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Danielsen S, Strandberg-Larsen K, Hawton K, Nordentoft M, Erlangsen A, Madsen T. The iceberg model of suicidal ideation and behaviour in Danish adolescents: integration of national registry and self-reported data within a national birth cohort. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02503-w. [PMID: 38916768 DOI: 10.1007/s00787-024-02503-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/17/2024] [Indexed: 06/26/2024]
Abstract
Hospital records are used to identify suicide attempts in many countries but not all individuals present to hospital after a suicide attempt i.e., suggesting a 'hidden number'. Our aim was to present the prevalence of suicide ideation, plans, attempts, and suicides among Danish adolescents, including attempts not resulting in hospital contact. The study population consisted of participants in the Danish National Birth Cohort participating in an 18-year follow-up, with individual-level linkage to national register data. Prevalence was estimated with a variable with mutually exclusive categories ranging from no suicidality to self-reported suicide ideation, -plans, -attempt and hospital-recorded suicide attempt and stratified on sex and parental income. The 'hidden number' was estimated as the ratio between suicide attempts with and without hospital contact. Among 47 858 participants, all aged 18-years, 36% girls and 28% boys reported suicide ideation at least once in their life. In addition, 6% girls and 3% boys had either reported or been recorded with a suicide attempt. For every attempt recorded in the hospital setting, two girls (ratio, 1:2) and six boys (ratio, 1:6) reported having attempted suicide without hospital contact. The prevalence of any suicide attempt was 8% and 3% in the lowest and highest income group, respectively. Before age 18, 0·011% girls and 0·016% boys had died by suicide. In conclusion, suicidal ideation and behaviour are common in adolescents and there is a substantial 'hidden number' of adolescents with suicide attempt. These results emphasize the need for early age suicide preventive interventions in community-settings e.g., school environments.
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Affiliation(s)
- Stine Danielsen
- Danish Research Institute for Suicide Prevention - DRISP, Mental Health Center Copenhagen, University of Copenhagen, Gentofte Hospitalsvej 15, Opg. 15, 4. floor, Hellerup, DK - 2900, Denmark.
| | - Katrine Strandberg-Larsen
- Section of Epidemiology, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, bd. 24, PO Box 2099, Copenhagen, DK - 1014, Denmark
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of OxfordWarneford Hospital, Oxford, OX3 7JX, England
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention - DRISP, Mental Health Center Copenhagen, University of Copenhagen, Gentofte Hospitalsvej 15, Opg. 15, 4. floor, Hellerup, DK - 2900, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention - DRISP, Mental Health Center Copenhagen, University of Copenhagen, Gentofte Hospitalsvej 15, Opg. 15, 4. floor, Hellerup, DK - 2900, Denmark
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Trine Madsen
- Danish Research Institute for Suicide Prevention - DRISP, Mental Health Center Copenhagen, University of Copenhagen, Gentofte Hospitalsvej 15, Opg. 15, 4. floor, Hellerup, DK - 2900, Denmark
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Milella MS, Petraccia L, Pirelli F, Foti G, Sapio M, Berardi R, Caprioli D, Pugliese F, Vivino G. Self-harm by single- and multi-agent medication poisoning in a retrospective analysis of a Poison Control Center database from January 2018 to December 2022. Pharmacoepidemiol Drug Saf 2024; 33:e5767. [PMID: 38357800 DOI: 10.1002/pds.5767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 01/08/2024] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE Medication poisoning is the most common method of self-harm. Longitudinal studies incorporating pre- and post-COVID-19 pandemic data are required to describe the phenomenon and to evaluate the long-term impact on mental health. METHODS Calls to the Poison Control Center of Policlinico Umberto I Hospital - Sapienza University of Rome, Italy, were analyzed retrospectively for characteristics and clinical presentation of cases of interest from January 2018 to December 2022. RESULTS A total of 756 cases of self-harm by medication poisonings were recorded in the study period. A reduction in rate of cases in 2020 was followed by a return to pre-pandemic levels by 2021. When separately analyzing single- and multi-agent cases, occurrence of cases involving just one medication increased since early 2021, with a peak in 2022 (7.8% of total calls, 95% CI 6.2-9.5, from 4.9%, 95% CI 4.1-5.8 in 2018). This increase in the rate of cases, mostly of none or mild severity, was driven by youth aged 12-21, in which the relative proportion of single- versus multi-agent cases showed an increasing trend since 2020 (from 42.6% in 2018 to 78.6% in 2022). Acetaminophen was the medication most frequently involved and benzodiazepines the largest class. A psychiatric background was increasingly seen in 2022, especially in age group 12-21. CONCLUSION Single-agent medication self-harm may be an increasingly prevailing phenomenon. Young adolescents with a psychiatric background might be most vulnerable to this behavior in the COVID-19 pandemic aftermath. Healthcare professionals should expect favorable clinical outcome and improve both counseling and psychotherapy supervision in individuals at risk.
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Affiliation(s)
- Michele Stanislaw Milella
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Luisa Petraccia
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Francesca Pirelli
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Giuseppe Foti
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Maria Sapio
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Rosaria Berardi
- Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital-Sapienza, University of Rome, Rome, Italy
| | - Daniele Caprioli
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Francesco Pugliese
- Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital-Sapienza, University of Rome, Rome, Italy
| | - Gabriella Vivino
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
- Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital-Sapienza, University of Rome, Rome, Italy
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Munch SD, Madsen T, Nordentoft M, Erlangsen A, Hjorthøj C. Association between substance-induced psychosis and suicide attempt: A Danish nation-wide register-based study. Addiction 2023; 118:2440-2448. [PMID: 37574563 DOI: 10.1111/add.16311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 06/30/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND AND AIMS Substance-induced psychosis has previously been linked to an excess risk of suicide; however, the association between substance-induced psychosis and suicide attempt has hitherto not been investigated. We investigated whether substance-induced psychosis was associated with a higher risk of subsequent suicide attempt. DESIGN Nation-wide prospective register-based cohort study. SETTING Denmark. PARTICIPANTS All people living in Denmark aged 13 years or more during 1995 to 2017. MEASUREMENTS Substance-induced psychosis and suicide attempts were identified through hospital records as ICD-10 codes. FINDINGS A total of 8900 (78.8% males) individuals were diagnosed with a substance-induced psychosis, and 740 of these had a suicide attempt during follow-up. People with a substance-induced psychosis had a higher risk of a subsequent suicide attempt [hazard ratio (HR) = 13.4, 95% confidence interval (CI) = 12.4-14.4] when compared with the general population. The highest hazard ratios were found for psychosis induced by opioids (HR = 26.4, 95% CI = 18.2-38.2); alcohol (HR = 17.7, 95% CI = 15.2-20.6); sedatives (HR = 17.2, 95% CI = 8.9-33.0); and cocaine (HR = 15.6, 95% CI = 10.7-22.8), while cannabis-induced psychosis was linked to an HR of 8.9 (95% CI = 7.7-10.3). Approximately 15% of patients with substance-induced psychosis had had a suicide attempt within 20 years of their substance-induced psychosis diagnosis. CONCLUSIONS In Denmark, substance-induced psychosis appears to be strongly associated with subsequent suicide attempt, underscoring the importance of attention and better follow-up for this patient group.
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Affiliation(s)
- Solvejg Dam Munch
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Trine Madsen
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Danish Research Institute of Suicide Prevention, Mental Health Center Copenhagen, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Danish Research Institute of Suicide Prevention, Mental Health Center Copenhagen, Copenhagen, Denmark
| | - Annette Erlangsen
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Danish Research Institute of Suicide Prevention, Mental Health Center Copenhagen, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center of Mental Health Research, Australian National University, Canberra, Australia
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
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Pitman A, Logeswaran Y, McDonald K, Cerel J, Lewis G, Erlangsen A. Investigating risk of self-harm and suicide on anniversaries after bereavement by suicide and other causes: a Danish population-based self-controlled case series study. Epidemiol Psychiatr Sci 2023; 32:e53. [PMID: 37551142 PMCID: PMC10465319 DOI: 10.1017/s2045796023000653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/28/2023] [Accepted: 07/13/2023] [Indexed: 08/09/2023] Open
Abstract
AIMS To investigate mechanisms of suicide risk in people bereaved by suicide, prompted by observations that bereaved people experience higher levels of distress around dates of emotional significance. We hypothesised that suicide-bereaved first-degree relatives and partners experience an increased risk of self-harm and suicide around dates of (i) anniversaries of the death and (ii) the deceased's birthday, compared with intervening periods. METHODS We conducted a self-controlled case series study using national register data on all individuals living in Denmark from 1 January 1980 to 31 December 2016 and who were bereaved by the suicide of a first-degree relative or partner (spouse or cohabitee) during that period, and who had the outcome (any episode of self-harm or suicide) within 5 years and 6 weeks of the bereavement. We compared relative incidence of suicidal behaviour in (i) the first 30 days after bereavement and (ii) in the aggregated exposed periods (6 weeks either side of death anniversaries; 6 weeks either side of the deceased's birthdays) to the reference (aggregated unexposed intervening periods). As an indirect comparison, we repeated these models in people bereaved by other causes. RESULTS We found no evidence of an elevated risk of suicidal behaviour during periods around anniversaries of a death or the deceased's birthdays in people bereaved by suicide (adjusted incidence rate ratio [IRRadj] = 1.00; 95% confidence interval [CI] = 0.87-1.16) or other causes (IRRadj = 1.04; 95% CI = 1.00-1.08) compared with intervening periods. Rates were elevated in the 30 days immediately after bereavement by other causes (IRRadj: 1.95, 95% CI: 1.77-2.22). CONCLUSIONS Although people bereaved by suicide are at elevated risk of self-harm and suicide, our findings do not suggest that this risk is heightened around emotionally significant anniversaries. Bereavement care should be accessible at all points after a traumatic loss as needs will differ over the grief trajectory.
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Affiliation(s)
- Alexandra Pitman
- UCL Division of Psychiatry, University College London (UCL), London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | | | - Keltie McDonald
- UCL Division of Psychiatry, University College London (UCL), London, UK
| | - Julie Cerel
- College of Social Work, University of Kentucky, Lexington, KY, USA
| | - Gemma Lewis
- UCL Division of Psychiatry, University College London (UCL), London, UK
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Psychiatric Centre Copenhagen, Hellerup, Copenhagen, Denmark
- Copenhagen Research Centre for Mental Health, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Hellerup, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
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Ineson KM, Erlangsen A, Nordentoft M, Benros ME, Madsen T. Traumatic brain injury and risk of subsequent attempted suicide and violent crime. Psychol Med 2023; 53:4094-4102. [PMID: 35400353 DOI: 10.1017/s0033291722000769] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) can cause long-lasting sequelae that may increase the risk of suicidal or criminal behaviour, but large-scale longitudinal studies are lacking on the link between TBI and events of suicide attempt and violent crime. This study examined the incidence of suicide attempt and violent crime following hospital contact for TBI in a nationwide cohort study. METHODS We used nationwide register data covering all individuals aged 10+ living in Denmark during 1980-2016 (n = 7 783 951). Of these, 587 522 individuals had a hospital contact for TBI. Incidence rate ratios (IRR) were calculated by Poisson regression analyses while adjusted for relevant covariates including other fractures and psychiatric diagnoses. RESULTS Individuals with TBI had higher rates of suicide attempt (females IRR, 2.78; 95% CI 2.71-2.85; males IRR, 3.00; 95% CI 2.93-3.08) compared to individuals without TBI in adjusted analyses. Multiple TBI and temporal proximity to TBI were associated with higher rates of suicide attempt. Individuals with TBI had higher rates of violent crime (females IRR, 2.43; 95% CI 2.36-2.49; males IRR, 1.80, 95% CI 1.78-1.82) compared with individuals without TBI. Higher rates of violent crime were found after multiple TBI and temporal proximity to TBI. CONCLUSIONS This nationwide cohort study found higher rates of suicide attempt and violent crime among individuals with prior hospital diagnosed TBI, compared with individuals without TBI. This emphasises the need for preventive efforts immediately after TBI diagnosis, which might mitigate the risks of a trajectory toward suicidal or violent behaviours.
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Affiliation(s)
- Katrine M Ineson
- CORE - Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Annette Erlangsen
- CORE - Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center of Mental Health Research, Australian National University, Canberra, Australia
| | - Merete Nordentoft
- CORE - Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Michael E Benros
- CORE - Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Trine Madsen
- CORE - Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Erlangsen A, Jacobsen AL, Ranning A, Delamare AL, Nordentoft M, Frisch M. Transgender Identity and Suicide Attempts and Mortality in Denmark. JAMA 2023; 329:2145-2153. [PMID: 37367977 PMCID: PMC10300682 DOI: 10.1001/jama.2023.8627] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 05/02/2023] [Indexed: 06/28/2023]
Abstract
Importance Prior studies have suggested that transgender individuals may be a high-risk group with respect to suicide attempt and mortality, but large-scale, population-based investigations are lacking. Objective To examine in a national setting whether transgender individuals have higher rates of suicide attempt and mortality than nontransgender individuals. Design, Setting, and Participants Nationwide, register-based, retrospective cohort study on all 6 657 456 Danish-born individuals aged 15 years or older who lived in Denmark between January 1, 1980, and December 31, 2021. Exposure Transgender identity was determined through national hospital records and administrative records of legal change of gender. Main Outcomes and Measures Suicide attempts, suicide deaths, nonsuicidal deaths, and deaths by any cause during 1980 through 2021 were identified in national hospitalization and causes of death registers. Adjusted incidence rate ratios (aIRRs) with 95% CIs controlling for calendar period, sex assigned at birth, and age were calculated. Results The 6 657 456 study participants (50.0% assigned male sex at birth) were followed up during 171 023 873 person-years. Overall, 3759 individuals (0.06%; 52.5% assigned male sex at birth) were identified as transgender at a median age of 22 years (IQR, 18-31 years) and followed up during 21 404 person-years, during which 92 suicide attempts, 12 suicides, and 245 suicide-unrelated deaths occurred. Standardized suicide attempt rates per 100 000 person-years were 498 for transgender vs 71 for nontransgender individuals (aIRR, 7.7; 95% CI, 5.9-10.2). Standardized suicide mortality rates per 100 000 person-years were 75 for transgender vs 21 for nontransgender individuals (aIRR, 3.5; 95% CI, 2.0-6.3). Standardized suicide-unrelated mortality rates per 100 000 person-years were 2380 for transgender vs 1310 for nontransgender individuals (aIRR, 1.9; 95% CI, 1.6-2.2), and standardized all-cause mortality rates per 100 000 person-years were 2559 for transgender vs 1331 for nontransgender individuals (aIRR, 2.0; 95% CI, 1.7-2.4). Despite declining rates of suicide attempts and mortality during the 42 years covered, aIRRs remained significantly elevated in recent calendar periods up to and including 2021 for suicide attempts (aIRR, 6.6; 95% CI, 4.5-9.5), suicide mortality (aIRR, 2.8; 95% CI, 1.3-5.9), suicide-unrelated mortality (aIRR, 1.7; 95% CI, 1.5-2.1), and all-cause mortality (aIRR, 1.7; 95% CI, 1.4-2.1). Conclusions and Relevance In this Danish population-based, retrospective cohort study, results suggest that transgender individuals had significantly higher rates of suicide attempt, suicide mortality, suicide-unrelated mortality, and all-cause mortality compared with the nontransgender population.
