gambling disorder (still named pathological gambling in that diagnostic system) has the diagnostic code F63.0 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The transition time from a person\u0026rsquo;s onset of gambling until the onset of problematic gambling, is correlated with a more severe and chronic gambling disorder, at least in males (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The diagnosis described in the \u003cem\u003eDiagnostic and Statistical Manual of Mental Disorder, Fifth edition\u003c/em\u003e (DSM-5) of the American Psychiatric Association (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), is referred to as gambling disorder (GD). Gambling disorder (GD) can be defined as recurrent gambling with negative consequences, increased tolerance, and withdrawal effects and difficulties when attempting to quit or cut down on gambling. Pathological gambling, an older name of the diagnosis, was described as an impulse control disorder, but GD is now reclassified as an addictive disorder due to its similarities to alcohol and drug use disorders (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eApproximately 1.4% of adults worldwide are estimated to have a gambling problem (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In the setting studied here, Sweden, about 1.3% have problematic gambling, and the risk for problematic gambling appears to be especially high for people who start to gamble with money before they turn 18, or related to life events, such as losing your job, having a deteriorating housing situation and receiving sickness compensation (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIt has been shown that people who are gambling on online casinos are experiencing the most severe problems (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Gambling is a worldwide entity which continues to grow. It is estimated that all forms of commercial gambling as an industry will reach a profit of 700\u0026nbsp;billion US dollars by the year 2028. This digitalization has expanded the gambling market, especially in low- and middle-income countries (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSuicide continues to be a major public health issue and a common cause of death in many settings. In Sweden, during 2023, 1328 people were claimed dead due to intentional self-harm (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), classified as ICD-10 X60-X84 intentional self-harm (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Additionally, 289 deaths were reported as suspected suicides, but with uncertain intent (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), referred to as the ICD-10 codes Y10-34 (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The most common method used in these cases were poisoning and hanging, but the choice of method differed between men and women. Among men, hanging, poisoning and usage of firearms were all common, meanwhile women almost never used firearms (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Women are more likely to have suicide ideations and to commit suicide attempts, while men have a higher suicide mortality, typically referred to as the gender paradox of suicide (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFinancial indebtedness, such as an eviction (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), has also been shown to be a risk factor of suicide (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). People with GD have been described to have a significantly higher risk of overall mortality and a much greater risk of suicide than the rest of the population (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In addition to the risk increase related to indebtedness \u003cem\u003eper se\u003c/em\u003e (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), individuals with GD often experience a lower quality of life, and health and relationship problems (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePrevious studies have shown that substance use disorders and other psychiatric comorbidities, such as anxiety, depression and personality disorders, are associated with a higher incidence of intentional self-harm among individuals with GD (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In addition to this, studies have shown that the odds ratio of suicide and suicide attempts among people with GD is higher among people who also suffer from alcohol use disorders and among women (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In a cohort study made in Norway, an increased risk of suicide in people with GD compared to the general population was seen. In the GD population, suicide was the most common cause of death. Compared with other psychiatric disorders, such as mood disorder, substance use disorder, alcohol dependence or psychotic disorder, there was a lower risk of suicide among individuals with GD (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePeople with GD often experience economic challenges as a symptom of their disease. Therefore, it is reasonable to believe that being a recipient of social welfare payments (SWP) may be associated with GD. This makes it important to investigate the role of SWP in the elevated risk of suicide in GD. Even though intentional self-harm was more common in GD when receiving SWP (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), it has not yet been studied whether this group that received SWP have a higher risk of actually committing suicide. This study aims to investigate the relationship between SWP and suicide, in individuals with GD and in matched controls, with the following specific research questions:\u003c/p\u003e\u003cp\u003e1) Is economic hardship, defined as receiving SWP, a risk factor for suicide and suicide attempt in people with GD and is there an association when psychiatric disorders, age and gender are taken into account? 2) Is there a difference between when in time the SWP was received compared to the suicide/suicide attempt, in regard to other psychiatric disorders, age and gender?\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study was a case-control study, with 3689 individuals diagnosed with gambling disorder (F63.0) and a randomly selected control group, with two controls matched personally with each of the GD group individuals with respect to age, gender and municipality of residence, and who had never been diagnosed with GD. This led to a total of 11067 individuals in the study population. Individuals under 18 years of age were excluded, primarily due to the different preconditions for receiving SWP. This excluded 291 individuals in total, which lead to a study population of 10776 individuals (3592 cases and 7184 controls).