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Mental disorders and the risk for the subsequent first suicide attempt: results of a community study on adolescents and young adults. Eur Child Adolesc Psychiatry 2018; 27:839-848. [PMID: 29027588 PMCID: PMC6013520 DOI: 10.1007/s00787-017-1060-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/25/2017] [Indexed: 10/29/2022]
Abstract
Adolescents and young adults represent the high-risk group for first onset of both DSM-IV mental disorders and lifetime suicide attempt (SA). Yet few studies have evaluated the temporal association of prior mental disorders and subsequent first SA in a young community sample. We examined (a) such associations using a broad range of specific DSM-IV mental disorders, (b) the risk of experiencing the outcome due to prior comorbidity, and (c) the proportion of SAs that could be attributed to prior disorders. During a 10-year prospective study, data were gathered from 3021 community subjects, 14-24 years of age at baseline. DSM-IV disorders and SA were assessed with the Munich-Composite International Diagnostic Interview. Cox models with time-dependent covariates were used to estimate the temporal associations of prior mental disorders with subsequent first SA. Most prior mental disorders showed elevated risk for subsequent first SA. Highest risks were associated with posttraumatic stress disorder (PTSD), dysthymia, and nicotine dependence. Comorbidity elevated the risk for subsequent first SA, and the more disorders a subject had, the higher the risk for first SA. More than 90% of SAs in the exposed group could be attributed to PTSD, and over 30% of SAs in the total sample could be attributed to specific phobia. Several DSM-IV disorders increase the risk for first SA in adolescents and young adults. Several promising early intervention targets were observed, e.g., specific phobia, nicotine dependence, dysthymia, and whether a young person is burdened with comorbid mental disorders.
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Lindgren M, Manninen M, Kalska H, Mustonen U, Laajasalo T, Moilanen K, Huttunen MO, Cannon TD, Suvisaari J, Therman S. Suicidality, self-harm and psychotic-like symptoms in a general adolescent psychiatric sample. Early Interv Psychiatry 2017; 11:113-122. [PMID: 25582971 DOI: 10.1111/eip.12218] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 10/15/2014] [Accepted: 12/02/2014] [Indexed: 01/21/2023]
Abstract
AIM We investigated the associations between clinical high-risk for psychosis (CHR), psychotic-like symptoms and suicidality among adolescent psychiatric patients. METHODS The sample consisted of 54 CHR and 107 non-CHR psychiatric patients aged 15-18 in Helsinki, Finland, who were assessed at the beginning of their psychiatric treatment with the Structured Interview for Prodromal Syndromes (SIPS). Current suicidality was measured with the Beck Depression Inventory (item 9), while lifetime suicidality was evaluated from all available data, including patient files. The participants were followed for 2.8-8.9 years via the national hospital discharge register, with the follow-up outcome being intentional self-harm. Data on suicides were also gathered from the Causes of Death statistics. RESULTS Only 30.5% of the adolescents had no suicidal ideation at the beginning of their treatment. CHR risk state and SIPS-assessed delusions, suspiciousness, and hallucinations were associated with higher current suicidality. Of the 154 adolescents with register follow-up, there were five (3.2%) with intentional self-harm resulting in hospital treatment, all female. CHR status was not associated with self-harm. Current suicidality, familial risk of psychosis, and SIPS decreased expression of emotions were associated with self-harm during follow-up. In a Cox regression analysis model among girls, only decreased expression of emotions remained a significant predictor of intentional self-harm. Baseline suicidality measures were not associated with transitions to psychosis. CONCLUSIONS CHR status was associated with higher current suicidality but did not predict follow-up intentional self-harm in treatment-seeking adolescents. Decreased expression of emotions may indicate higher risk of intentional self-harm in adolescent treatment-seeking girls.
