Epidemiological aspects of attempted suicide--a case-control study in Gent, Belgium

In order to study the distribution of attempted suicide among the population of Gent, exploratory and analytical case-control studies were carried out. The strength of the association between attempted suicide and marital and employment status was calculated taking into account the confounding and/or effect-modifying roles of age, gender, and the living situation. Unmarried individuals who were not living alone were at increased risk of attempted suicide compared to (cohabiting) married individuals. Young and middle-aged unemployed males and middle-aged unemployed females had significantly increased risks compared to employed individuals. In addition to a causal interpretation of the demonstrated associations, the roles of chance, reverse causality, and confounding or bias were considered. Selection and information biases may have accounted for the observed associations. For instance, in previous monitoring studies on attempted suicide, surprisingly little attention has been paid to the reliability of the information collected. The question of how one can reliably assess patients who may provide unreliable information remains unanswered. However, several findings support a role of causality in explaining the associations. The present studies therefore provide additional evidence for a detrimental affect of certain socio-demographic or -economic conditions on the occurrence of attempted suicide.