\u003c/p\u003e\u003cp\u003eSocial welfare payments (SWP) are provided to cover food, medical expenses and clothes among other things that are seen as life necessities. SWP are usually not provided if the individual has economic assets (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The data was extracted from the Longitudinal Integrated Database for Health Insurances and Labour market studies (LISA-register) from Statistics of Sweden, Death cause register and Swedish national patient register for inpatient and outpatient care. Social welfare payments were retrieved from the LISA-register. The Death cause register contained the diagnostic codes for all individuals who passed away. ICD10 codes X60-84 for intentional self-harm and Y10-34 for event of undetermined intent were considered to represent suicidal behavior. To select people with GD (diagnostic code F63.0), the Swedish national patient register for inpatient and outpatient care was used. This register was also used to identify psychiatric comorbidities. All the registers included data from 2005 through 2019. IBM SPSS Statistic Data Editor Version 29.0.2 was used for all statistical testing.\u003c/p\u003e\u003cp\u003eChi2-tests were used to compare prevalence of SWP, the prevalence of suicide by ICD10 codes X60-84, and the prevalence of suicide by either X60-84 or Y10-34 in the GD group and the control group, respectively.\u003c/p\u003e\u003cp\u003eIn order to discover any differences in committing suicide while receiving SWP in the GD group versus in the control group, another Chi2-test was carried out, and thereafter, a logistic regression was carried out, adjusting the risk factors to one another. The risk factors investigated in this study were having GD or not, ever having received SWP or not, having a psychiatric comorbidity, gender and age. Having a psychiatric comorbidity included everyone with a chapter F diagnosis other than F63.0 (GD). Age was grouped into people younger than 20, 20\u0026ndash;29, 30\u0026ndash;39, 40\u0026ndash;49, 50\u0026ndash;59, 60\u0026ndash;69 and 70 years or more. Since all individuals under 18 years were excluded in this study, the group younger than 20 years only contained people 18\u0026ndash;20 years old.\u003c/p\u003e\u003cp\u003eFinally, a final Chi2-test was used to compare when the suicide/suicide attempt (altogether grouped as suicidal behavior, SB) occurred in relation to the year of receiving SWP. All individuals were divided into four different groups; one group which did not have a suicide attempt/suicide (\u003cem\u003eNo SB\u003c/em\u003e), one group who displayed suicidal behavior before receiving SWP (\u003cem\u003eSB before SWP\u003c/em\u003e), one group which displayed suicidal behavior the same year or after receiving SWP (\u003cem\u003eSB during/after\u003c/em\u003e) and the last group which displayed suicidal behavior but did not receive SWP (\u003cem\u003eSB without SWP\u003c/em\u003e). If someone displayed suicidal behavior more than once during the study period, the first year of a suicide attempt was put in relation to receiving SWP. The same was applied for individuals who had received SWP during more than one year. The prevalence of psychatric comorbidities, gender differences and age differences were examined in these groups.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003ePrevalence of suicide among people with GD and controls are described and compared with each other in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The GD group had a higher prevalence of SWP compared to the control group. In the GD group, there were 1441 individuals who had social support before they were diagnosed with GD, 201 individuals who were diagnosed first and received SWP later on, and 202 individuals who were diagnosed and received their first SWP during the same year.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence of intentional self-harm (X60-84) as a cause of death, combined prevalence of intentional self-harm (X60-84) and event of uncertain intent (Y10-34) as causes of death, and prevalence of SWP in the GD group and in the matched control group.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGD (n, %)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl (n, %)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCause of death\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eX60-84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42 (30.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther causes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e94 (69.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78 (85.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e136 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e227\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCause of death\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eX60-84 or Y10-34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52 (38.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (15.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther causes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84 (61.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77 (84.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e136 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e227\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSWP present or not\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSWP present\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1844 (51.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1285 (17.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSWP not present\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1748 (48.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5899 (82.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3592 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7184 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10776\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003ePearson Chi-Square shows p\u0026thinsp;=\u0026thinsp;0.004* and p\u0026thinsp;\u0026lt;\u0026thinsp;0.001**.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn the GD group, there were 52 individuals who passed away from suicide (X60-84 or Y10-34), with 28 of them having a prior suicide attempt. In the control group, there were 14 individuals who passed away from suicide (X60-84 or Y10-34), with 5 of them having a prior suicide attempt. In total there were 891 individuals who had a suicide attempt, 703 of them having a GD diagnosis and 188 were controls. In total, 407 of them had a suicide attempt after receiving SWP and 127 had a suicide attempt before receiving SWP (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eNo significant association could be seen between people receiving SWP or not at any point during the period of 2005\u0026ndash;2019, and the occurrence of fatal suicide, neither in total or in the separate GD group, nor in the separate control group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Regarding the broader concept of suicidal behavior (fatal suicide or non-fatal suicide attempt), a significant association could be seen between having received SWP and the occurrence of suicidal behaviour, both in the GD group separately, in the control group separately, and in total (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence of SWP in the population who committed suicide (X60-84 or Y10-34), in both the GD-group and the control group.