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. 2024 Dec 18;24(1):3515.
doi: 10.1186/s12889-024-20887-x.

Occupational groups and risk of suicidal behavior in men: a Swedish national cohort study during 2002-2019

Jenny Nyberg  1   2 , Catrin Wessman  3 , Mia Söderberg  3 , Anthony D LaMontagne  4   5 , Kjell Toren  3   6 , Margda Waern  7   8 , Maria Åberg  3   9
Affiliations

Occupational groups and risk of suicidal behavior in men: a Swedish national cohort study during 2002-2019

Jenny Nyberg et al. BMC Public Health. .

Abstract

Introduction: The risk of suicide has been shown to vary by occupation. We aim to identify contemporary occupational groups at greatest risk for suicidal behaviour (fatal and non-fatal), in Swedish men of working-age.

Methods: A population-based cohort study of male conscripts without history of self-harm who enlisted during 1968-2001 and were followed-up during 2002-2019 (n = 1 542 665). Occupational groups and suicidal behaviours were identified using national registers. Incidence rate ratios (IRR) for suicidal behaviour at ages 25-65 were calculated among occupational groups, and compared to the incidence rate of the whole cohort.

Results: Major occupational groups with increased risk for suicidal behavior included elementary occupations, building and manufacturing, service, care and shop sale and mechanical manufacturing and transport. Subgroup analyses revealed particularly high risks for assistant nurses, other service workers not elsewhere classified, building frame and related trades workers and cleaners and helpers.

Conclusions: Men with elementary occupations as well as personal care and building and manufacturing workers were at greatest risk. This study provides a comprehensive description of risks for suicidal behaviour among occupational groups in men of working-age. These results suggest occupational groups that should be targeted for general suicide prevention intervention.

Keywords: Epidemiology; Incidence rate ratio; Risk assessment; Self-harm; Suicide; Work-related.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All procedures involving human subjects were approved by the Ethics Committee of the University of Gothenburg (462–14) and Confidentiality Clearance at Statistics Sweden. Given that all data used was psuedonymized and coded by Statistics Sweden, informed consent to participate was not obtained from the participants. Consent for publication: Not applicable for Swedish register-based studies, as the contribution of personal data to research is included in the contract between Swedish residents and the Swedish state provided that the research is ethically conducted [36]. The Ethical committees in Sweden are generally acknowledged to represent the public, and approval from an Ethical committee can largely replace individual approvals from study participants in registry-based research. As stated by Ludvigsson et al. [36], the arguments that informed consent is not needed for registry-based studies in Sweden include: 1) Many research proposals would be impossible due to the sheer number of study participants (over 1 million participants); 2) It would dramatically reduce rate of participation and statistical power of most nationwide population-based studies, and lessen the scientific validity; 3) Risk for selection bias, since consent would be notably harder to obtain in high-risk groups, where positive outcomes are most frequent; 4) Individuals with registry-based information will be dead when the study is performed, and thus, consent is impossible; 5) Most large-scale research would be prohibited due to the extreme costs of obtaining the consent of millions of individuals with health data. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study design and population. Schematic illustration of the study-design (a) where the pink line shows the period for recording suicidal behaviour and the blue line the period for recording occupation, including the three-year period where occupation was recorded for men lacking information the year prior to suicidal behaviour (blue dotted line). Flowchart of the study population (b) shows included and excluded men and number of men with first episode of fatal/non-fatal suicidal behaviour
Fig. 2
Fig. 2
Risk for suicidal behaviour among all major occupational groups. Incidence rate ratios (IRR) and 95% confidence intervals (CI) for suicidal behaviour (fatal or non-fatal) in the major occupational groups compared to the overall incidence rate of the total study population
Fig. 3
Fig. 3
Risk for suicidal behaviour among sub-major to unite occupational groups within major occupational groups 8–9. Significant incidence rate ratios (IRR) and 95% confidence intervals (CI) for suicidal behaviour in the sub-major (2-digit level), minor (3-digit level) and unit (4-digit level) occupational groups, compared to the incidence rate of the total study population. Only occupational codes with statistically significant risk estimates and with sufficient statistical power are presented. Number of events as well as number of events per person-year for each occupational group are also presented in order to visualize sample sizes (for full data, see Additional file 1)
Fig. 4
Fig. 4
Risk for suicidal behaviour among sub-major to unit occupational groups within major occupational groups 4–7. Significant incidence rate ratios (IRR) and 95% confidence intervals (CI) for suicidal behaviour in the sub-major (2-digit level), minor (3-digit level) and unit (4-digit level) occupational groups, compared to the incidence rate of the total study population. Only occupational codes with statistically significant risk estimates and with sufficient statistical power are presented. Number of events as well as number of events per person-year for each occupational group are also presented in order to visualize sample sizes (for full data, see Additional file 1)
Fig. 5
Fig. 5
Risk for suicidal behaviour among sub-major to unit occupational groups within major occupational groups 1–3. Significant incidence rate ratios (IRR) and 95% confidence intervals (CI) for suicidal behaviour in the sub-major (2-digit level), minor (3-digit level) and unit (4-digit level) occupational groups, compared to the incidence rate of the total study population. Only occupational codes with statistically significant risk estimates and with sufficient statistical power are presented. Number of events as well as number of events per person-year for each occupational group are also presented in order to visualize sample sizes (for full data, see Additional file 1)
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