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Affiliation(s)
- Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center of Mental Health Research, Australian National University, Canberra, Australia
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Anna Lund Jacobsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Anne Ranning
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | | | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Morten Frisch
- Department of Epidemiology Research, Project SEXUS Group, Statens Serum Institut, Copenhagen, Denmark
- Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Jakobsen SG, Nielsen T, Larsen CP, Andersen PT, Lauritsen J, Stenager E, Christiansen E. Definitions and incidence rates of self-harm and suicide attempts in Europe: A scoping review. J Psychiatr Res 2023; 164:28-36. [PMID: 37311401 DOI: 10.1016/j.jpsychires.2023.05.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 05/02/2023] [Accepted: 05/18/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION European countries use various terminologies for self-harm and attempted suicide, which are sometimes used interchangeably. This complicates cross-country comparisons of incidence rates. This scoping review aimed to examine the definitions used and the possibilities to identify and compare incidence rates of self-harm and attempted suicide in Europe. METHODS A literature search was conducted in Embase, Medline and PsycINFO for studies published from 1990 to 2021, followed by grey literature searches. Data were collected for total populations originating from health care institutions or registries. Results were presented in tabular form supplemented by a qualitative summary by area. RESULTS A total of 3160 articles were screened, resulting in 43 studies included from databases and further 29 studies from other sources. Most studies used the term 'suicide attempt' rather than 'self-harm' and reported person-based rates with annual incidence rates from age 15+. None of the rates were considered comparable due to different reporting traditions related to classification codes and statistical approaches. CONCLUSION The present extensive literature on self-harm and attempted suicide cannot be used to compare findings between countries because of the high degree of heterogeneity among studies. International agreement on definitions and registration practices is needed to improve knowledge and understanding of suicidal behaviour.
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Affiliation(s)
- Sarah Grube Jakobsen
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Suicide Research, Odense, Denmark.
| | - Torben Nielsen
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Christina Petrea Larsen
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Suicide Research, Odense, Denmark
| | - Pernille Tanggaard Andersen
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Jens Lauritsen
- Accident Analysis Group, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital & Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Erik Christiansen
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Suicide Research, Odense, Denmark
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Ayre K, Liu X, Howard LM, Dutta R, Munk-Olsen T. Self-harm in pregnancy and the postnatal year: prevalence and risk factors. Psychol Med 2023; 53:2895-2903. [PMID: 37449482 PMCID: PMC10235666 DOI: 10.1017/s0033291721004876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Self-harm in pregnancy or the year after birth ('perinatal self-harm') is clinically important, yet prevalence rates, temporal trends and risk factors are unclear. METHODS A cohort study of 679 881 mothers (1 172 191 pregnancies) was conducted using Danish population register data-linkage. Hospital treatment for self-harm during pregnancy and the postnatal period (12 months after live delivery) were primary outcomes. Prevalence rates 1997-2015, in women with and without psychiatric history, were calculated. Cox regression was used to identify risk factors. RESULTS Prevalence rates of self-harm were, in pregnancy, 32.2 (95% CI 28.9-35.4)/100 000 deliveries and, postnatally, 63.3 (95% CI 58.8-67.9)/100 000 deliveries. Prevalence rates of perinatal self-harm in women without a psychiatric history remained stable but declined among women with a psychiatric history. Risk factors for perinatal self-harm: younger age, non-Danish birth, prior self-harm, psychiatric history and parental psychiatric history. Additional risk factors for postnatal self-harm: multiparity and preterm birth. Of psychiatric conditions, personality disorder was most strongly associated with pregnancy self-harm (aHR 3.15, 95% CI 1.68-5.89); psychosis was most strongly associated with postnatal self-harm (aHR 6.36, 95% CI 4.30-9.41). For psychiatric disorders, aHRs were higher postnatally, particularly for psychotic and mood disorders. CONCLUSIONS Perinatal self-harm is more common in women with pre-existing psychiatric history and declined between 1997 and 2015, although not among women without pre-existing history. Our results suggest it may be a consequence of adversity and psychopathology, so preventative intervention research should consider both social and psychological determinants among women with and without psychiatric history.
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Affiliation(s)
- Karyn Ayre
- Section of Women's Mental Health, Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, London, UK
| | - Xiaoqin Liu
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Louise M. Howard
- Section of Women's Mental Health, Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, London, UK
| | - Rina Dutta
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, London, UK
- Academic Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Trine Munk-Olsen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Erlangsen A, Qin P, Madsen T, Hawton K, Osler M, Hjorthøj C, Benros ME, Ethelberg S, Mølbak K, Laursen TM, Nordentoft M, Nilsson SF. Association between SARS-CoV-2 infection and self-harm: Danish nationwide register-based cohort study. Br J Psychiatry 2023; 222:167-174. [PMID: 36636817 PMCID: PMC10895503 DOI: 10.1192/bjp.2022.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Case studies have linked SARS-CoV-2 infection to suicidal behaviour. However, conclusive evidence is lacking. AIMS To examine whether a history of SARS-CoV-2 infection or SARS-CoV-2-related hospital admission was associated with self-harm in the general population and in high-risk groups. METHOD A cohort design was applied to nationwide data on all people aged ≥15 years and living in Denmark between 27 February 2020 and 15 October 2021. Exposure was identified as having had a positive SARS-CoV-2 PCR test, and further assessed as SARS-CoV-2-related hospital admission. Rates of probable self-harm were examined using adjusted incidence rate ratios (aIRRs). The following subgroups were identified: (a) lower educational level, (b) chronic medical conditions, (c) disability pension, (d) mental disorders, (e) substance use disorders, and history of (f) homelessness and (g) imprisonment. RESULTS Among 4 412 248 included individuals, 260 663 (5.9%) had tested positive for SARS-CoV-2. Out of 5453 individuals presenting with self-harm, 131 (2.4%) had been infected. Individuals with a history of a positive SARS-CoV-2 test result had an aIRR for self-harm of 0.86 (95% CI 0.72-1.03) compared with those without. High rates were found after a SARS-CoV-2-related hospital admission (aIRR = 7.68; 95% CI 5.61-10.51) or a non-SARS-CoV-2-related admission (aIRR = 10.27; 95% CI 9.65-10.93) versus non-infected and not admitted. In sensitivity analyses with a more restrictive definition of self-harm, a positive PCR test was associated with lower rates of self-harm. CONCLUSIONS Individuals with a PCR-confirmed SARS-CoV-2 infection did not have higher rates of self-harm than those without. Hospital admission in general, rather than being SARS-CoV-2 positive. seemed to be linked to elevated rates of self-harm.
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Affiliation(s)
- Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; and Center of Mental Health Research, Australian National University, Canberra, Australia
| | - Ping Qin
- National Center for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trine Madsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; and Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, UK; and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg & Frederiksberg Hospitals, Copenhagen, Denmark; and Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark; and Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael E. Benros
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; and Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Steen Ethelberg
- Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Copenhagen, Denmark; and Department of Global Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kåre Mølbak
- Epidemiological Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark; and Department of Veterinary and Animal Science, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Munk Laursen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sandra Feodor Nilsson
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
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10
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Jensen KJ, Osler M, Bødker N, Riise J, Petersen J. Healthcare resource utilization prior to suicide death or suicide attempt in patients with major depressive disorder-A Danish registry-based cohort study. Suicide Life Threat Behav 2023. [PMID: 36825304 DOI: 10.1111/sltb.12953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/22/2022] [Accepted: 02/04/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Major depressive disorder (MDD) is associated with suicide events and with increased healthcare resource utilization (HRU). The aim was to analyze the pattern of HRU prior to death by suicide or suicide attempt in patients with MDD using national registries. METHODS Danish adults with MDD, who died by suicide or had a first-time suicide attempt, were matched with MDD controls on age, sex, and MDD severity and analyzed for psychiatric and non-psychiatric hospital and private practitioner contacts, and prescriptions 1 year prior to the event. For individuals having a second suicide attempt, HRU prior to first and second suicide attempt was analyzed. RESULTS Among 1061 individuals dying by suicide and 3759 individuals with suicide attempt, compared with their controls, the proportion with psychiatric hospitalization was more than 50% increased, mainly accounted for by acute contacts. The difference to the matched controls decreased with increasing MDD severity. Non-psychiatric HRU was increased as well. The proportion with psychiatric hospitalizations or ED visits was reduced prior to the second attempt compared with first attempt. CONCLUSION Among individuals with MDD, psychiatric and non-psychiatric HRU was increased 1 year prior to suicide event. The proportion of individuals who had psychiatric HRU decreased from first to second suicide attempt.
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Affiliation(s)
- Kristoffer Jarlov Jensen
- Copenhagen Phase IV Unit (Phase4Cph), Center for Clinical Research and Prevention & Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Merete Osler
- Section for Data, Biostatistics and Pharmacoepidemiology, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,Section for Epidemiology, Institute for Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Janne Petersen
- Copenhagen Phase IV Unit (Phase4Cph), Center for Clinical Research and Prevention & Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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11
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Sørensen HJ, Antonsen S, Benros ME, Erlangsen A, Albiñana C, Nordentoft M, Børglum AD, Mors O, Werge T, Mortensen PB, Hougaard D, Webb RT, Agerbo E. School performance and genetic propensities for educational attainment and depression in the etiology of self-harm: a Danish population-based study. Nord J Psychiatry 2023; 77:179-187. [PMID: 35635301 PMCID: PMC9883111 DOI: 10.1080/08039488.2022.2078998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 04/21/2022] [Accepted: 04/29/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Poor school performance is linked to higher risks of self-harm. The association might be explained through genetic liabilities for depression or educational attainment. We investigated the association between school performance and self-harm in a population-based sample while assessing the potential influence of polygenic risk scores (PRSs) for depression (PRSMDD) and for educational attainment (PRSEDU). METHOD We conducted a follow-up study of individuals born 1987-98 and followed from age 18 until 2016. The total sample consisted of a case group (23,779 diagnosed with mental disorders; schizophrenia, bipolar disorder, depression, autism, and attention deficit hyperactivity disorder (ADHD) and a randomly sampled comparison group (n = 10,925). Genome-wide data were obtained from the Neonatal Screening Biobank and information on school performance, family psychiatric history, and socioeconomic status from national administrative registers. RESULTS Individuals in the top PRSMDD decile were at higher self-harm risk in the case group (IRR: 1.30; 95% CI 1.15-1.46), whereas individuals in the top PRSEDU decile were at lower self-harm risk (IRR: 0.63; 95% CI: 0.55-0.74). Poorer school performance was associated with higher self-harm risk in persons diagnosed with any mental disorder (IRR: 1.69; 95% CI: 1.44-1.99) and among the comparison group (IRR: 7.93; 95% CI: 4.47-15.18). Observed effects of PRSMDD and PRSEDU on self-harm risk were strongest for individuals with poor school performance. CONCLUSION Associations between PRSMDD and self-harm risk and between PRSEDU and self-harm risk were found. Nevertheless, these polygenic scores seem currently of limited clinical utility for identifying individuals at high self-harm risk.
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Affiliation(s)
- Holger J. Sørensen
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Copenhagen Research Center for Mental Health, CORE, University of Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - Sussie Antonsen
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- NCRR - National Centre for Register-Based Research, Department of Economics & Business Economics, Aarhus University, Denmark
| | - Michael E. Benros
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Copenhagen Research Center for Mental Health, CORE, University of Copenhagen, Denmark
| | - Annette Erlangsen
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Copenhagen Research Center for Mental Health, CORE, University of Copenhagen, Denmark
- Danish Research Institute for Suicide Prevention, Denmark
- Department of Mental Health, Bloomberg Johns Hopkins School of Public Health, USA
- Centre for Mental Health Research, Australian National University, Australia
| | - Clara Albiñana
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- NCRR - National Centre for Register-Based Research, Department of Economics & Business Economics, Aarhus University, Denmark
| | - Merete Nordentoft
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Copenhagen Research Center for Mental Health, CORE, University of Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - Anders D. Børglum
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Department of Biomedicine and Centre for Integrative Sequencing (iSEQ), Aarhus University, Aarhus, Denmark
- Center for Genomics and Personalized Medicine, Aarhus, Denmark
| | - Ole Mors
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Thomas Werge
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Denmark
- Institute of Biological Psychiatry, MHC, Sankt Hans Mental Health Services, Copenhagen, Roskilde, Denmark
| | - Preben B. Mortensen
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- NCRR - National Centre for Register-Based Research, Department of Economics & Business Economics, Aarhus University, Denmark
| | - David Hougaard
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Centre for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Roger T. Webb
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Esben Agerbo
- iPSYCH—The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- NCRR - National Centre for Register-Based Research, Department of Economics & Business Economics, Aarhus University, Denmark
- CIRRAU - Centre for Integrated Register- Based Research, Aarhus University, Aarhus, Denmark
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12
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Bøe AS, Mehlum L, Melle I, Qin P. Psychiatric disorders among adults treated for deliberate self-harm in general hospital: A national register study. J Affect Disord 2022; 319:490-496. [PMID: 36162670 DOI: 10.1016/j.jad.2022.09.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 09/07/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Psychiatric disorders are common among individuals treated for deliberate self-harm (DSH) in general hospitals. However, few large-scale studies have explicitly addressed psychiatric disorders among adult DSH patients. AIM To examine the presence of psychiatric disorders among adults presenting to general hospitals following DSH, and further to establish clinical and sociodemographic determinants of being diagnosed with a psychiatric disorder in this patient population. METHOD Data from several national registers were interlinked to identify all individuals aged 18 and older presenting to general hospital for DSH during the period 2008-2018. Logistic regression was used to examine the association between psychiatric disorders (ICD-10) and clinical and sociodemographic characteristics of the DSH patients. RESULTS Altogether 39,534 subjects with 63,622 episodes of DSH were included in the study with a gender ratio (F:M) of 1.48. The majority were unmarried and had low income and education. Psychiatric disorders were present in 58.5 % of all episodes and in 54.3 % of the index episodes. Affective disorders displayed the highest prevalence (18.3 %), followed by alcohol use disorder (16.4 %). Personality disorders were highly prevalent among young females with multiple DSH episodes. Middle-aged individuals had the highest prevalence of psychiatric disorders. Presence of psychiatric disorders was significantly associated with DSH repetition. LIMITATIONS Data was restricted to variables available in the registers. CONCLUSIONS Psychiatric disorders were common among DSH patients in the present cohort, but distributed differently between the genders. DSH repetition and middle-age was associated with being diagnosed with a psychiatric disorder.