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGD/Control\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSWP present\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSWP not present\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003e(100%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eSuicide\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21 (40.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31 (59.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eNot suicide\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1823 (51.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1717 (48.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3540\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.111\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eSuicide\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12 (85.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eNot suicide\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1283 (21.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5887 (82.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.725\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eSuicide\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23 (34.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43 (65.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eNot suicide\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3106 (29.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7604 (71.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e10710\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.297\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003ePearson Chi-square test was used.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChi-square test with both suicide by, and suicide attempts with the X60-84 or Y10-34. This test does not take into account when in time you received SWP in relation to the attempt.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGD/Control\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSWP present\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSWP not present\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSuicide or attempt\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e467 (64.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e260 (35.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e727\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo suicide/attempt\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1377 (48.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1488 (51.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2865\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSuicide or attempt\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e78 (39.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e119 (60.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e197\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo suicide/attempt\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1207 (17.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5780 (82.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6987\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSuicide or attempt\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e545 (59.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e379 (41%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e924\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo suicide/attempt\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2584 (26.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7268 (73.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9852\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA logistic regression analysis showed that factors associated wither suicidal behavior (suicide or suicide attempts) were the presence of another psychiatric diagnosis (other than F63.0), having a GD diagnosis, having SWP present, or being female, whereas increasing age was not an independent risk factor (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLogistic regression analysis, comparing different risk factors for suicide and/or suicide attempts (X60-84 or Y10-34).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCI (95%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGD/control\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.00-2.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther psychiatric diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.89\u0026ndash;11.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSWP present\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.38\u0026ndash;1.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender (female)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.36\u0026ndash;1.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (rising)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.91\u0026ndash;1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.287\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe time perspective, i.e. when in time individuals received their SWP in relation to their suicide or suicide attempt, is described in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, which shows that there were statistically significant differences with respect to psychiatric diagnosis and gender, both within the GD group and within the control group. A linear-by-linear comparison concerning psychiatric diagnosis was also significant both in the GD group and in the control group, whereas the gender differences between the time-related groups were seen only within the GD group. Comparing the same groups with regards to their gender, in both GD and controls, there was an association between being a female and having a suicide attempt before receiving SWP. The test was statistically significant in both the GD and the control group. However, a linear-by-linear comparison was only significant in the GD group and in total.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChi-square test comparing individuals who had suicidal behavior (SB), defined as having a suicide attempt or committed suicide (X60-84 or Y10-34) in different time aspects. Comparing individuals with SB without any SWP, individuals who had SB before receiving SWP, individuals who received SWP before/the same year as having SB and individuals who had no SB, in regard to having a psychiatric comorbidity (another psychiatric diagnosis other than F63.0) and gender.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGD/control\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOther psychiatric diagnosis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo other psychiatric diagnosis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal (100%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB without SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e244 (93.