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Affiliation(s)
- Maija Lindgren
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.,Institute of Behavioural Sciences (Discipline of Psychology), University of Helsinki, Helsinki, Finland
| | - Marko Manninen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.,Institute of Behavioural Sciences (Discipline of Psychology), University of Helsinki, Helsinki, Finland
| | - Hely Kalska
- Institute of Behavioural Sciences (Discipline of Psychology), University of Helsinki, Helsinki, Finland
| | - Ulla Mustonen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Taina Laajasalo
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.,Institute of Behavioural Sciences (Discipline of Psychology), University of Helsinki, Helsinki, Finland
| | - Kari Moilanen
- Adolescence Unit, Helsinki University Central Hospital, Helsinki, Finland
| | - Matti O Huttunen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Jaana Suvisaari
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Sebastian Therman
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.,Institute of Behavioural Sciences (Discipline of Psychology), University of Helsinki, Helsinki, Finland
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Beckman K, Mittendorfer-Rutz E, Lichtenstein P, Larsson H, Almqvist C, Runeson B, Dahlin M. Mental illness and suicide after self-harm among young adults: long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort. Psychol Med 2016; 46:3397-3405. [PMID: 27644850 DOI: 10.1017/s0033291716002282] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Self-harm among young adults is a common and increasing phenomenon in many parts of the world. The long-term prognosis after self-harm at young age is inadequately known. We aimed to estimate the risk of mental illness and suicide in adult life after self-harm in young adulthood and to identify prognostic factors for adverse outcome. METHOD We conducted a national population-based matched case-cohort study. Patients aged 18-24 years (n = 13 731) hospitalized after self-harm between 1990 and 2003 and unexposed individuals of the same age (n = 137 310 ) were followed until December 2009. Outcomes were suicide, psychiatric hospitalization and psychotropic medication in short-term (1-5 years) and long-term (>5 years) follow-up. RESULTS Self-harm implied an increased relative risk of suicide during follow-up [hazard ratio (HR) 16.4, 95% confidence interval (CI) 12.9-20.9). At long-term follow-up, 20.3% had psychiatric hospitalizations and 51.1% psychotropic medications, most commonly antidepressants and anxiolytics. There was a six-fold risk of psychiatric hospitalization (HR 6.3, 95% CI 5.8-6.8) and almost three-fold risk of psychotropic medication (HR 2.8, 95% CI 2.7-3.0) in long-term follow-up. Mental disorder at baseline, especially a psychotic disorder, and a family history of suicide were associated with adverse outcome among self-harm patients. CONCLUSION We found highly increased risks of future mental illness and suicide among young adults after self-harm. A history of a mental disorder was an important indicator of long-term adverse outcome. Clinicians should consider the substantially increased risk of suicide among self-harm patients with psychotic disorders.
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Affiliation(s)
- K Beckman
- Centre for Psychiatry Research, Department of Clinical Neuroscience,Karolinska Institutet and Stockholm Health Care Services,Stockholm City Council, St Goran,Stockholm,Sweden
| | - E Mittendorfer-Rutz
- Department of Clinical Neuroscience,Insurance Medicine,Karolinska Institutet,Stockholm,Sweden
| | - P Lichtenstein
- Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden
| | - H Larsson
- Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden
| | - C Almqvist
- Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden
| | - B Runeson
- Centre for Psychiatry Research, Department of Clinical Neuroscience,Karolinska Institutet and Stockholm Health Care Services,Stockholm City Council, St Goran,Stockholm,Sweden
| | - M Dahlin
- Centre for Psychiatry Research, Department of Clinical Neuroscience,Karolinska Institutet and Stockholm Health Care Services,Stockholm City Council, St Goran,Stockholm,Sweden
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Remes H, Martikainen P. Young adult's own and parental social characteristics predict injury morbidity: a register-based follow-up of 135,000 men and women. BMC Public Health 2015; 15:429. [PMID: 25928001 PMCID: PMC4460703 DOI: 10.1186/s12889-015-1763-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 04/21/2015] [Indexed: 11/23/2022] Open
Abstract
Background Sociodemographic differences in injury mortality are well-established, but population-level studies on social patterns of injury morbidity remain few in numbers, particularly among young adults. Yet injuries are the leading cause of mortality, morbidity and disability among young people. Studies among children have shown steep social gradients in severe injuries, but less is known on the social patterning of injuries in late adolescence and early adulthood, when young people are in the process of becoming independent adults. This study examines how young adults’ current living arrangements, education, main economic activity, and parental social background are associated with hospital-treated injuries in late adolescence and early adulthood. Methods The study uses prospective, individual-level data gathered from several administrative sources. From a representative 11% sample of the total Finnish population, we included young people between ages 17–29 years during the follow-up (N = 134 938). We used incidence rates and Cox proportional hazards models to study hospital-treated injuries and poisonings in 1998–2008. Results Higher rates of injury were found among young adults living alone, single mothers, the lower educated and the non-employed, as well as those with lower parental social background, experience of childhood family changes or living with a single parent, and those who had left the parental home at a young age. Injury risks were consistently higher among young adults with lower education, but current living arrangements and main economic activity showed some age-related nuances in the associations: both earlier and later than average transitions in education, employment, and family formation associated with increased injury risks. The social differentials were strongest in poisonings, intentional self-harm, and assaults, but social patterns were also found in falls, traffic-related injuries and other unintentional injuries, underlining the existence of multiple distinct mechanisms and pathways behind the differentials. Conclusions The transition to adulthood is a life period of heightened risk of injury, during which both parental social background and the young people’s own social position are important determinants of serious injuries that require inpatient care. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1763-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hanna Remes
- Department of Social Research, University of Helsinki, P.O. Box 18, FI-00014, Helsinki, Finland.