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Affiliation(s)
- Anne Seljenes Bøe
- The National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway.
| | - Lars Mehlum
- The National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, Norway
| | - Ping Qin
- The National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway
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13
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Høier NK, Madsen T, Spira AP, Hawton K, Jennum P, Nordentoft M, Erlangsen A. Associations between treatment with melatonin and suicidal behavior: a nationwide cohort study. J Clin Sleep Med 2022; 18:2451-2458. [PMID: 35801338 PMCID: PMC9516579 DOI: 10.5664/jcsm.10118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Melatonin is often prescribed to patients with sleep disorders who are known to have elevated suicide risks, yet melatonin's association with suicidal behavior remains to be examined. We investigated whether individuals prescribed melatonin had higher rates of suicide and suicide attempts when compared to individuals who were not prescribed this drug, including both those with and without known mental disorders. METHODS A cohort design was applied to longitudinal, register data on all persons aged ≥ 10 years in Denmark during 2007-2016. Based on data from the National Prescription Registry, periods of being in treatment with melatonin were defined using information on the number of tablets and the daily defined dose. We calculated incidence rate ratios for suicide and suicide attempts, as identified in register records, comparing those in treatment with melatonin to those not in treatment. RESULTS Among 5,798,923 individuals, 10,577 (0.2%) were treated with melatonin (mean treatment length, 50 days) during the study period. Of those, 22 died by suicide and 134 had at least 1 suicide attempt. People in treatment with melatonin had a 4-fold higher rate of suicide (incidence rate ratio, 4.8; 95% CI, 3.0-7.5) and a 5-fold higher rate of suicide attempt (incidence rate ratio, 5.9; 95% CI, 4.4-8.0) than those not in treatment and when adjusting for sex and age group. CONCLUSIONS Treatment with melatonin was associated with suicide and suicide attempt. Although there are several possible explanations, attention to suicide risk is particularly warranted for people with mental comorbidity who are in treatment with melatonin. CITATION Høier NK, Madsen T, Spira AP, et al. Associations between treatment with melatonin and suicidal behavior: a nationwide cohort study. J Clin Sleep Med. 2022;18(10):2451-2458.
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Affiliation(s)
- Nikolaj Kjær Høier
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Trine Madsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Adam P. Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center on Aging and Health, Baltimore, Maryland
| | - Keith Hawton
- Center for Suicide Research, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Poul Jennum
- Danish Center for Sleep Medicine, Rigshospitalet and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
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14
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Ranning A, Uddin MJ, Sørensen HJ, Laursen TM, Thorup AAE, Madsen T, Nordentoft M, Erlangsen A. Intergenerational transmission of suicide attempt in a cohort of 4.4 million children. Psychol Med 2022; 52:3202-3209. [PMID: 33827720 DOI: 10.1017/s0033291720005310] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The association between suicide attempts (SAs) in parents and children is unclear, and risk indicators for intergenerational transmission remain undocumented. We aimed to assess this association, considering the child's developmental period at the time of parents' attempted suicide, and the parental relation. METHODS Using a prospective cohort design, nationwide population data were linked to the Psychiatric Central Register and National Patient Register for all individuals aged 10 years or older living in Denmark between 1980 and 2016. We assessed incidence rate ratios (IRRs) and cumulative hazards for children's first SA. RESULTS In a cohort of 4 419 651 children, 163 056 (3.7%) had experienced a parental SA. An SA was recorded among 6996 (4.3%) of the exposed children as opposed to 70112 (1.6%) in unexposed individuals. Higher rates were noted when a parental SA occurred during early childhood (0 ⩽ age < 2) [IRR, 4.7; 95% confidence interval (CI) 4.2-5.4] v. late childhood (6 ⩽ age < 13) (IRR, 3.6; 95% CI 3.4-3.8) when compared to those unexposed. Children exposed prior to age 2 had the highest rates of all sub-groups when reaching age 13-17 (IRR, 6.5; 95% CI 6.0-7.1) and 18-25 years (IRR, 6.8; 95% CI 6.2-7.4). Maternal SA (IRR, 3.4; 95% CI 3.2-3.5) was associated with higher rates than paternal (IRR, 2.8; 95% CI 2.7-2.9). CONCLUSION Parental SA was associated with children's own SA. Exposure during early developmental stages was associated with the highest rates. Early preventive efforts are warranted as is monitoring of suicide risk in the children from age 13.
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Affiliation(s)
- Anne Ranning
- Copenhagen Research Center for Mental Health, Copenhagen, Denmark
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Md Jamal Uddin
- Copenhagen Research Center for Mental Health, Copenhagen, Denmark
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | | | - Thomas Munk Laursen
- National Center for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Anne A E Thorup
- Child and Adolescent Mental Health Center, Capital Region of Denmark, Denmark
| | - Trine Madsen
- Copenhagen Research Center for Mental Health, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health, Copenhagen, Denmark
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center of Mental Health Research, Australian National University, Canberra, Australia
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15
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Jacobsen AL, Madsen T, Ranning A, Nielsen AS, Nordentoft M, Erlangsen A. Level of Suicidal Ideation Among Callers to the Danish Suicide Prevention Helpline. Arch Suicide Res 2022:1-16. [PMID: 35703206 DOI: 10.1080/13811118.2022.2084005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE The aim of this study was to: (1) determine the proportion of callers to a national helpline for suicide prevention who were evaluated to be at risk of suicide; (2) identify characteristics associated with being at risk; (3) determine the level of suicidal ideation among callers, as measured by a clinical scale, and compared to the general population. METHOD Data on all calls answered at the Danish helpline for suicide prevention during 2018-2019 were analyzed. These consisted of socio-demographic covariates and items related to suicidality, including the Suicidal Ideation Attribute Scale (SIDAS). Data on SIDAS for the general population derived from a survey. Being at risk of suicide, as evaluated by the counselors, was examined as outcome in adjusted logistic regressions. RESULTS Among 42,393 answered calls, 24,933 (59%) related to personal concerns. Of these, 47% and 14% of callers, respectively, had suicidal thoughts and concrete suicidal plans, while 53% were evaluated to be at risk. Higher risks were found when issues related to self-harm, mental health problems, eating disorders, incest, physical health problems, substance abuse, or sexual assault were mentioned. In all 37% of callers who were administered the SIDAS scale were evaluated to be at high risk of suicide compared to 1.5% in the general population. CONCLUSIONS A substantial share of callers to a national helpline for suicide prevention were evaluated to be at risk of suicide, also when using a clinical scale. This emphasizes the potential for counselors to prevent suicidal behavior.HighlightsMore than half of callers reaching out to the helpline were evaluated to be at risk of suicide, and 37% were identified as being at high risk using SIDAS, a clinical scale.Being woman, of younger age, having a history of previous suicide attempt as well as experiencing problems related to self-harm, mental disorders, sexual assault, substance abuse, and physical health problems was associated with risk of suicide, as evaluated by counselors.This seemingly is the first study to compare clinical scores of helpline callers to those of the general population and significantly higher levels of suicidal ideation were found among helpline callers.
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16
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Ranning A, Madsen T, Hawton K, Nordentoft M, Erlangsen A. Transgenerational concordance in parent-to-child transmission of suicidal behaviour: a retrospective, nationwide, register-based cohort study of 4 419 642 individuals in Denmark. Lancet Psychiatry 2022; 9:363-374. [PMID: 35354063 DOI: 10.1016/s2215-0366(22)00042-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Suicidal behaviour runs in families, but the nature of transgenerational concordance needs elucidation. The aim of this study was to examine parent-to-child transmission by investigating whether presence and nature of parental suicidal behaviour was associated with suicidal behaviour in children. METHODS We did a retrospective, nationwide, register-based cohort study in Demark using register data. We included all individuals born after 1953 who were 10 years or older and who were recorded as living in Denmark at some point between Jan 1, 1980, and Dec 31, 2016. Adults listed as living with their child at first registration in the Civil Registration System were considered as parents; later records of different legal parents allowed identification of potential step-parents. Self-reported ethnicity data were not available. Exposure to parental suicide attempt and suicide was identified using information from hospital contacts and causes of death from national registers. The examined outcomes were suicide attempt and death by suicide. We calculated incidence rate ratios (IRRs) and cumulative hazards for children's suicide attempt and suicide, taking into account type of parental suicidal behaviour, child's age of exposure, and sex. FINDINGS In total, 4 419 642 individuals aged 10-63 years were observed during 1980-2016. Of these individuals, 150 222 (3·4%) were exposed to one or more parents with a suicide attempt, 31 564 (0·7%) to at least one parent who died by suicide, and 12 834 (0·3%) to both events. Individuals exposed to parental suicide attempt had higher rates of suicide attempt (IRR 2·72 [95% CI 2·33-3·17]) than individuals exposed to parental suicide (1·77 [1·50-2·09]) when compared with unexposed individuals. Higher rates of suicide were found for individuals exposed to parental suicide (IRR 3·18 [95% CI 2·84-3·58]) than for those exposed to parental suicide attempt (2·37 [2·19-2·57]). The cumulative hazard of suicide attempt was 0·07 for individuals exposed to parental suicide attempt, and the cumulative hazard of suicide was 0·009 for individuals exposed to parental suicide. Individuals exposed to parental suicide had higher odds of violent suicidal methods than those exposed to suicide attempt alone (odds ratio 2·0 [95% CI 1·7-2·3]). INTERPRETATION A concordant pattern of higher rates of the same type of suicidal behaviour as the one of the parents was observed, including type of suicide method. Preventive, family-oriented interventions are warranted to mitigate familial transmission of risk, as are clinical considerations of familial exposure in risk assessment of patients. FUNDING Mental Health Services, Capital Region of Denmark.
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Affiliation(s)
- Anne Ranning
- Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
| | - Trine Madsen
- Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, UK; Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Department of clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Annette Erlangsen
- Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center of Mental Health Research, Australian National University, Canberra, ACT, Australia
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17
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Fitzgerald C, Christensen RHB, Simons J, Andersen PK, Benros ME, Nordentoft M, Erlangsen A, Hawton K. Effectiveness of medical treatment for bipolar disorder regarding suicide, self-harm and psychiatric hospital admission: between- and within-individual study on Danish national data. Br J Psychiatry 2022; 221:1-9. [PMID: 35450547 DOI: 10.1192/bjp.2022.54] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mood stabilisers are the main treatment for bipolar disorder. However, it is uncertain which drugs have the best outcomes. AIMS To investigate whether rates of suicide, self-harm and psychiatric hospital admission in individuals with bipolar disorder differ between mood stabilisers. METHOD A cohort design was applied to people aged ≥15 years who were diagnosed with bipolar disorder and living in Denmark during 1995-2016. Treatment with lithium, valproate, other mood stabilisers and antipsychotics were compared in between- and within-individual analyses, and adjusted for sociodemographic characteristics and previous self-harm. RESULTS A total of 33 337 individuals with bipolar disorder were included (266 900 person-years). When compared with individuals not receiving treatment, those receiving lithium had a lower rate of suicide (hazard ratio 0.40, 95% CI 0.31-0.51). When comparing treatment and non-treatment periods in the same individuals, lower rates of self-harm were found for lithium (hazard ratio 0.74, 95% CI 0.61-0.91). Lower rates of psychiatric hospital admission were found for all drug categories compared with non-treatment periods in within-individual analyses (P<0.001). The low rates of self-harm and hospital admission for lithium in within-individual analyses were supported by results of between-individual analyses. CONCLUSIONS Lithium was associated with lower rates of suicide, self-harm and psychiatric hospital readmission in all analyses. With respect to suicide, lithium was superior to no treatment. Although confounding by indication cannot be excluded, lithium seems to have better outcomes in the treatment of bipolar disorder than other mood stabilisers.
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Affiliation(s)
- Cecilie Fitzgerald
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Denmark; and Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Denmark
| | | | | | | | | | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Denmark; Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Denmark; and Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Denmark; Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Denmark; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA; and Center of Mental Health Research, Australian National University, Australia
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, UK; and, Oxford Health NHS Foundation Trust, UK
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Dyvesether SM, Hastrup LH, Hawton K, Nordentoft M, Erlangsen A. Direct costs of hospital care of self-harm: A national register-based cohort study. Acta Psychiatr Scand 2022; 145:319-331. [PMID: 34758107 DOI: 10.1111/acps.13383] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/15/2021] [Accepted: 11/07/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To estimate national direct hospital costs associated with treatment of self-harm and to analyse whether costs differ with respect to demographic and clinical characteristics. METHODS A cohort design was applied to register data on all people living in Denmark (5.8 million inhabitants) from Jan 1, 2012 to Dec 31, 2016. Self-harm presentations at all hospitals by persons aged 10 years and older were included. Total costs and costs related to somatic and psychiatric care and treatment setting (inpatient, emergency department and outpatient) were calculated (in US dollars). The association between specific characteristics and somatic inpatient costs was analysed adjusted using generalized linear models and expressed as Odds Ratios (OR). RESULTS In all, 42,634 (97.3%) self-harm presentations by 30,366 persons were included. Annual somatic and psychiatric costs amounted to $25,241,518 and $34,696,388, respectively, and the median cost per episode was $2248 (IQR: $1553-$4138). Predictors of high somatic inpatient costs were: admission to intensive care (OR = 15.6; 95% CI, 13.7-17.9), particularly dangerous methods of self-harm, such as being hit by moving objects (OR = 6.5; 95% CI, 2.7-15.7) and shooting (OR = 6.0; 95% CI, 3.4-10.7), and age ≥75 years (OR = 1.8; 95% CI, 1.5-2.2). A small group of persons (0.7%) with ≥10 presentations accounted for 8.2% of somatic and 15.3% of total hospital costs. CONCLUSION Substantial hospital costs were noted for inpatient treatment. Although one-time presenters accounted for the major share of costs, smaller patient groups accounted for considerable shares. Hospital costs of self-harm should be included in evaluation of initiatives for prevention and treatment.