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (6.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e262\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB before SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e104 (97.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (2.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB during/after SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e354 (98.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (1.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e358\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo SB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2223 (77.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e642 (22.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2865\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e** ⁺\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB without SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62 (52.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57 (47.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB before SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (90.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (10.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB during/after SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50 (86.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (13.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo SB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1011 (14.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5976 (85.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6987\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e** ⁺\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB without SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e306 (80.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75 (19.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e381\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB before SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e122 (96.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (3.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB during/after SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e404 (97.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (2.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e416\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo SB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3234 (32.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6618 (67.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9852\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e** ⁺\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB without SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e190 (72.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72 (27.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e262\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB before SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64 (59.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43 (40.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB during/after SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e237 (66.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e121 (33.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e358\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo SB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2300 (80.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e565 (19.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2865\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e** ⁺\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB without SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85 (71.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34 (28.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB before SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (60.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (40.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB during/after SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50 (86.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (13.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo SB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5434 (77.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1553 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6987\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB without SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e275 (72.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e106 (27.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e381\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB before SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76 (59.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51 (40.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB during/after SWP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e287 (69.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e129 (31.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e416\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo SB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7734 (78.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2118 (21.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9852\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e** ⁺\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003ePearson Chi-square test shows p\u0026thinsp;=\u0026thinsp;0.033* and p\u0026thinsp;\u0026lt;\u0026thinsp;0.001**.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eLinear-by-linear p\u0026thinsp;\u0026lt;\u0026thinsp;0.001⁺.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eBoth in the GD and the control group, there were a significant association between age and the different time prespective between SB and SWP. However, when looking at the total dataset, there were no significant differences regarding age (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChi-square test comparing different age-intervals with individuals who had SB without any SWP, individuals who had SB before receiving SWP, individuals who received SWP before/the same year as SB and individuals who had no SB. Suicide or suicide attempt by X64-80 or Y10-34 defines SB.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eSB without\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSWP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSB before SWP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eSB during/after SWP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eNo SB\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (6.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (6.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (3.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e87 (82.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77 (7.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34 (3.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e112 (10.