| | - Pekka Martikainen
- Department of Social Research, University of Helsinki, P.O. Box 18, FI-00014, Helsinki, Finland. .,Max Planck Institute for Demographic Research, Rostock, Germany.
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Kasteenpohja T, Marttunen M, Aalto-Setälä T, Perälä J, Saarni SI, Suvisaari J. Treatment received and treatment adequacy of depressive disorders among young adults in Finland. BMC Psychiatry 2015; 15:47. [PMID: 25881327 PMCID: PMC4364633 DOI: 10.1186/s12888-015-0427-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 02/20/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Under-treated depression may be especially harmful in early adulthood. The aims of this study are to describe treatments received for depressive disorders, to define factors associated with treatment adequacy and dropouts from treatment in a Finnish general population sample of young adults. METHODS A nationally representative two-stage cluster sample of 1894 Finns aged 19 to 34 years was sent a questionnaire containing several mental health screens. All screen positives and a random sample of screen negatives were invited to participate in a mental health assessment including a SCID interview. Case records from mental health treatments for the same sample were obtained for the final diagnostic assessment. Based on all available information, receiving antidepressant pharmacotherapy for at least two months with at least four visits with any type of physician or at least eight sessions of psychotherapy within 12 months or at least four days of hospitalization were regarded as minimally adequate treatment. Treatment dropout was rated if the treatment strategy was assessed to be adequate according to the case records but the patient discontinued the visits. RESULTS Of participants with depressive disorders (n = 142), 40.9% received minimally adequate treatment. In multiple logistic regression models, substance use disorder and female gender were associated with at least one visit with a physician, while having major depressive disorder was associated with visits with a physician at least 4 times a year. Women had higher odds of having received any psychotherapy and psychotherapy lasting for at least 8 sessions in a year. Low education and a history of suicide attempt were associated with increased odds of treatment dropout. None of the factors explained the final outcome of minimally adequate treatment. CONCLUSIONS Treatment adequacy in the present study was better than previously seen, but more efforts are needed to provide adequate treatment for young adults, especially those with low education and suicidality.
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Affiliation(s)
- Teija Kasteenpohja
- Department Health, Mental Health Unit, National Institute for Health and Welfare, P.O. Box 30, , 00271, Helsinki, Finland.
| | - Mauri Marttunen
- Department Health, Mental Health Unit, National Institute for Health and Welfare, P.O. Box 30, , 00271, Helsinki, Finland. .,Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | | | - Jonna Perälä
- Department Health, Mental Health Unit, National Institute for Health and Welfare, P.O. Box 30, , 00271, Helsinki, Finland.
| | - Samuli I Saarni
- Department Health, Mental Health Unit, National Institute for Health and Welfare, P.O. Box 30, , 00271, Helsinki, Finland. .,Turku University Hospital and University of Turku, Turku, Finland.
| | - Jaana Suvisaari
- Department Health, Mental Health Unit, National Institute for Health and Welfare, P.O. Box 30, , 00271, Helsinki, Finland. .,Department of Social Psychiatry, Tampere School of Public Health, University of Tampere, Tampere, Finland.