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Affiliation(s)
| | - Lene Halling Hastrup
- Psychiatric Research Unit, Psychiatry in Region Zealand, Slagelse, Denmark
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Psychiatric Center Copenhagen, Hellerup, Denmark
- Copenhagen Research Center for Mental Health CORE, Mental Health Center Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Psychiatric Center Copenhagen, Hellerup, Denmark
- Copenhagen Research Center for Mental Health CORE, Mental Health Center Copenhagen, Hellerup, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Mental Health Research, Australian National University, Canberra, ACT, Australia
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19
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Mehlum L. Cost of self-harm to society is high and increasing: A call for evidence-based and systematic treatment approaches. Acta Psychiatr Scand 2022; 145:317-318. [PMID: 35263444 DOI: 10.1111/acps.13402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/23/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Lars Mehlum
- Institute of Clinical Medicine, National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway
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20
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Khan Amiri D, Madsen T, Norredam M, Brande SE, Mittendorfer-Rutz E, Nordentoft M, Erlangsen A. Suicide and Suicide Attempts Among Asylum-Seekers in Denmark. Arch Suicide Res 2021; 27:415-425. [PMID: 34877921 DOI: 10.1080/13811118.2021.2011809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE There are concerns that asylum-seekers are at increased risk of suicide attempt and suicide mortality. Yet, largescale nationwide studies are limited. Our aim was to examine whether asylum-seekers in Denmark had higher rates of suicide attempt and suicide when compared to the general population. METHODS A retrospective cohort design was used. Data on asylum-seekers and the general population living in Denmark during 2009-2019 were obtained from the Immigration services and national registers. Indirect standardization was applied to adjust for differences with respect to age group and sex and Incidence Rate Ratios (IRR) with 95% confidence intervals were calculated. RESULTS In a population of 78,666 asylum-seekers, a total of 601 suicide attempts and 9 suicides were recorded. The rate of suicide attempt was 842.0 per 100,000 person-years for asylum-seekers and 92.3 per 100,000 person-years for the general population. When adjusting for differences related to age group and sex, an IRR of 8.5 (95% CI: 7.6-9.5) was found for suicide attempt between 2014-2019. The IRR for suicide attempt unaccompanied minors between 2015 and 2019 was 5.8 (95% CI: 4.3-7.5) when adjusting for age group. We did not find an elevated rate of suicide among asylum-seekers (IRR: 1.6, 95% CI: 0.6-3.5). CONCLUSIONS Asylum-seekers were found to have higher rates of suicide attempt than the general population in Denmark. This also applied to unaccompanied minors. Our study emphasizes the need for awareness and preventive measures targeting mental health and suicidal behavior among asylum-seekers.HIGHLIGHTSAsylum-seekers had an 8-fold higher rate of suicide attempt than the general population.The suicide attempt rate for asylum-seekers reached its lowest levels during recent years.Unaccompanied minors had a 5-fold higher frequency of suicide attempt when compared to peers in the general population.We did not find elevated rates of death by suicide among asylum-seekers. No suicide deaths were recorded among unaccompanied minors.
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21
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Gradus JL, Rosellini AJ, Horváth-Puhó E, Jiang T, Street AE, Galatzer-Levy I, Lash TL, Sørensen HT. Predicting Sex-Specific Nonfatal Suicide Attempt Risk Using Machine Learning and Data From Danish National Registries. Am J Epidemiol 2021; 190:2517-2527. [PMID: 33877265 PMCID: PMC8796814 DOI: 10.1093/aje/kwab112] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 12/15/2022] Open
Abstract
Suicide attempts are a leading cause of injury globally. Accurate prediction of suicide attempts might offer opportunities for prevention. This case-cohort study used machine learning to examine sex-specific risk profiles for suicide attempts in Danish nationwide registry data. Cases were all persons who made a nonfatal suicide attempt between 1995 and 2015 (n = 22,974); the subcohort was a 5% random sample of the population at risk on January 1, 1995 (n = 265,183). We developed sex-stratified classification trees and random forests using 1,458 predictors, including demographic factors, family histories, psychiatric and physical health diagnoses, surgery, and prescribed medications. We found that substance use disorders/treatment, prescribed psychiatric medications, previous poisoning diagnoses, and stress disorders were important factors for predicting suicide attempts among men and women. Individuals in the top 5% of predicted risk accounted for 44.7% of all suicide attempts among men and 43.2% of all attempts among women. Our findings illuminate novel risk factors and interactions that are most predictive of nonfatal suicide attempts, while consistency between our findings and previous work in this area adds to the call to move machine learning suicide research toward the examination of high-risk subpopulations.
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Affiliation(s)
- Jaimie L Gradus
- Correspondence to Dr. Jaimie L. Gradus, Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, T318E, Boston MA 02118 (e-mail: )
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22
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Adams RS, Jiang T, Rosellini AJ, Horváth-Puhó E, Street AE, Keyes KM, Cerdá M, Lash TL, Sørensen HT, Gradus JL. Sex-Specific Risk Profiles for Suicide Among Persons with Substance Use Disorders in Denmark. Addiction 2021; 116:2882-2892. [PMID: 33620758 PMCID: PMC8459184 DOI: 10.1111/add.15455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/14/2020] [Accepted: 02/10/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS Persons with substance use disorders (SUDs) are at elevated risk of suicide death. We identified novel risk factors and interactions that predict suicide among men and women with SUD using machine learning. DESIGN Case-cohort study. SETTING Denmark. PARTICIPANTS The sample was restricted to persons with their first SUD diagnosis during 1995 to 2015. Cases were persons who died by suicide in Denmark during 1995 to 2015 (n = 2774) and the comparison subcohort was a 5% random sample of individuals in Denmark on 1 January 1995 (n = 13 179). MEASUREMENTS Suicide death was recorded in the Danish Cause of Death Registry. Predictors included social and demographic information, mental and physical health diagnoses, surgeries, medications, and poisonings. FINDINGS Persons among the highest risk for suicide, as identified by the classification trees, were men prescribed antidepressants in the 4 years before suicide and had a poisoning diagnosis in the 4 years before suicide; and women who were 30+ years old and had a poisoning diagnosis 4 years before and 12 months before suicide. Among men with SUD, the random forest identified five variables that were most important in predicting suicide; reaction to severe stress and adjustment disorders, drugs used to treat addictive disorders, age 30+ years, antidepressant use, and poisoning in the 4 prior years. Among women with SUD, the random forest found that the most important predictors of suicide were prior poisonings and reaction to severe stress and adjustment disorders. Individuals in the top 5% of predicted risk accounted for 15% of all suicide deaths among men and 24% of all suicides among women. CONCLUSIONS In Denmark, prior poisoning and comorbid psychiatric disorders may be among the most important indicators of suicide risk among persons with substance use disorders, particularly among women.
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Affiliation(s)
- Rachel Sayko Adams
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
- Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Health Administration, Aurora, CO, USA
| | - Tammy Jiang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Anthony J Rosellini
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | | | - Amy E Street
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Henrik Toft Sørensen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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23
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Martínez-Alés G, Cruz Rodríguez JB, Lázaro P, Domingo-Relloso A, Barrigón ML, Angora R, Rodríguez-Vega B, Jiménez-Sola E, Sánchez-Castro P, Román-Mazuecos E, Villoria L, Ortega AJ, Navío M, Stanley B, Rosenheck R, Baca-García E, Bravo-Ortiz MF. Cost-effectiveness of a Contact Intervention and a Psychotherapeutic Program for Post-discharge Suicide Prevention. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:737-746. [PMID: 33317338 PMCID: PMC8329894 DOI: 10.1177/0706743720980135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine the cost-effectiveness of 2 strategies for post-discharge suicide prevention, an Enhanced Contact intervention based on repeated in-person and telephone contacts, and an individual 2-month long problem-solving Psychotherapy program, in comparison to facilitated access to outpatient care following a suicide attempt. METHODS We conducted a cost-effectiveness analysis based on a decision tree between January and December 2019. Comparative effectiveness estimates were obtained from an observational study conducted between 2013 and 2017 in Madrid, Spain. Electronic health care records documented resource use (including extra-hospital emergency care, mortality, inpatient admission, and disability leave). Direct cost data were derived from Madrid's official list of public health care prices. Indirect cost data were derived from Spain's National Institute of Statistics. RESULTS Both augmentation strategies were more cost-effective than a single priority outpatient appointment considering reasonable thresholds of willingness to pay. Under the base-case scenario, Enhanced Contact and Psychotherapy incurred, respectively, €2,340 and 6,260 per averted attempt, compared to a single priority appointment. Deterministic and probabilistic sensitivity analyses showed both augmentation strategies to remain cost-effective under several scenarios. Enhanced Contact was slightly cost minimizing in comparison to Psychotherapy (base-case scenario: €-196 per averted attempt). CONCLUSIONS Two post-discharge suicide prevention strategies based on Enhanced Contact and Psychotherapy were cost-effective in comparison to a single priority appointment. Increasing contacts between suicide attempters and mental health-care providers was slightly cost minimizing compared to psychotherapy.
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Affiliation(s)
| | | | - Pablo Lázaro
- Independent Health Services Researcher, Madrid, Spain
| | | | | | | | - Beatriz Rodríguez-Vega
- La Paz University Hospital, Universidad Autónoma de Madrid School of Medicine, Madrid,
Spain
| | | | | | | | | | | | - Mercedes Navío
- Madrid Mental Health Regional Office, Mental Health Biomedical
Research Networking Center (CIBERSAM), Madrid, Spain
| | - Barbara Stanley
- New York State Psychiatric Institute, Columbia University Vagelos College of Physicians & Surgeons, NY, USA
| | | | - Enrique Baca-García
- Mental Health Biomedical Research Networking Center (CIBERSAM),
Universidad Autónoma de Madrid School of Medicine, Fundación Jiménez Díaz University
Hospital, Madrid, Spain; Universidad Católica del Maule, Talca, Chile; Department of
psychiatry, Centre Hospitalier, Universitaire de Nîmes
| | - María Fe Bravo-Ortiz
- La Paz University Hospital, Universidad Autónoma de Madrid School of Medicine, Madrid,
Spain
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24
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Hvidkjaer KL, Ranning A, Madsen T, Fleischer E, Eckardt JP, Hjorthøj C, Cerel J, Nordentoft M, Erlangsen A. People exposed to suicide attempts: Frequency, impact, and the support received. Suicide Life Threat Behav 2021; 51:467-477. [PMID: 33258173 DOI: 10.1111/sltb.12720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/24/2020] [Accepted: 08/18/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Little is known about people who have been exposed to a suicide attempt by someone they know. The purpose of this study was to examine how many people have been exposed to a suicide attempt by someone they knew and whether the exposure was associated with general well-being and suicidal ideation. METHOD A population-based online survey was conducted during 2019 in Denmark (n = 6,191). The associations between exposures to suicide attempt and general well-being (WHO-5) and suicidal ideation (Suicidal Ideation Attributes Scale) were examined using linear regression analyses. RESULTS Overall, 24.6% reported having experienced a suicide attempt by someone they knew. Of those, 46.5% had experienced a suicide attempt of a close relation and this group reported having been more affected by the event. Those exposed scored lower on general well-being (b: -3.0; 95% CI: -4.2 to -1.8; p > 0.001) and higher on suicidal ideation (b: 1.6; 95% CI: 1.3 - 1.9; p = 0.001) than those not exposed. Half of the exposed reported not having received sufficient support after the event. CONCLUSION Suicide attempt affects a substantial share of the population, and it might be relevant to ensure that support is available for those exposed perceived to be in need of support.
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Affiliation(s)
| | - Anne Ranning
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.,Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital
| | - Trine Madsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.,Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital
| | - Elene Fleischer
- Network for the Affected by Suicidal Behavior (NEFOS, Odense, Denmark
| | - Jens Peter Eckardt
- Research Unit at Bedre Psykiatri (Better Psychiatry, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Julie Cerel
- College of Social Work, University of Kentucky, Lexington, KY, USA
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.,Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.,Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
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25
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Paracetamol-related intentional drug overdose among young people: a national registry study of characteristics, incidence and trends, 2007-2018. Soc Psychiatry Psychiatr Epidemiol 2021; 56:773-781. [PMID: 33146859 DOI: 10.1007/s00127-020-01981-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 10/24/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Incidence rates of hospital-presenting self-harm are highest in people under 25 years and are reportedly increasing in some countries. Intentional drug overdose (IDO) is the most common self-harm method among young people, with paracetamol the drug most frequently used. This study aimed to describe the characteristics, incidence, and temporal trends in paracetamol-related IDO among young people. METHODS Data from the National Self-Harm Registry Ireland on hospital-presenting self-harm by individuals aged 1024 years during 2007-2018 were examined. Annual IDO rates per 100,000 were calculated by age and gender. Joinpoint regression analyses and incidence rate ratios were used to examine trends in the incidence of paracetamol-related IDO. RESULTS During the study, 10,985 paracetamol-related IDOs were recorded. The incidence of paracetamol-related IDO among young people increased by 9% between 2007 and 2018 (IRR 1.09 95% CI 1.00-1.19), with the highest annual percentage change (APC) in females aged 18-24 years (APC 1.2%). Conversely, rates of paracetamol-related IDO among males aged 18-24 years decreased significantly (APC 1.6%). Between 2013 and 2018, excesses of 386 and 151 paracetamol-related IDOs were observed in females aged 10-17 and 18-24 years, respectively, and 42 excess presentations were observed for males aged 10-17 years. There were 107 fewer presentations than expected for males aged 18-24 years. CONCLUSION The increase in paracetamol-related IDO among specific groups of young people, particularly young females is an issue of growing concern. Interventions targeting IDO among young people are needed, incorporating measures to address the availability of paracetamol and aftercare following IDO.
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Erlangsen A, Banks E, Joshy G, Calear AL, Welsh J, Batterham PJ, Conwell Y, Salvador-Carulla L. Physical, mental, and social wellbeing and their association with death by suicide and self-harm in older adults: a community-based cohort study. Int J Geriatr Psychiatry 2021; 36:647-656. [PMID: 33166417 DOI: 10.1002/gps.5463] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/01/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess associations between physical, mental, and social well-being and suicide and self-harm in a community-based sample of older adults. METHODS Using a cohort design, questionnaire data from 102,880 individuals aged 65 years or older living in New South Wales, Australia during 2006-2009 were linked to hospital and cause-of-death databases until 2017. Poisson regressions obtained adjusted incidence rate ratios (IRRs). RESULTS One hundred nine suicides and 191 deliberate self-harm (DSH) events occurred. Compared to those reporting excellent/good overall health, older adults reporting fair overall health had higher suicide rates (IRR = 2.8, 95% confidence interval: 1.8-4.4). Also, suffering from physical limitations was associated with higher rates of suicide. A fair versus excellent/good memory was associated with higher rates of suicide (IRR = 2.0, 1.3-3.3). Male erectile dysfunction was linked to self-harm (IRR = 2.8, 1.0-7.7). Suicide rates were elevated with baseline Kessler-10 scores of 20-50 versus 10-15 (IRR = 5.0, 2.9-8.9); the corresponding IRR for DSH was 2.9 (1.8-4.8). Elevated rates were observed for both self-reported depression and anxiety. Poor versus excellent/good quality of life was associated with suicide (IRR = 4.3, 1.7-10.7) and achieving less than desired to due to emotional problems was linked to self-harm (IRR = 1.8 1.3-2.4). Rates of suicide ande DSH were lower in those with ≥5 people to depend on versus one (suicide: IRR = 0.5, 0.3-0.9; DSH: IRR = 0.5, 0.3-0.7). CONCLUSIONS Older adults experiencing health problems, including those relating to overall health or memory, and those with psychological distress had elevated rates of suicidal behavior. Rates of subsequent self-harm and/or death by suicide were elevated in participants with small social networks.