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e865 (79.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e76 (6.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31 (2.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e102 (8.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e943 (81.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56 (7.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (3.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78 (10.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e563 (78.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e50\u0026ndash;59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (7.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (2.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54 (13.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e308 (77.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60\u0026ndash;69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (13.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (2.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (5.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e79 (79.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (17.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (3.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (10.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20 (69.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eControl\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eSB without\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSWP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSB before SWP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eSB during/after SWP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eNo SB\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (3.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (1.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e201 (95.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (0.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29 (1.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2098 (96.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35 (1.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (0.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19 (0.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2247 (97.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (1.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (0.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (0.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1410 (98.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e50\u0026ndash;59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (2.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (0.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e780 (97.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60\u0026ndash;69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (2.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e193 (97.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e58 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.049\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eSB without\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSWP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSB before SWP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eSB during/after SWP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eNo SB\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (4.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (2.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (1.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e288 (91.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e117 (3.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43 (1.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e141 (4.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2963 (90.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e111 (3.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34 (1.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e121 (3.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3190 (92.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (3.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26 (1.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85 (3.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1973 (91.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e50\u0026ndash;59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44 (3.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (1.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55 (4.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1088 (90.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60\u0026ndash;69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (5.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (1.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (1.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e272 (91.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (5.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (3.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e78 (89.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.158\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eFirstly, this study derives from a case-control data material where individuals diagnosed with a gambling disorder are at higher risk of suicidal behaviour than people who are not, as shown previously in research from the same data sources (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The same is shown when considering mortality by suicide and by events of uncertain intent as the same outcome. This corresponds well with previously published studies in this area, also describing an increased mortality rate by suicide in people with GD (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Furthermore, receiving SWP, as an indicator of economic hardship, was also more frequent in people with GD than it was in the control group, just as previously suggested (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, there was no significant connection between receiving SWP and committing suicide. In contrast, when looking at the broader concept of suicidal behavior, defined as suicide and suicide attempts, a significant connection between SWP and suicidality could be seen. The group that received SWP had a higher rate of suicidality compared to the people not receiving SWP. Surprisingly, this association was stronger in controls than in individuals with GD. This result indicates that SWP may not be the main contributor to the reason for the increased risk of suicide or suicidality in individuals with GD, and that the relative risk of self-harm when in economic hardship may be greater in people without a GD. A possible explanation for this may be the fact that psychiatric comorbidities are very common in people with gambling disorders (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and have a heavy impact on their risk of self-harm. Psychiatric disorders could therefore be more impactful than economic hardship among people with GD, but also, in patients with GD, other factors than the economic hardship, such as the addictive disorder itself, may play the largest part in the risk increase for suicidal behavior. Even having the diagnosis of GD as such seems to be a greater risk factor than the economic hardship experienced in people with SWP. This is an important discovery and may guide future research in gambling-related suicide.