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Tucker RP, Buchanan CA, O'Keefe VM, Wingate LR. Does the Experience of Interpersonal Predictors of Suicidal Desire Predict Positive Attitudes Toward Physician Assisted Suicide? OMEGA-JOURNAL OF DEATH AND DYING 2014; 69:137-49. [DOI: 10.2190/om.69.2.c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The current study examined the relationship between Physician Assisted Suicide (PAS) attitudes and interpersonal risk factors of suicidal desire as outlined by the interpersonal-psychological theory of suicidal behavior (Joiner, 2005). It was hypothesized that both thwarted belongingness and perceived burdensomeness would be positively related to PAS acceptance. Results indicated that thwarted belongingness and perceived burdensomeness predicted significance of favorable attitudes toward PAS in a college sample. Results suggest that attitudes toward PAS may be influenced by the experience of thwarted belongingness and perceived burdensomeness and provide a clear rationale for the study of these variables in populations more apt to consider hastened death. Future work regarding the application of the interpersonal-psychological theory of suicidal behavior in hastened death research is discussed.
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Victor SE, Klonsky ED. Correlates of suicide attempts among self-injurers: A meta-analysis. Clin Psychol Rev 2014; 34:282-97. [DOI: 10.1016/j.cpr.2014.03.005] [Citation(s) in RCA: 196] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 02/11/2014] [Accepted: 03/25/2014] [Indexed: 12/27/2022]
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Gooding PA, Sheehy K, Tarrier N. Perceived stops to suicidal thoughts, plans, and actions in persons experiencing psychosis. CRISIS 2014; 34:273-81. [PMID: 23608231 DOI: 10.1027/0227-5910/a000194] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Suicide has been conceived as involving a continuum, whereby suicidal plans and acts emerge from thoughts about suicide. Suicide prevention strategies need to determine whether different responses are needed at these points on the continuum. AIMS This study investigates factors that were perceived to counter suicidal ideation, plans, and acts. METHOD The 36 participants, all of whom had had experiences of psychosis and some level of suicidality, were presented with a vignette describing a protagonist with psychotic symptoms. They were asked to indicate what would counter the suicidal thoughts, plans, and acts of the protagonist described in the vignette. Qualitative techniques were first used to code these free responses into themes/categories. Correspondence analysis was then applied to the frequency of responses in each of these categories. RESULTS Social support was identified as a strong counter to suicidal ideation but not as a counter to suicidal plans or acts. Help from health professionals was strongly related to the cessation of suicidal plans as were the opinions of the protagonist's children. Changing cognitions and strengthening psychological resources were more weakly associated with the cessation of suicidal ideation and plans. The protagonist's children were considered potentially helpful in addressing suicidal acts. CONCLUSION These results suggest that both overlapping and nonoverlapping factors need to be considered in understanding suicide prevention, dependent on whether individuals are thinking about, planning, or attempting suicide.
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Affiliation(s)
- P A Gooding
- School of Psychological Sciences, University of Manchester, UK.
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Kanamüller J, Riala K, Nivala M, Hakko H, Räsänen P. Correlates of sexual abuse in a sample of adolescent girls admitted to psychiatric inpatient care. JOURNAL OF CHILD SEXUAL ABUSE 2014; 23:804-823. [PMID: 25101753 DOI: 10.1080/10538712.2014.950401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We examined correlations of child sexual abuse among 300 adolescent girls in psychiatric inpatient treatment. Diagnostic and Statistical Manual of Mental Disorders (4th ed.)-based psychiatric diagnoses were obtained from the Schedule for Affective Disorder and Schizophrenia for School-Age Children-Present and Lifetime and from data on family and behavioral characteristics from the European Addiction Severity Index (EuropASI). A total of 79 girls (26.3%) had experienced child sexual abuse during their lifetime. Child sexual abuse was associated with an adolescent's home environment, sibling status, smoking, posttraumatic stress disorder diagnosis, self-mutilating behavior, and suicidal behavior. At least 62% of the perpetrators were acquaintances of the victims. Correlates of child sexual abuse can be used to identify child sexual abuse victims and persons at heightened risk for child sexual abuse.
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Abstract
To understand psychometric characteristics of Beck Suicide Intent Scale (SIS) and different characteristics of suicides between high and low intent in Chinese culture. Data of 386 suicides and 416 living controls aged 15-34 years were used to analyze psychometric characteristics of SIS with 6 items. SIS with 6 items had high reliability and validity. Different characteristics were found between suicides with high intent and low intent. Hopelessness, depression, impulsivity, and approach coping skill were common factors of suicide with high and low intent. Education years, marriage, social support, and mental disorders were specific factors of suicide with low intent. High intent suicides had different characteristics from low intent suicides. SIS with 6 items is suitable for use in young rural China.
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Affiliation(s)
- Jie Zhang
- School of Public Health, Shandong University, China
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