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Affiliation(s)
- Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Copenhagen Research Centre For Mental Health, Capital Region of Denmark, Denmark.,Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Grace Joshy
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Jennifer Welsh
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Yeates Conwell
- Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, New York, USA
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
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Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev 2021; 4:CD013668. [PMID: 33884617 PMCID: PMC8094743 DOI: 10.1002/14651858.cd013668.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most counties, often repeated, and associated with suicide. There has been a substantial increase in both the number of trials and therapeutic approaches of psychosocial interventions for SH in adults. This review therefore updates a previous Cochrane Review (last published in 2016) on the role of psychosocial interventions in the treatment of SH in adults. OBJECTIVES To assess the effects of psychosocial interventions for self-harm (SH) compared to comparison types of care (e.g. treatment-as-usual, routine psychiatric care, enhanced usual care, active comparator) for adults (aged 18 years or older) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic reviews [CDSR]), together with MEDLINE, Ovid Embase, and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing interventions of specific psychosocial treatments versus treatment-as-usual (TAU), routine psychiatric care, enhanced usual care (EUC), active comparator, or a combination of these, in the treatment of adults with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratio (ORs) and their 95% confidence intervals (CIs). For continuous outcomes, we calculated mean differences (MDs) or standardised mean differences (SMDs) and 95% CIs. The overall quality of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from 76 trials with a total of 21,414 participants. Participants in these trials were predominately female (61.9%) with a mean age of 31.8 years (standard deviation [SD] 11.7 years). On the basis of data from four trials, individual cognitive behavioural therapy (CBT)-based psychotherapy may reduce repetition of SH as compared to TAU or another comparator by the end of the intervention (OR 0.35, 95% CI 0.12 to 1.02; N = 238; k = 4; GRADE: low certainty evidence), although there was imprecision in the effect estimate. At longer follow-up time points (e.g., 6- and 12-months) there was some evidence that individual CBT-based psychotherapy may reduce SH repetition. Whilst there may be a slightly lower rate of SH repetition for dialectical behaviour therapy (DBT) (66.0%) as compared to TAU or alternative psychotherapy (68.2%), the evidence remains uncertain as to whether DBT reduces absolute repetition of SH by the post-intervention assessment. On the basis of data from a single trial, mentalisation-based therapy (MBT) reduces repetition of SH and frequency of SH by the post-intervention assessment (OR 0.35, 95% CI 0.17 to 0.73; N = 134; k = 1; GRADE: high-certainty evidence). A group-based emotion-regulation psychotherapy may also reduce repetition of SH by the post-intervention assessment based on evidence from two trials by the same author group (OR 0.34, 95% CI 0.13 to 0.88; N = 83; k = 2; moderate-certainty evidence). There is probably little to no effect for different variants of DBT on absolute repetition of SH, including DBT group-based skills training, DBT individual skills training, or an experimental form of DBT in which participants were given significantly longer cognitive exposure to stressful events. The evidence remains uncertain as to whether provision of information and support, based on the Suicide Trends in At-Risk Territories (START) and the SUicide-PREvention Multisite Intervention Study on Suicidal behaviors (SUPRE-MISS) models, have any effect on repetition of SH by the post-intervention assessment. There was no evidence of a difference for psychodynamic psychotherapy, case management, general practitioner (GP) management, remote contact interventions, and other multimodal interventions, or a variety of brief emergency department-based interventions. AUTHORS' CONCLUSIONS Overall, there were significant methodological limitations across the trials included in this review. Given the moderate or very low quality of the available evidence, there is only uncertain evidence regarding a number of psychosocial interventions for adults who engage in SH. Psychosocial therapy based on CBT approaches may result in fewer individuals repeating SH at longer follow-up time points, although no such effect was found at the post-intervention assessment and the quality of evidence, according to the GRADE criteria, was low. Given findings in single trials, or trials by the same author group, both MBT and group-based emotion regulation therapy should be further developed and evaluated in adults. DBT may also lead to a reduction in frequency of SH. Other interventions were mostly evaluated in single trials of moderate to very low quality such that the evidence relating to the use of these interventions is inconclusive at present.
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Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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Gronemann FH, Jørgensen MB, Nordentoft M, Andersen PK, Osler M. Treatment-resistant depression and risk of all-cause mortality and suicidality in Danish patients with major depression. J Psychiatr Res 2021; 135:197-202. [PMID: 33493949 DOI: 10.1016/j.jpsychires.2021.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/06/2021] [Accepted: 01/15/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Treatment-resistant depression (TRD) has been associated with higher mortality and risk of suicide, but this has mainly been showed in few studies which did not include self-harm. The aim was to investigate the association of TRD with all-cause mortality, suicide and self-harm in a nationwide cohort of patients with major depression and explore any differences in relation to patient characteristics. METHODS First-time hospital contacts for major depression between January 1, 1996 and December 31, 2014 were identified in Danish patient registers (ICD-10: F32 and F33). TRD was defined as two shifts in antidepressant treatment, assessed from one year prior depression diagnosis until one year after. Information on mortality, suicide and self-harm was obtained from Danish registers and associations between TRD and the three prognostic outcomes were analyzed using Cox Proportional Hazard Regression. RESULTS TRD was not associated with all-cause mortality the first year of follow-up (adjusted HR (aHR) 1.04, 95% confidence interval (CI) [0.98-1.11]), and the HR for mortality was lower the following 1-5 years. However, TRD was associated with higher rates of suicide (0-1 year: aHR 2.20, 95% CI [1.77-2.74]; 1-5 years: aHR 1.70, 95% CI [1.42-2.03]) and self-harming behavior (0-1 year: aHR 1.51, 95% CI [1.36-1.66]; 1-5 years: aHR 1.59, 95% CI [1.48-1.70]). The above risk estimates varied only slightly across sociodemographic and clinical patient characteristics. CONCLUSIONS Patients with TRD have higher rates of suicide and self-harm compared with non-TRD patients, whereas there seems to be no increase overall in all-cause mortality - in fact, there was a lower rate at follow-up after 1 year. We found only a few differences in HRs for mortality or suicidality across patient characteristics.
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Affiliation(s)
- Frederikke Hørdam Gronemann
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark.
| | - Martin Balslev Jørgensen
- Psychiatric Centre Copenhagen, Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Psychiatric Centre Copenhagen, Copenhagen, Denmark; Lundbeck Foundation Initiative for Integrative Psychiatric Research iPsych, Copenhagen and Aarhus, Denmark
| | - Per Kragh Andersen
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark; Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
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Kerkelä M, Gyllenberg D, Gissler M, Sillanmäki L, Keski-Säntti M, Hinkka-Yli-Salomäki S, Filatova S, Hurtig T, Miettunen J, Sourander A, Veijola J. Cumulative incidences of hospital-treated psychiatric disorders are increasing in five Finnish birth cohorts. Acta Psychiatr Scand 2021; 143:119-129. [PMID: 33111973 PMCID: PMC7894526 DOI: 10.1111/acps.13247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to explore changes in the incidences of childhood and early adulthood hospital-treated psychiatric disorders in five large Finnish birth cohorts of individuals born between 1966 and 1997. METHODS The five birth cohorts were as follows: Northern Finland Birth Cohort 1966 (NFBC 1966) and 1986 (NFBC 1986), 1987 Finnish Birth Cohort (FBC 1987) and 1997 (FBC 1997), and Finnish 1981 Birth Cohort Study (FBCS 1981). Incidences of hospital-treated psychiatric disorders in each cohort were calculated separately for males (N = 71,209) and females (N = 65,190). Poisson regression was used to test difference in proportions of psychiatric disorders in wide range of diagnosis classes separately in childhood and adolescence, and early adulthood. RESULTS The total incidences of psychiatric disorders in childhood and adolescence among males has increased in the birth cohorts over decades (Incidence Rate Ratio, IRR = 1.04 (1.04-1.05); p < 0.001). Similar result was seen among females (IRR = 1.04 (1.03-1.04); p < 0.001). In early adulthood, there was significant increase among females (IRR = 1.04 (1.03-1.05); p < 0.001), but among males, the change was not significant (IRR = 0.99 (0.99-1.00), p = 0.051). CONCLUSIONS The main finding was that the cumulative incidence of hospital-treated psychiatric disorders increased over the decades in Finland. The increasing trend in hospital-treated psychiatric disorders in early adulthood was detected in females but not in males. In the youngest cohorts, the cumulative incidence of hospital-treated psychiatric disorders was at the same level in males and females, whereas in oldest cohort, males had higher incidence than females.
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Affiliation(s)
- Martta Kerkelä
- Research Unit of Clinical NeuroscienceUniversity of OuluOuluFinland
| | - David Gyllenberg
- Deparment of Child PsychiatryINVEST Research Flagship CenterTurku University HospitalUniversity of TurkuTurkuFinland,Finnish Institute for Health and WelfareHelsinkiFinland,Department of Adolescent PsychiatryUniversity of Helsinki and Helsinki University Central HospitalHelsinkiFinland
| | - Mika Gissler
- Deparment of Child PsychiatryINVEST Research Flagship CenterTurku University HospitalUniversity of TurkuTurkuFinland,Finnish Institute for Health and WelfareHelsinkiFinland,Department of Neurobiology, Care Sciences and SocietyKarolinska InstituteStockholmSweden
| | - Lauri Sillanmäki
- Deparment of Child PsychiatryINVEST Research Flagship CenterTurku University HospitalUniversity of TurkuTurkuFinland
| | | | - Susanna Hinkka-Yli-Salomäki
- Deparment of Child PsychiatryINVEST Research Flagship CenterTurku University HospitalUniversity of TurkuTurkuFinland
| | - Svetlana Filatova
- Deparment of Child PsychiatryINVEST Research Flagship CenterTurku University HospitalUniversity of TurkuTurkuFinland
| | - Tuula Hurtig
- Research Unit of Clinical NeuroscienceUniversity of OuluOuluFinland,PEDEGO Research UnitClinic of Child PsychiatryUniversity of OuluUniversity Hospital of OuluOuluFinland
| | - Jouko Miettunen
- Center for Life Course Health ResearchUniversity of OuluOuluFinland,Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | - Andre Sourander
- Deparment of Child PsychiatryINVEST Research Flagship CenterTurku University HospitalUniversity of TurkuTurkuFinland
| | - Juha Veijola
- Research Unit of Clinical NeuroscienceUniversity of OuluOuluFinland,Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland,Department of PsychiatryUniversity Hospital of OuluOuluFinland
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Erlangsen A, Banks E, Joshy G, Calear AL, Welsh J, Batterham PJ, Salvador-Carulla L. Measures of mental, physical, and social wellbeing and their association with death by suicide and self-harm in a cohort of 266,324 persons aged 45 years and over. Soc Psychiatry Psychiatr Epidemiol 2021; 56:295-303. [PMID: 32812087 DOI: 10.1007/s00127-020-01929-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/07/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to examine the relation of mental, physical, and social wellbeing measures to death by suicide and self-harm (SH). METHODS Using a cohort design, questionnaire data on 266,324 responders aged ≥ 45 years, living in NSW, Australia were linked to hospital and death databases during 2006-2017. Adjusted incidence rate ratios (IRR) were calculated. RESULTS Overall, 212 suicides and 723 SH episodes were observed. A dose-response relationship with suicidal behaviour was found for Kessler-10 Psychological Distress Scale; IRRs of 4.5 (95% CI 2.4-8.3) for suicide and 8.3 (95% CI 6.5-10.7) for SH were observed for scores of high versus low distress. Elevated rates were also observed for those reporting poor versus good or excellent health (suicide, IRR: 3.8, 95% CI 2.2-6.9; SH, IRR: 4.5 95% CI 3.4-6.1); being dependent versus not dependent on help with daily tasks (suicide, IRR: 2.4 95% CI 1.5-3.7; SH, IRR: 2.6 95% CI 2.0-3.3); being a current smoker (suicide, IRR: 1.8, 95% CI 1.1-2.9; SH, IRR: 2.9 95% CI 2.3-3.5) having versus not having male erectile problems (SH, IRR: 1.9 95% CI 1.4-2.5). Participants with ≥ 5 people versus one person to depend on had reduced suicidal behaviour (suicide, IRR: 0.5 95% CI 0.3-0.7, SH, IRR: 0.5 95% CI 0.4-0.6). CONCLUSIONS An active social network was linked to lower rates of suicide and self-harm. Adverse health, dependence on help, psychological distress were associated with higher rates of suicide and self-harm, while erectile problems were linked to an elevated rate of self-harm.
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Affiliation(s)
- Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark. .,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark. .,Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia.
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Grace Joshy
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Jennifer Welsh
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia., Menzies Centre for Health Policy, School of Public Health, The Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Pharmacological interventions for self-harm in adults. Cochrane Database Syst Rev 2021; 1:CD013669. [PMID: 35608866 PMCID: PMC8094615 DOI: 10.1002/14651858.cd013669.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most countries, often repeated, and associated with suicide. Evidence assessing the effectiveness of pharmacological agents and/or natural products in the treatment of SH is lacking, especially when compared with the evidence for psychosocial interventions. This review therefore updates a previous Cochrane Review (last published in 2015) on the role of pharmacological interventions for SH in adults. OBJECTIVES To assess the effects of pharmacological agents or natural products for SH compared to comparison types of treatment (e.g. placebo or alternative pharmacological treatment) for adults (aged 18 years or older) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic Reviews [CDSR]), together with MEDLINE. Ovid Embase and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing pharmacological agents or natural products with placebo/alternative pharmacological treatment in individuals with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment acceptability, treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratios (ORs) and their 95% confidence internals (CIs). For continuous outcomes we calculated the mean difference (MD) or standardised mean difference (SMD) and 95% CI. The overall certainty of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from seven trials with a total of 574 participants. Participants in these trials were predominately female (63.5%) with a mean age of 35.3 years (standard deviation (SD) 3.1 years). It is uncertain if newer generation antidepressants reduce repetition of SH compared to placebo (OR 0.59, 95% CI 0.29 to 1.19; N = 129; k = 2; very low-certainty evidence). There may be a lower rate of SH repetition for antipsychotics (21%) as compared to placebo (75%) (OR 0.09, 95% CI 0.02 to 0.50; N = 30; k = 1; low-certainty evidence). However, there was no evidence of a difference between antipsychotics compared to another comparator drug/dose for repetition of SH (OR 1.51, 95% CI 0.50 to 4.58; N = 53; k = 1; low-certainty evidence). There was also no evidence of a difference for mood stabilisers compared to placebo for repetition of SH (OR 0.99, 95% CI 0.33 to 2.95; N = 167; k = 1; very low-certainty evidence), or for natural products compared to placebo for repetition of SH (OR 1.33, 95% CI 0.38 to 4.62; N = 49; k = 1; lo- certainty) evidence. AUTHORS' CONCLUSIONS Given the low or very low quality of the available evidence, and the small number of trials identified, there is only uncertain evidence regarding pharmacological interventions in patients who engage in SH. More and larger trials of pharmacotherapy are required, preferably using newer agents. These might include evaluation of newer atypical antipsychotics. Further work should also include evaluation of adverse effects of pharmacological agents. Other research could include evaluation of combined pharmacotherapy and psychological treatment.