\u003c/p\u003e\u003cp\u003eWhen it comes to differences between male and female, the biggest difference was seen in people having a suicide attempt/suicide after receiving SWP, with a smaller male-to-female ratio in the control group than in the GD group. When looking at the GD and the control group together, there was an association between being male gender and never having a suicide attempt/suicide, which correlates well with previous studies suggesting that suicide attempts are more common in women than in men (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Since the suicide attempt group is much larger than the suicide group in this study, suicide attempts had a heavier impact on the results.\u003c/p\u003e\u003cp\u003eA relatively large group with a GD diagnosis that received SWP after having a suicide attempt, an association that does not necessarily mean that the suicide attempt leads to financial problems, as the reception of SWP may be the result of a longer time period of financial difficulties before SWP is actually applied for or granted. It would be of interest to investigate this further with more in-depth, individual interview study designs, to get a better understanding of the financial situation in these individuals and in the possible association between suicide attempts and SWP in these individuals.\u003c/p\u003e\u003cp\u003eAnother aspect is that there were a few individuals who had a suicide attempt, then received SWP and later committed suicide. It is beyond the scope of the present study to analyze whether, in these individuals, their financial status had an impact on their complete suicide or not. This makes this group difficult to analyze, since it probably both contains individuals whose financial status impacted their suicidality, and individuals where economic hardship did not have an impact on the suicide attempt.\u003c/p\u003e\u003cp\u003eOne limitation with the current study is that not all who have financial problems receive SWP. In case of a faster development of GD, it may be more likely that an individual has not yet applied for or not yet received SWP, even though they are acutely struggeling with a financial crisis which could have an impact on their possible suicidality. It is difficult to avoid this limitation, and SWP can still be seen as a good indicator of long-term financial difficulties, although it cannot definitely determine who is suffering from financial difficulties and who is not.\u003c/p\u003e\u003cp\u003eAnother limitation with the study is that it is not possible to know if SWP indicates financial problems at the exact time of the suicide/suicide attempt. For example, if they received SWP and a few years later had a suicide attempt, they could have been in an improved financial situation by then. Here, the choice was made to interpret all reception of SWP as an indicator of a present or recent (and still relevant) financial problem.\u003c/p\u003e\u003cp\u003eAn unavoidable limitation is that the data used in this study only covers the years 2005\u0026ndash;2019. This presents a couple of limits. Firstly, it cannot considered what happened before 2005. For example, people may have received SWP in 2004 and no other time and will therefore be categorized in the group not receiving SWP during the study period. Another possible limitation time brings to this study is that gambling is increasing and evolving through the years. Gambling in 2005 does not look the same as it did in 2019 with the considerable digitalization of gambling (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In the same way, gambling might have evolved even more since 2019, and this warrants further study of gambling in relation to over-indebtedness and suicidal behaviour in more recent years.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, even though receiving SWP appeared to contribute significantly to a higher risk of suicide and suicidality in individuals with GD, the same association, and even with a stronger statistical association, was seen in controls. Other risk factors such as psychiatric comorbidities seem to have a higher correlation with suicidal behaviour than did SWP. This knowledge is important for clinicians to be able to identify risk factors for suicide in GD and be able to intervene in time.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eHuman ethics and consent to participate declaration\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Swedish Ethical Review Authority (Uppsala, Sweden), decision number 2019-01559. The study was conducted according to the Declaration of Helsinki. As this is a deidentified national register study, and in accordance with the ethical permission of the Swedish Ethical Review Authority, no informed consent was required from the included individuals, whose identity was unknown to the researchers.\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study was carried out without any project-specific funding, but it was made possible thanks to the last author\u0026rsquo;s overall research funding from the state-owned gambling operator of Sweden (AB Svenska Spel) and from the regional health care organization (Region Sk\u0026aring;ne).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. No individual data are published.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u0026nbsp;\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the Swedish Board of Health and Welfare, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the Swedish Board of Health and Welfare and from the Swedish Ethical Review Authority.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePotenza MN, Balodis IM, Derevensky J, Grant JE, Petry NM, Verdejo-Garcia A, et al. Gambling disorder. Nat Rev Dis Primers. 2019;5(1):51.\u003c/li\u003e\n\u003cli\u003eTran LT, Wardle H, Colledge-Frisby S, Taylor S, Lynch M, Rehm J, et al. The prevalence of gambling and problematic gambling: a systematic review and meta-analysis. Lancet Public Health. 2024;9(8):e594-e613.\u003c/li\u003e\n\u003cli\u003eFauth-Buhler M, Mann K, Potenza MN. Pathological gambling: a review of the neurobiological evidence relevant for its classification as an addictive disorder. Addict Biol. 2017;22(4):885-97.\u003c/li\u003e\n\u003cli\u003ePettorruso M, Testa G, Granero R, Martinotti G, d\u0026apos;Andrea G, di Giannantonio M, et al. The transition time to gambling disorder: The roles that age, gambling preference and personality traits play. Addict Behav. 2021;116:106813.