Workplace bullying and risk of suicide and suicide attempts: A register-based prospective cohort study of 98 330 participants in Denmark

Objectives The aim of this study was to analyze whether individuals reporting exposure to workplace bullying had a higher risk of suicidal behavior, including both suicide attempt and death by suicide, than those not reporting such exposure. Methods Using a prospective cohort study design, we linked data from nine Danish questionnaire-based surveys (2004–2014) to national registers up to 31 December 2016. Exposure to workplace bullying was measured by a single item. Suicide attempts were identified in hospital registers and death by suicide in the Cause of Death Reg-ister. Among participants with no previous suicide attempts, we estimated hazard ratios (HR) and 95% confidence intervals (CI), adjusting for sex, age, marital status, socioeconomic status, and history of psychiatric morbidity. Results The sample consisted of 98 330 participants (713 798 person-years), 63.6% were women, and the mean age was 44.5 years. Of these participants, 10 259 (10.4%) reported workplace bullying. During a mean follow-up of 7.3 years, we observed 184 cases of suicidal behavior, including 145 suicide attempts, 35 deaths by suicide and 4 cases that died by suicide after surviving a suicide attempt. The fully-adjusted HR for the association between workplace bullying and suicidal behavior was 1.65 (95% CI 1.06–2.58). The HR for suicide attempts and death by suicide were 1.65 (1.09–2.50) and 2.08 (0.82–5.27), respectively. Analyses stratified by sex showed a sta-tistically significant association between workplace bullying and suicidal behavior among men but not women. Conclusions The results suggest that exposure to workplace bullying is associated with an elevated risk of suicidal behavior among men.