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Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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Kõlves K, Fitzgerald C, Nordentoft M, Wood SJ, Erlangsen A. Assessment of Suicidal Behaviors Among Individuals With Autism Spectrum Disorder in Denmark. JAMA Netw Open 2021; 4:e2033565. [PMID: 33433599 DOI: 10.1001/jamanetworkopen.2020.33565] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE There is limited evidence supporting an association of autism spectrum disorder (ASD) with suicidality and the risk factors for suicide attempt and suicide among people with ASD. Existing research highlights the need for national cohort studies. OBJECTIVES To analyze whether people with ASD have higher rates of suicide attempt and suicide compared with people without ASD using national register data, identify potential risk factors for suicide attempt and suicide among those with ASD, and examine associations with comorbid disorders. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, nationwide register data from January 1, 1995, to December 31, 2016, were gathered on 6 559 266 individuals in Denmark aged 10 years or older. Statistical analysis was performed from November 20, 2018, to November 21, 2020. MAIN OUTCOMES AND MEASURES Rates of suicide attempt and suicide among persons with ASD were compared with rates among persons without ASD, using Poisson regression models to calculate incidence rate ratios adjusted for sex, age, and time period. RESULTS Of the total study population of 6 559 266 individuals, 35 020 individuals (25 718 male [73.4%]; mean [SD] age at diagnosis, 13.4 [9.3] years) received a diagnosis of ASD. A total of 64 109 incidents of suicide attempts (587 [0.9%] among individuals with ASD) and 14 197 suicides (53 [0.4%] among individuals with ASD) were recorded. Persons with ASD had a more than 3-fold higher rate of suicide attempt (adjusted incidence rate ratio [aIRR], 3.19; 95% CI, 2.93-3.46) and suicide (aIRR, 3.75; 95% CI, 2.85-4.92) than those without ASD. For individuals with ASD, the aIRR for suicide attempt among female individuals was 4.41-fold (95% CI, 3.74-5.19) higher compared with male individuals; for individuals without ASD, the aIRR for female individuals was 1.41-fold (95% CI, 1.39-1.43) higher compared with male individuals. Higher rates of suicide attempt were noted across all age groups for those with ASD. Persons with a diagnosis of ASD only had an aIRR of 1.33 (95% CI, 0.99-1.78) for suicide attempt, whereas those with other comorbid disorders had an aIRR of 9.27 (95% CI, 8.51-10.10) for suicide attempt compared with those without any psychiatric disorders. A total of 542 of 587 individuals with ASD (92.3%) who attempted suicide had at least 1 other comorbid condition and 48 of 53 individuals with ASD (90.6%) who died by suicide had at least 1 other comorbid condition. CONCLUSIONS AND RELEVANCE This nationwide retrospective cohort study found a higher rate of suicide attempt and suicide among persons with ASD. Psychiatric comorbidity was found to be a major risk factor, with more than 90% of those with ASD who attempted or died by suicide having another comorbid condition. Several risk factors are different from the risk factors in the general population, which suggests the need for tailored suicide prevention strategies.
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Affiliation(s)
- Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
| | - Cecilie Fitzgerald
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stephen James Wood
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Orygen, the National Centre of Excellence for Youth Mental Health, Parkville, Victoria, Australia
- School of Psychology, University of Birmingham, Edgbaston, United Kingdom
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Centre for Mental Health Research, Australian National University, Canberra, Australia
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Parental death by external causes and risk of hospital-treated deliberate self-harm in bereaved offspring. Eur Child Adolesc Psychiatry 2021; 30:539-548. [PMID: 32318879 PMCID: PMC8041704 DOI: 10.1007/s00787-020-01534-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/08/2020] [Indexed: 10/25/2022]
Abstract
Previous studies have reported an increased risk of hospital-treated deliberate self-harm (DSH) in offspring who have lost a parent, but inconclusive findings regarding differences between loss from suicide and accidents. The present study aimed to investigate the association between parental death by external causes before age 18 and hospital-treated DSH, and potential differences between different accidents and suicide. This nested-case-control study was based on data from longitudinal Norwegian registers. Subjects comprised 12,526 people born between 1970 and 2003 who received acute somatic treatment because of DSH at hospitals and associated services between 2008 and 2013 (cases), and 222,362 controls matched for gender and date of birth with no recorded DSH treatment. Information concerning deceased parent's death and offspring's DSH treatment and socioeconomic data was merged. Data were analysed with conditional logistic regression. Results indicated that offspring who had lost a parent to suicide (OR 2.32, 95% CI 1.92-2.80) and death by accidents such as falls, poisoning, and drowning (OR 1.79, 95% CI 1.38-2.33) had a significantly increased risk of hospital-treated DSH compared to offspring who had not experienced such loss. Parental bereavement from transport accidents and other external causes were not associated with significantly increased risks. No differences were evident for different genders of deceased, ages at bereavement, or genders of bereaved. The improved identification of bereaved offspring at particular risk of hospital-treated DSH should be utilized to implement effective prevention and treatment programs in specialist healthcare aimed at the individuals at highest risk.
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Lunde KB, Mehlum L, Melle I, Qin P. Deliberate self-harm and associated risk factors in young adults: the importance of education attainment and sick leave. Soc Psychiatry Psychiatr Epidemiol 2021; 56:153-164. [PMID: 32556378 PMCID: PMC7847451 DOI: 10.1007/s00127-020-01893-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/09/2020] [Indexed: 11/12/2022]
Abstract
PURPOSE The prevalence of deliberate self-harm (DSH) is high in young adults. However, few studies have examined risk in this specific age group. We, therefore, examined the relative influence and interactive nature of a wide range of potential sociodemographic and sick leave related risk factors in young adults, aged 18-35 years, using Norwegian register data. METHODS All subjects with at least one episode of hospital presentation for DSH registered in the Norwegian Patient Register during the period 2008-2013 were compared with age, gender and date matched population controls using a nested case-control design. The relative influence of factors and their interactions were assessed using conditional logistic regression and recursive partitioning models. RESULTS 9 873 study cases were compared to 186 092 controls. Socioeconomic status, marital status, sick leave and several demographic factors influenced risk for DSH. Specifically, low education (OR 7.44, 95% CI 6.82-8.12), current sick leave due to psychiatric disorders (OR 18.25, 95% CI 14.97-22.25) and being previously married (OR 3.83, 95% CI 3.37-4.36) showed the highest effect sizes. Importantly, there was an interaction between education and sick leave, where those with either low education and no sick leave (OR 13.33, 95% CI 11.66-15.23) or high education and sick leave (OR 18. 87, 95% CI 17.41-24.21) were the subgroups at highest risk. CONCLUSION DSH in young adults is associated with multiple sociodemographic and health disadvantages. Importantly, the two high-risk subgroups imply different pathways of risk and a need for differentiated preventative efforts.
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Affiliation(s)
- Ketil Berge Lunde
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Lars Mehlum
- grid.5510.10000 0004 1936 8921National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- grid.5510.10000 0004 1936 8921NORMENT, K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ping Qin
- grid.5510.10000 0004 1936 8921National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Rimvall MK, van Os J, Rask CU, Olsen EM, Skovgaard AM, Clemmensen L, Larsen JT, Verhulst F, Jeppesen P. Psychotic experiences from preadolescence to adolescence: when should we be worried about adolescent risk behaviors? Eur Child Adolesc Psychiatry 2020; 29:1251-1264. [PMID: 31732797 DOI: 10.1007/s00787-019-01439-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 11/11/2019] [Indexed: 11/26/2022]
Abstract
Psychotic experiences (PE), below the threshold of psychotic disorder, are common in the general population. PE are associated with risk behaviors such as suicidality, non-suicidal self-injury (NSSI) and substance use. However, PE as specific or causal phenomena of these risk behaviors are still debated. We aimed to examine the longitudinal trajectories of PE from preadolescence to adolescence and their associated risk behaviors in adolescence. A total of 1138 adolescents from the Copenhagen Child Cohort 2000 were assessed for PE and risk behaviors (NSSI, suicide ideation and -attempts and substance use) at age 11 and 16 years, along with measures of general psychopathology and depressive symptoms specifically. Self-reported impact of general psychopathology tended to be associated with more PE persistence. PE were associated with all risk behaviors in cross section at both follow-ups. Persistent PE from ages 11 to 16 and incident PE at age 16 were associated with risk behaviors at age 16, whereas remitting PE from age 11 to 16 were not. After adjustment for co-occurring depressive symptoms and general psychopathology, all associations were markedly reduced. After exclusion of preadolescents who already had expressed risk behavior at age 11, PE in preadolescence did not stand out as an independent predictor of incident adolescent risk behaviors. The current study suggests that PE in preadolescence and adolescence may not play a direct causal role regarding NSSI, suicidality, and substance use. However, PE are still useful clinical markers of severity of psychopathology and associated risk behaviors.
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Affiliation(s)
- Martin K Rimvall
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Hellerup, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Jim van Os
- Department of Psychiatry, University Medical Centre Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychosis Studies, King's College London, King's Health Partners, Institute of Psychiatry, London, UK
| | - Charlotte Ulrikka Rask
- Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Else Marie Olsen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Centre for Clinical Research and Prevention, the Capital Region of Denmark, Copenhagen, Denmark
| | - Anne Mette Skovgaard
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lars Clemmensen
- Center for Telepsychiatry, Mental Health Services, Region of Southern Denmark, Odense, Denmark
| | - Janne Tidselbak Larsen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Frank Verhulst
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Child Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pia Jeppesen
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Witt KG, Hawton K, Hetrick SE, Taylor Salisbury TL, Townsend E, Hazell P. Psychosocial interventions for self-harm in adults. Hippokratia 2020. [DOI: 10.1002/14651858.cd013668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry; University of Oxford; Oxford UK
| | - Sarah E Hetrick
- Department of Psychological Medicine; University of Auckland; Auckland New Zealand
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology; University of Nottingham; Nottingham UK
| | - Philip Hazell
- Discipline of Psychiatry; The University of Sydney School of Medicine; Sydney Australia
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Witt KG, Hawton K, Hetrick SE, Taylor Salisbury TL, Townsend E, Hazell P. Pharmacological interventions for self-harm in adults. Hippokratia 2020. [DOI: 10.1002/14651858.cd013669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry; University of Oxford; Oxford UK
| | - Sarah E Hetrick
- Department of Psychological Medicine; University of Auckland; Auckland New Zealand
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology; University of Nottingham; Nottingham UK
| | - Philip Hazell
- Discipline of Psychiatry; The University of Sydney School of Medicine; Sydney Australia
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Hopelessness is associated with repeated suicidal behaviors after discharge in patients admitted to emergency departments for attempted suicide. J Affect Disord 2020; 272:170-175. [PMID: 32379612 DOI: 10.1016/j.jad.2020.04.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/03/2020] [Accepted: 04/24/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hopelessness may be associated with an increased risk of suicide. However, findings regarding the long-term predictive ability of the Beck Hopelessness Scale (BHS) for suicide are inconsistent. This study investigated the long-term predictive ability of BHS scores for subsequent self-harm episodes in individuals admitted to an emergency department after attempting suicide. METHODS The BHS was administered to 805 adult patients with a DSM-IV-TR axis I disorder admitted to an emergency department following a suicide attempt. The patients were followed for at least 18 months and up to 5 years. The incidence of the first subsequent suicidal behavior (attempt or dying by suicide) was examined and the numbers per person-year of overall repeat self-harm episodes, suicide attempt episodes, and non-suicidal self-harm episodes were evaluated. RESULTS The total BHS scores showed significant associations with the overall number of self-harm episodes per person-year (incidence rate ratio [IRR], 1.05; 95% confidence interval [CI], 1.03-1.07; p < 0.0001), the number of suicide attempt episodes per person-year (IRR, 1.05; 95%CI, 1.03-1.08; p < 0.0001), and the number of non-suicidal self-harm episodes per person-year (IRR, 1.05; 95%CI, 1.03-1.07; p < 0.0001). LIMITATIONS The study excluded children and adolescents. The sample size, while large, was insufficient to ensure generalizability, or to allow subanalyses based on specific disorders. CONCLUSIONS Hopelessness scores assessed in the emergency department after a self-harming episode were associated with a rate of repetition of suicidal behaviors after discharge. Additional strategies to address hopelessness of these patients are warranted.
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Morthorst BR, Erlangsen A, Chaine M, Eriksson F, Hawton K, Dalhoff K, Nordentoft M. Restriction of non-opioid analgesics sold over-the-counter in Denmark: A national study of impact on poisonings. J Affect Disord 2020; 268:61-68. [PMID: 32158008 DOI: 10.1016/j.jad.2020.02.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/14/2020] [Accepted: 02/26/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Self-poisoning with non-opioid analgesics presents a growing challenge to health care providers. We aimed to assess the impact of an 18-year age restriction of OTC sales and a pack size restriction of non-opioid analgesics sold OTC in pharmacies on hospital-treated poisonings and poisoning severity measured using biomarkers. METHODS We applied a before and after design using interrupted time series analysis. Data on all poisonings recorded as hospital admissions were obtained during 2002-2015 and biochemical parameters from laboratory databases during 2011-2015, both covering the entire Danish population. RESULTS The age restriction was followed by a 17% level reduction in admissions for non-opioid analgesic poisoning among young people age 10-17 years (RR 0.830; 95% CI 0.697-0.988; p < 0.036). After the pack size restriction, an instant level reduction of 18.5% (RR 0.815; 95% CI 0.729-0.912; p < 0.001) was observed for the entire population. A 27% decrease in the number of poisonings with alanine transaminase levels (ALT) ≥ 210 U/L was observed (RR 0.734; 95% CI 0.579-0.931; p = 0.011) followed by 40% decrease in biomarkers indicative of liver failure (RR 0.597; 95% CI 0.421-0.847; p = 0.004). We also observed similar reductions for other poisonings such as psychotropics. LIMITATIONS Although declines in poisonings were observed after implementation of means restrictive measures, a causal link cannot be inferred. CONCLUSION Age and pack size restriction were assiociated with a reduction in the numbers of poisonings. This was also observed for pharmaceutical poisonings in general, which might suggest a non-specific or spill-over effect.
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Affiliation(s)
- Britt Reuter Morthorst
- Institute of Clinical Medicine, Faculty of Medical and Health Science, University of Copenhagen, Copenhagen, Denmark; Danish Research Institute for Suicide Prevention, Copenhagen Research Center for Mental Health (CORE), mental Health Center Copenhagen, Copenhagen, Denmark; Child & Adolescent Mental Health Services Capital Region of Denmark, Gentofte Hospitalsvej 15, DK - 2900 Hellerup.