\u003c/li\u003e\n\u003cli\u003eAmerican Psychiatric Association. Diagnostic and Statistical Manual Of Mental Disorders. Arlington: American Psychiatric Publishing; 2013. p. 585-6.\u003c/li\u003e\n\u003cli\u003eFolkh\u0026auml;lsomyndigheten. Tabellsammanst\u0026auml;llning f\u0026ouml;r Swelogs prevalensunders\u0026ouml;kning 2021. Solna/\u0026Ouml;stersund; 2023. Contract No.: 22230.\u003c/li\u003e\n\u003cli\u003eWardle H, Degenhardt L, Marionneau V, Reith G, Livingstone C, Sparrow M, et al. The Lancet Public Health Commission on gambling. Lancet Public Health. 2024:e950-3.\u003c/li\u003e\n\u003cli\u003eFolkh\u0026auml;lsomyndigheten. Statistik om suicid Solna/\u0026Ouml;stersund: Folkh\u0026auml;lsomyndigheten; 2024 [2/12-2024]. Available from: https://www.folkhalsomyndigheten.se/livsvillkor-levnadsvanor/psykisk-halsa-och-suicidprevention/suicidprevention/statistik-om-suicid/.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. ICD10 2019 [3/12-2024]. Available from: https://icd.who.int/browse10/2019/en.\u003c/li\u003e\n\u003cli\u003eCanetto SS, Sakinofsky I. The Gender Paradox in Suicide. Suicide and Life-Threatening Behavior. 1998;28(1):1-23.\u003c/li\u003e\n\u003cli\u003eRojas Y, Stenberg S\u0026Aring;. Evictions and suicide: a follow-up study of almost 22,000 Swedish households in the wake of the global financial crisis. J Epidemiol Community Health. 2016;70(4):409-13.\u003c/li\u003e\n\u003cli\u003eRojas Y. Financial indebtedness and suicide: A 1-year follow-up study of a population registered at the Swedish Enforcement Authority. Int J Soc Psychiatry. 2022;68(7):1445-53.\u003c/li\u003e\n\u003cli\u003eKarlsson A, H\u0026aring;kansson A. Gambling disorder, increased mortality, suicidality, and associated comorbidity: A longitudinal nationwide register study. J Behav Addict. 2018;7(4):1091-9.\u003c/li\u003e\n\u003cli\u003eKarlsson A, Hed\u0026eacute;n O, Hansson H, Sandgren J, H\u0026aring;kansson A. Psychiatric Comorbidity and Economic Hardship as Risk Factors for Intentional Self-Harm in Gambling Disorder-A Nationwide Register Study. Front Psychiatry. 2021;12:688285.\u003c/li\u003e\n\u003cli\u003eH\u0026aring;kansson A, Karlsson A. Suicide Attempt in Patients With Gambling Disorder-Associations With Comorbidity Including Substance Use Disorders. Front Psychiatry. 2020;11:593533.\u003c/li\u003e\n\u003cli\u003eKristensen JH, Baravelli CM, Leino T, Pallesen S, Griffiths MD, Erevik EK. Association between gambling disorder and suicide mortality: a comparative cohort study using Norwegian health registry data. Lancet Reg Health Eur. 2025;48:101127.\u003c/li\u003e\n\u003cli\u003eSocialstyrelsen. Ekonomiskt bist\u0026aring;nd - f\u0026ouml;r privatpersoner: Socialstyrelsen; 2019 [updated 4/4-20235/12-2024]. Available from: https://www.socialstyrelsen.se/kunskapsstod-och-regler/omraden/ekonomiskt-bistand/ekonomiskt-bistand-for-privatpersoner/.\u003c/li\u003e\n\u003cli\u003eKidane A, Karlsson A, H\u0026aring;kansson A. Suicide and attempted suicide in gambling disorder \u0026ndash; results from a nationwide case-control study. Psychiatry Res 2025;348:116476. \u003c/li\u003e\n\u003cli\u003eDowling NA, Cowlishaw S, Jackson AC, Merkouris SS, Francis KL, Christensen DR. Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis. Aust N Z J Psychiatry. 2015;49(6):519-39.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Gambling disorder, Suicidality, Economic hardship, Over-indebtedness","lastPublishedDoi":"10.21203/rs.3.rs-7474708/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7474708/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eGambling disorder is an important problem around the world and is linked to self-harm and suicides which are more common in people with gambling disorders than in people without. Economic hardship is believed to be a risk factor for self-harm in people with gambling disorder and is also common among people with gambling disorder. Therefore, the aim of this study was to investigate economic hardship, defined here as social welfare payments, as a possible risk factor for suicide in people with a gambling disorder.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis case-control study contained data from registers including 3592 people with gambling disorder, compared to a total of 7184 age- and gender-matched controls, all with an age of 18 or older. These groups were used to analyze the association between suicide/suicide attempts and social welfare payments and adjust this risk to other possible risk factors. Lastly, a comparison was made between potential suicides/suicides attempts in regard to when in time the individuals received social welfare payments and compare the prevalence of psychiatric disorders, age and gender with the different outcomes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe OR for suicide or suicide attempts when receiving social welfare payments, in the group with a gambling disorder, was 1.94 (CI 95%, 1.64\u0026ndash;2.30). However, this risk was even greater among the control group with an OR of 3.14 (CI 95%, 2.34\u0026ndash;4.20). Adjusted to other risk factors, both psychiatric disorders and being diagnosed with gambling disorder seemed to be a greater risk for suicide/suicide attempts.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eIn conclusion, even though social welfare payments seemed to be a risk factor for suicide in the gambling disorder group, the risk was greater within the control group and other risk factors than social welfare payments appeared to play a bigger part when it comes to suicides/suicide attempts. The generally increased risk of suicidal behaviour in people with over-indebtedness is confirmed.\u003c/p\u003e","manuscriptTitle":"Economic hardship as an independent risk factor for suicidality in individuals with gambling disorder","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 12:30:51","doi":"10.21203/rs.3.rs-7474708/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"318757786932602467910405817941429941875","date":"2025-11-14T10:56:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"127041404914481884260382347433749827910","date":"2025-11-12T10:33:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-10T12:52:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"128947899607516120058357961173980687232","date":"2025-09-26T11:53:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-26T01:08:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-19T07:44:31+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-11T05:47:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-10T21:23:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2025-09-10T21:20:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f6288595-5fa3-460f-bf93-82c83c549b91","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-08T12:30:51+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 12:30:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7474708","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7474708","identity":"rs-7474708","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}