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Copenhagen Research Center for Mental Health (CORE), mental Health Center Copenhagen, Copenhagen, Denmark; Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA; Center for Mental Health Research, College of Health and Medicine, Australian National University, Canberra, Australia
| | | | - Frank Eriksson
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, Oxford University, Oxford, UK
| | - Kim Dalhoff
- Department of Clinical Pharmacology and Clinical Toxicology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Merete Nordentoft
- Institute of Clinical Medicine, Faculty of Medical and Health Science, University of Copenhagen, Copenhagen, Denmark; Danish Research Institute for Suicide Prevention, Copenhagen Research Center for Mental Health (CORE), mental Health Center Copenhagen, Copenhagen, Denmark
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Deliberate self-harm: Case identification and incidence estimate upon data from national patient registry. PLoS One 2020; 15:e0231885. [PMID: 32339191 PMCID: PMC7185602 DOI: 10.1371/journal.pone.0231885] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 04/02/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patient registry is a valuable source for identification of deliberate self-harm (DSH) incidents on a population basis; however, little research has provided sufficient details that could inform best utilization of this complicated data source for DSH research and statistics. In this study we want to use data from the Norwegian Patient Register to delineate a diagnostic coding system to identify medically treated DSH incidents, to profile general characteristics of these incidents, and to estimate incidence rate of DSHs in the national population of Norway. METHODS We obtained all records of patient contacts to somatic hospitals and emergency centers due to external causes from 2008 through 2013. For each contact, we retrieved clinical data on primary and comorbid diagnoses, urgency of contact, etc., alongside with personal general information. After careful mining, the data were further processed following a multi-step analytic strategy. Descriptive analysis was used to profile DSH incidents and to estimate incidence rates and corresponding 95% confidence intervals. FINDINGS From 1 459 384 eligible incident contacts for emergency injury treatment, we identified 13 533 incidents that had a recorded diagnosis of DSH, i.e., with a supplemental code of X6n. Upon delineation of these recorded DSHs, we devised a diagnostic coding system to identify all possible DSH incidents. This yielded a total of 38 433 incidents to be considered as likely incidents of DSH (adjusted incidents)-a number that is 2.84 times higher than that of the recorded DSH incidents during the study period. While the proposed diagnostic system captured more incidents by males and old adults, the adjusted DSHs remained more common in females than males, and occurred most frequently within young people of 18-21 years. These incidents imply about 6400 DSH incidents from 5100 persons per year and correspond to a yearly cumulative incidence rate of 121.0 (95% CI: 113.4-128.2) per 100000 population over 10 years old with particularly high rates in teenage girls of 15-19 years old (296.1/100000) and females and males of 20-24 years old (282.5 and 178.8/100000, respectively). CONCLUSION The insightful details of data processing and the rich findings from this study underscore the importance of patient registry in studying and reporting DSH incidents on a population level.
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41
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Steeg S, Carr MJ, Mok PLH, Pedersen CB, Antonsen S, Ashcroft DM, Kapur N, Erlangsen A, Nordentoft M, Webb RT. Temporal trends in incidence of hospital-treated self-harm among adolescents in Denmark: national register-based study. Soc Psychiatry Psychiatr Epidemiol 2020; 55:415-421. [PMID: 31654088 DOI: 10.1007/s00127-019-01794-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Studies conducted in the UK and in Ireland have reported increased rates of self-harm in adolescent females from around the time of the 2008 economic recession and through periods of subsequent national austerity programme implementation. It is not known if incidence rates have increased similarly in other Western European countries during this period. METHODS Data from interlinked national administrative registers were extracted for individuals born in Denmark during 1981-2006. We estimated gender- and age-specific incidence rates (IRs) per 10,000 person-years at risk for hospital-treated non-fatal self-harm during 2000-2016 at ages 10-19 years. RESULTS Incidence of self-harm peaked in 2007 (IR 25.1) and then decreased consistently year on year to 13.8 in 2016. This pattern was found in all age groups, in both males and females and in each parental income tertile. During the last 6 years of the observation period, 2011-2016, girls aged 13-16 had the highest incidence rates whereas, among boys, incidence was highest among 17-19 year olds throughout. CONCLUSIONS The temporal increases in incidence rates of self-harm among adolescents observed in some Western European countries experiencing major economic recession were not observed in Denmark. Restrictions to sales of analgesics, access to dedicated suicide prevention clinics, higher levels of social spending and a stronger welfare system may have protected potentially vulnerable adolescents from the increases seen in other countries. A better understanding of the specific mechanisms behind the temporal patterns in self-harm incidence in Denmark is needed to help inform suicide prevention in other nations.
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Affiliation(s)
- Sarah Steeg
- Division of Psychology and Mental Health, Centre for Mental Health and Safety, Manchester Academic Health Science Centre, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, England, UK. .,Manchester Academic Health Science Centre (MAHSC), Manchester, UK.
| | - Matthew J Carr
- Division of Psychology and Mental Health, Centre for Mental Health and Safety, Manchester Academic Health Science Centre, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, England, UK.,Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Pearl L H Mok
- Division of Psychology and Mental Health, Centre for Mental Health and Safety, Manchester Academic Health Science Centre, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, England, UK.,Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Carsten B Pedersen
- Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark.,National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Sussie Antonsen
- Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark.,National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Darren M Ashcroft
- Division of Pharmacy and Optometry, Centre for Pharmacoepidemiology and Drug Safety, The University of Manchester, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Nav Kapur
- Division of Psychology and Mental Health, Centre for Mental Health and Safety, Manchester Academic Health Science Centre, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, England, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Roger T Webb
- Division of Psychology and Mental Health, Centre for Mental Health and Safety, Manchester Academic Health Science Centre, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, England, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), Manchester, UK
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42
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Erlangsen A, Appadurai V, Wang Y, Turecki G, Mors O, Werge T, Mortensen PB, Starnawska A, Børglum AD, Schork A, Nudel R, Bækvad-Hansen M, Bybjerg-Grauholm J, Hougaard DM, Thompson WK, Nordentoft M, Agerbo E. Genetics of suicide attempts in individuals with and without mental disorders: a population-based genome-wide association study. Mol Psychiatry 2020; 25:2410-2421. [PMID: 30116032 PMCID: PMC7515833 DOI: 10.1038/s41380-018-0218-y] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/14/2018] [Accepted: 06/04/2018] [Indexed: 01/30/2023]
Abstract
Family studies have shown an aggregation of suicidal behavior in families. Yet, molecular studies are needed to identify loci accounting for genetic heritability. We conducted a genome-wide association study and estimated single nucleotide polymorphisms (SNP) heritability for a suicide attempt. In a case-cohort study, national data on all individuals born in Denmark after 1981 and diagnosed with severe mental disorders prior to 2013 (n = 57,377) and individuals from the general population (n = 30,000) were obtained. After quality control, the sample consisted of 6024 cases with an incidence of suicide attempt and 44,240 controls with no record of a suicide attempt. Suggestive associations between SNPs, rs6880062 (p-value: 5.4 × 10-8) and rs6880461 (p-value: 9.5 × 10-8), and suicide attempt were identified when adjusting for socio-demographics. Adjusting for mental disorders, three significant associations, all on chromosome 20, were identified: rs4809706 (p-value: 2.8 × 10-8), rs4810824 (p-value: 3.5 × 10-8), and rs6019297 (p-value: 4.7 × 108). Sub-group analysis of cases with affective disorders revealed SNPs associated with suicide attempts when compared to the general population for gene PDE4B. All SNPs explained 4.6% [CI-95: 2.9-6.3%] of the variation in suicide attempt. Controlling for mental disorders reduced the heritability to 1.9% [CI-95: 0.3-3.5%]. Affective and autism spectrum disorders exhibited a SNP heritability of 5.6% [CI-95: 1.9-9.3%] and 9.6% [CI-95: 1.1-18.1%], respectively. Using the largest sample to date, we identified significant SNP associations with suicide attempts and support for a genetic transmission of suicide attempt, which might not solely be explained by mental disorders.
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Affiliation(s)
- Annette Erlangsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark. .,Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark. .,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Center of Mental Health Research, Australian National University, Canberra, Australia.
| | - Vivek Appadurai
- grid.452548.a0000 0000 9817 5300The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark ,grid.466916.a0000 0004 0631 4836Institute of Biological Psychiatry, Mental Health Center St. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
| | - Yunpeng Wang
- grid.452548.a0000 0000 9817 5300The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark ,grid.5510.10000 0004 1936 8921Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.5510.10000 0004 1936 8921Division of Mental Health and Addiction, University of Oslo, Oslo, Norway
| | - Gustavo Turecki
- grid.14709.3b0000 0004 1936 8649McGill Group for Suicide Studies, Douglas Hospital Research Centre, Department of Psychiatry, McGill University, Montreal, Canada
| | - Ole Mors
- grid.452548.a0000 0000 9817 5300The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark ,grid.154185.c0000 0004 0512 597XPsychosis Research Unit, Aarhus University Hospital, Risskov, Denmark
| | - Thomas Werge
- grid.452548.a0000 0000 9817 5300The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark ,grid.466916.a0000 0004 0631 4836Institute of Biological Psychiatry, Mental Health Center St. Hans, Mental Health Services Copenhagen, Roskilde, Denmark ,grid.5254.60000 0001 0674 042XInstitute of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Preben B. Mortensen
- grid.452548.a0000 0000 9817 5300The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722National Centre for Register-based Research (NCRR) and Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Anna Starnawska
- grid.452548.a0000 0000 9817 5300The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Biomedicine and Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
| | - Anders D. Børglum
- grid.452548.a0000 0000 9817 5300The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Biomedicine and Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark ,grid.154185.c0000 0004 0512 597XCentre for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark
| | - Andrew Schork
- grid.452548.a0000 0000 9817 5300The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark ,grid.466916.a0000 0004 0631 4836Institute of Biological Psychiatry, Mental Health Center St. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
| | - Ron Nudel
- grid.452548.a0000 0000 9817 5300The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark ,grid.466916.a0000 0004 0631 4836Institute of Biological Psychiatry, Mental Health Center St. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
| | - Marie Bækvad-Hansen
- grid.452548.a0000 0000 9817 5300The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark ,grid.6203.70000 0004 0417 4147Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Jonas Bybjerg-Grauholm
- grid.452548.a0000 0000 9817 5300The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark ,grid.6203.70000 0004 0417 4147Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - David M. Hougaard
- grid.452548.a0000 0000 9817 5300The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark ,grid.6203.70000 0004 0417 4147Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Wesley K. Thompson
- grid.452548.a0000 0000 9817 5300The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark ,grid.5510.10000 0004 1936 8921Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.5510.10000 0004 1936 8921Division of Mental Health and Addiction, University of Oslo, Oslo, Norway ,grid.154185.c0000 0004 0512 597XPsychosis Research Unit, Aarhus University Hospital, Risskov, Denmark ,grid.266100.30000 0001 2107 4242Division of Biostatistics, Department of Family Medicine and Public Health, University of California, San Diego, CA USA
| | - Merete Nordentoft
- grid.452548.a0000 0000 9817 5300The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark ,grid.466916.a0000 0004 0631 4836Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XInstitute of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XResearch Unit, Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Esben Agerbo
- grid.452548.a0000 0000 9817 5300The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722National Centre for Register-based Research (NCRR) and Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
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McManus S, Gunnell D, Cooper C, Bebbington PE, Howard LM, Brugha T, Jenkins R, Hassiotis A, Weich S, Appleby L. Prevalence of non-suicidal self-harm and service contact in England, 2000-14: repeated cross-sectional surveys of the general population. Lancet Psychiatry 2019; 6:573-581. [PMID: 31175059 PMCID: PMC7646286 DOI: 10.1016/s2215-0366(19)30188-9] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/27/2019] [Accepted: 04/05/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND The number of people presenting to hospital emergency departments after self-harming has increased in England. However, most people who self-harm do not present to hospitals, so whether this rise reflects an increase in the prevalence of self-harm in the community is unknown. Also unknown is whether the prevalence of non-suicidal self-harm (NSSH) or suicidal self-harm, or both, has increased. We aimed to establish temporal trends in the prevalence of NSSH in England. METHODS We analysed data from participants in the 2000 (n=7243), 2007 (n=6444), and 2014 (n=6477) Adult Psychiatric Morbidity Surveys of the general population, selecting those aged 16-74 years and living in England. We used weighted data and controlled for complex survey design. We generated temporal trends in lifetime prevalence and methods of, and motivations for, NSSH, and consequent service contact. We used multiple variable logistic regression analyses to investigate factors associated with service contact. FINDINGS The prevalence of self-reported lifetime NSSH increased from 2·4% (95% CI 2·0-2·8) in 2000, to 6·4% (5·8-7·2) in 2014. Increases in prevalence were noted in both sexes and across age groups-most notably in women and girls aged 16-24 years, in whom prevalence increased from 6·5% (4·2-10·0) in 2000, to 19·7% (15·7-24·5) in 2014. The proportion of the population reporting NSSH to relieve unpleasant feelings of anger, tension, anxiety, or depression increased from 1·4% (95% CI 1·0-2·0) to 4·0% (3·2-5·0) in men and boys, and from 2·1% (1·6-2·7) to 6·8% (6·0-7·8) in women and girls, between 2000 and 2014. In 2014, 59·4% (95% CI 54·7-63·9) of participants who had engaged in NSSH reported no consequent medical or psychological service contact, compared with 51·2% (42·2-60·0) in 2000 and 51·8% (47·3-56·4) in 2007. Male participants and those aged 16-34 years were less likely to have contact with health services than were female participants and older people. INTERPRETATION The prevalence of NSSH has increased in England, but resultant service contact remains low. In 2014, about one in five female 16-24-year-olds reported NSSH. There are potential lifelong implications of NSSH, such as an increased frequency of suicide, especially if the behaviours are adopted as a long-term coping strategy. Self-harm needs to be discussed with young people without normalising it. Young people should be offered help by primary care, educational, and other services to find safer ways to deal with emotional stress. FUNDING NHS Digital, English Department of Health and Social Care, and the National Institute for Health Research.
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Affiliation(s)
| | - David Gunnell
- Population Health Sciences, University of Bristol, Bristol UK; National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | | | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Traolach Brugha
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Rachel Jenkins
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Louis Appleby
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Gjervig Hansen H, Köhler-Forsberg O, Petersen L, Nordentoft M, Postolache TT, Erlangsen A, Benros ME. Infections, Anti-infective Agents, and Risk of Deliberate Self-harm and Suicide in a Young Cohort: A Nationwide Study. Biol Psychiatry 2019; 85:744-751. [PMID: 30563760 DOI: 10.1016/j.biopsych.2018.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Evidence links infections to mental disorders and suicidal behavior. However, knowledge is sparse regarding less severe infections, anti-infective treatment, and deliberate self-harm. Using nationwide Danish longitudinal registers, we estimated associations between infections treated with anti-infective agents and infections requiring hospitalization with the risk of deliberate self-harm. METHODS A total of 1.3 million people born between 1977 and 2002 were followed during the period from 1995 to 2013. In total, 15,042 individuals were recorded with deliberate self-harm (92% had been treated with anti-infective agents and 19% had been hospitalized for infections) and 114 died by suicide (64% had been treated with anti-infective agents and 13% had been hospitalized for infections). Hazard rate ratios were obtained while adjusting for age, gender, calendar period, education, hospitalizations with infections, prescribed anti-infective agents during childhood, parental mental disorders, and parental deliberate self-harm. RESULTS Individuals with infections treated with anti-infective agents had an increased risk of deliberate self-harm with a hazard rate ratio of 1.80 (95% confidence interval = 1.68-1.91). The associations fitted a dose-response relationship (p < .001) and remained significant up to 5 years after last infection. An additive effect was found for individuals with an additional hospitalization for infections with an increased hazard rate ratio of 3.20 (95% confidence interval = 2.96-3.45) for deliberate self-harm. CONCLUSIONS An increased risk of deliberate self-harm was found among individuals with infections treated with anti-infective agents in temporal and dose-response associations. These results add to the growing literature on a possible link between infections and the pathophysiological mechanisms of suicidal behavior.
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Affiliation(s)
- Helene Gjervig Hansen
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.
| | - Ole Köhler-Forsberg
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark
| | - Liselotte Petersen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark; iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Teodor T Postolache
- University of Maryland School of Medicine, Baltimore, Maryland; Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Denver, Colorado; The Military and Veteran Microbiome Consortium for Research and Education, Denver, Colorado
| | - Annette Erlangsen
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Michael E Benros
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
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Pisinger VS, Hawton K, Tolstrup JS. School- and class-level variation in self-harm, suicide ideation and suicide attempts in Danish high schools. Scand J Public Health 2018; 47:146-156. [DOI: 10.1177/1403494818799873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: Strong associations have been found between being exposed to self-harm in family and friends and own self-harm in adolescence. Therefore, self-harm and suicide behaviour might tend to cluster within school and school classes. The aim of this study was to describe the prevalence, frequency and type of self-harm, suicide ideation and suicide attempts within Danish high schools and to test whether self-harm and suicide behaviour cluster in schools and school classes. Methods: Data came from the Danish National Youth Study 2014, a national survey. The respective study included 66,284 high-school students nested in 117 schools and 3146 school classes. The prevalence and clustering of self-harm behaviour, ever and within the last year, type of self-harm (e.g. cutting, burning, scratching and hitting) and suicide ideation and suicide attempts were investigated. Multi-level logistic regression was applied to quantify clustering among participants within the same class and school. Results: In total, 12,960 (20%) reported self-harm ever and 5706 (8.6%) within the last year. Prevalence was higher among girls than boys. Among girls, cutting (15%) and scratching (13%) was the most common type of self-harm, whereas among boys, hitting (6.7%) was most prevalent. The degree of clustering of self-harm and suicide behaviour was low, with school-level intra-class correlation coefficients (ICC) ranging from 0.8–1.8% and school class level ICC’s from 4.3–6.8%. Conclusions: This study shows that self-harm was common, especially in girls. The degree of clustering of self-harm and suicide behaviour in school and school classes was low.
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Affiliation(s)
- Veronica S.C. Pisinger
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, Oxford University and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Janne S. Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Olfson M, Blanco C, Wall M, Liu SM, Saha TD, Pickering RP, Grant BF. National Trends in Suicide Attempts Among Adults in the United States. JAMA Psychiatry 2017; 74:1095-1103. [PMID: 28903161 PMCID: PMC5710225 DOI: 10.1001/jamapsychiatry.2017.2582] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/04/2017] [Indexed: 11/14/2022]
Abstract
Importance A recent increase in suicide in the United States has raised public and clinical interest in determining whether a coincident national increase in suicide attempts has occurred and in characterizing trends in suicide attempts among sociodemographic and clinical groups. Objective To describe trends in recent suicide attempts in the United States. Design, Setting, and Participants Data came from the 2004-2005 wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the 2012-2013 NESARC-III. These nationally representative surveys asked identical questions to 69 341 adults, 21 years and older, concerning the occurrence and timing of suicide attempts. Risk differences adjusted for age, sex, and race/ethnicity (ARDs) assessed trends from the 2004-2005 to 2012-2013 surveys in suicide attempts across sociodemographic and psychiatric disorder strata. Additive interactions tests compared the magnitude of trends in prevalence of suicide attempts across levels of sociodemographic and psychiatric disorder groups. The analyses were performed from February 8, 2017, through May 31, 2017. Main Outcomes and Measures Self-reported attempted suicide in the 3 years before the interview. Results With use of data from the 69 341 participants (42.8% men and 57.2% women; mean [SD] age, 48.1 [17.2] years), the weighted percentage of US adults making a recent suicide attempt increased from 0.62% in 2004-2005 (221 of 34 629) to 0.79% in 2012-2013 (305 of 34 712; ARD, 0.17%; 95% CI, 0.01%-0.33%; P = .04). In both surveys, most adults with recent suicide attempts were female (2004-2005, 60.17%; 2012-2013, 60.94%) and younger than 50 years (2004-2005, 84.75%; 2012-2013, 80.38%). The ARD for suicide attempts was significantly larger among adults aged 21 to 34 years (0.48%; 95% CI, 0.09% to 0.87%) than among adults 65 years and older (0.06%; 95% CI, -0.02% to 0.14%; interaction P = .04). The ARD for suicide attempts was also significantly larger among adults with no more than a high school education (0.49%; 95% CI, 0.18% to 0.80%) than among college graduates (0.03%; 95% CI, -0.17% to 0.23%; interaction P = .003); the ARD was also significantly larger among adults with antisocial personality disorder (2.16% [95% CI, 0.61% to 3.71%] vs 0.07% [95% CI, -0.09% to 0.23%]; interaction P = .01), a history of violent behavior (1.04% [95% CI, 0.35% to 1.73%] vs 0.00% [95% CI, -0.12% to 0.12%]; interaction P = .003), or a history of anxiety (1.43% [95% CI, 0.47% to 2.39%] vs 0.18% [95% CI, 0.04% to 0.32%]; interaction P = .01) or depressive (0.99% [95% CI, -0.09% to 2.07%] vs -0.08% [95% CI, -0.20% to 0.04%]; interaction P = .05) disorders than among adults without these conditions. Conclusions and Relevance A recent overall increase in suicide attempts among adults in the United States has disproportionately affected younger adults with less formal education and those with antisocial personality disorder, anxiety disorders, depressive disorders, and a history of violence.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- The New York State Psychiatric Institute, Columbia University, New York, New York
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Rockville, Maryland
| | - Melanie Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- The New York State Psychiatric Institute, Columbia University, New York, New York
| | - Shang-Min Liu
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- The New York State Psychiatric Institute, Columbia University, New York, New York
| | - Tulshi D. Saha
- Division of Biometry and Epidemiology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Roger P. Pickering
- Division of Biometry and Epidemiology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Bridget F. Grant
- Division of Biometry and Epidemiology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
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Morgan C, Webb RT, Carr MJ, Kontopantelis E, Green J, Chew-Graham CA, Kapur N, Ashcroft DM. Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care. BMJ 2017; 359:j4351. [PMID: 29046278 PMCID: PMC5641980 DOI: 10.1136/bmj.j4351] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To examine temporal trends in sex and age specific incidence of self harm in children and adolescents, clinical management patterns, and risk of cause specific mortality following an index self harm episode at a young age.Design Population based cohort study.Setting UK Clinical Practice Research Datalink-electronic health records from 647 general practices, with practice level deprivation measured ecologically using the index of multiple deprivation. Patients from eligible English practices were linked to hospital episode statistics (HES) and Office for National Statistics (ONS) mortality records.Participants For the descriptive analytical phases we examined data pertaining to 16 912 patients aged 10-19 who harmed themselves during 2001-14. For analysis of cause specific mortality following self harm, 8638 patients eligible for HES and ONS linkage were matched by age, sex, and general practice with up to 20 unaffected children and adolescents (n=170 274).Main outcome measures In the first phase, temporal trends in sex and age specific annual incidence were examined. In the second phase, clinical management was assessed according to the likelihood of referral to mental health services and psychotropic drug prescribing. In the third phase, relative risks of all cause mortality, unnatural death (including suicide and accidental death), and fatal acute alcohol or drug poisoning were estimated as hazard ratios derived from stratified Cox proportional hazards models for the self harm cohort versus the matched unaffected comparison cohort.Results The annual incidence of self harm was observed to increase in girls (37.4 per 10 000) compared with boys (12.3 per 10 000), and a sharp 68% increase occurred among girls aged 13-16, from 45.9 per 10 000 in 2011 to 77.0 per 10 000 in 2014. Referrals within 12 months of the index self harm episode were 23% less likely for young patients registered at the most socially deprived practices, even though incidences were considerably higher in these localities. Children and adolescents who harmed themselves were approximately nine times more likely to die unnaturally during follow-up, with especially noticeable increases in risks of suicide (deprivation adjusted hazard ratio 17.5, 95% confidence interval 7.6 to 40.5) and fatal acute alcohol or drug poisoning (34.3, 10.2 to 115.7).Conclusions Gaining a better understanding of the mechanisms responsible for the recent apparent increase in the incidence of self harm among early-mid teenage girls, and coordinated initiatives to tackle health inequalities in the provision of services to distressed children and adolescents, represent urgent priorities for multiple public agencies.
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Affiliation(s)
- Catharine Morgan
- Centre for Pharmacoepidemiology and Drug Safety, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
| | - Roger T Webb
- Centre for Mental Health & Risk, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Matthew J Carr
- Centre for Mental Health & Risk, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Health Informatics, Manchester Academic Health Science Centre (MAHSC), Division of Informatics, Imaging and Data sciences, University of Manchester, Manchester, UK
| | - Jonathan Green
- Manchester Academic Health Science Centre, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK; Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Carolyn A Chew-Graham
- Research Institute for Primary Care and Health Sciences, West Midlands Collaboration for Leadership in Applied Health Research and Care, Keele University, Staffordshire, UK
| | - Nav Kapur
- Centre for Suicide Prevention, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Prestwich Hospital, Prestwich, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
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Conway PM, Erlangsen A, Teasdale TW, Jakobsen IS, Larsen KJ. Predictive Validity of the Columbia-Suicide Severity Rating Scale for Short-Term Suicidal Behavior: A Danish Study of Adolescents at a High Risk of Suicide. Arch Suicide Res 2017; 21:455-469. [PMID: 27602917 DOI: 10.1080/13811118.2016.1222318] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Using the Columbia-Suicide Severity Rating Scale (C-SSRS), we examined the predictive and incremental predictive validity of past-month suicidal behavior and ideation for short-term suicidal behavior among adolescents at high risk of suicide. The study was conducted in 2014 on a sample of 85 adolescents (90.6% females) who participated at follow-up (85.9%) out of the 99 (49.7%) baseline respondents. All adolescents were recruited from a specialized suicide-prevention clinic in Denmark. Through multivariate logistic regression analyses, we examined whether baseline suicidal behavior predicted subsequent suicidal behavior (actual attempts and suicidal behavior of any type, including preparatory acts, aborted, interrupted and actual attempts; mean follow-up of 80.8 days, SD = 52.4). Furthermore, we examined whether suicidal ideation severity and intensity incrementally predicted suicidal behavior at follow-up over and above suicidal behavior at baseline. Actual suicide attempts at baseline strongly predicted suicide attempts at follow-up. Baseline suicidal ideation severity and intensity did not significantly predict future actual attempts over and above baseline attempts. The suicidal ideation intensity items deterrents and duration were significant predictors of subsequent actual attempts after adjustment for baseline suicide attempts and suicidal behavior of any type, respectively. Suicidal ideation severity and intensity, and the intensity items frequency, duration and deterrents, all significantly predicted any type of suicidal behavior at follow-up, also after adjusting for baseline suicidal behavior. The present study points to an incremental predictive validity of the C-SSRS suicidal ideation scales for short-term suicidal behavior of any type among high-risk adolescents.
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Andreasson K, Krogh J, Bech P, Frandsen H, Buus N, Stanley B, Kerkhof A, Nordentoft M, Erlangsen A. MYPLAN -mobile phone application to manage crisis of persons at risk of suicide: study protocol for a randomized controlled trial. Trials 2017; 18:171. [PMID: 28399909 PMCID: PMC5387214 DOI: 10.1186/s13063-017-1876-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 03/03/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Persons with a past episode of self-harm or severe suicidal ideation are at elevated risk of self-harm as well as dying by suicide. It is well established that suicidal ideation fluctuates over time. Previous studies have shown that a personal safety plan can assist in providing support, when a person experiences suicide ideation, and help seeking professional assistance if needed. The aim of the trial is to determine whether a newly developed safety mobile app is more effective in reducing suicide ideation and other symptoms, compared to a safety plan on paper. METHODS/DESIGN The trial is designed as a two-arm, observer-blinded, parallel-group randomized clinical superiority trial, where participants will either receive: (1) Experimental intervention: the safety plan provided as the app MyPlan, or (2) Treatment as Usual: the safety plan in the original paper format. Based on a power calculation, a total of 546 participants, 273 in each arm will be included. They will be recruited from Danish Suicide Prevention Clinics. Both groups will receive standard psychosocial therapeutic care, up to 8-10 sessions of supportive psychotherapy. Primary outcome will be reduction in suicide ideation after 12 months. Follow-up interviews will be conducted at 3, 6, 9, and 12 months after date of inclusion. DISCUSSION A safety plan is a mandatory part of the treatment in the Suicide Prevention Clinics in Demark. There are no studies investigating the effectiveness of a safety plan app compared to a safety plan on paper on reducing suicide ideation in patients with suicide ideation and suicidal behavior. The trial will gain new knowledge of whether modern technology can augment the effects of traditional personalized safety planning. TRIAL REGISTRATION ClinicalTrials.gov, NCT02877316 . Registered on 19 August 2016.
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Affiliation(s)
- Kate Andreasson
- Psychiatric Centre North Zealand, University Hospital of Hillerød, Hillerød, Denmark
| | - Jesper Krogh
- Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Per Bech
- Psychiatric Centre North Zealand, University Hospital of Hillerød, Hillerød, Denmark
| | | | - Niels Buus
- Faculty of Nursing and Midwifery, University of Sydney, St. Vincent’s Hospital Sydney & St. Vincent Private Hospital Sydney, Sydney, Australia
| | - Barbara Stanley
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY USA
| | - Ad Kerkhof
- Department of Clinical Psychology, Vrije University, Amsterdam, The Netherlands
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Annette Erlangsen
- Mental Health Centre Copenhagen, Copenhagen, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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