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Hennipman-Herweijer C, Amerongen-Meeuse JVN, Schaap-Jonker H, Boonstra N. The experiences of living with a suicidal family member, and the impact on daily life: A systematic review and meta-aggregation. J Psychiatr Ment Health Nurs 2024; 31:883-903. [PMID: 38470095 DOI: 10.1111/jpm.13045] [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: 07/05/2023] [Revised: 11/22/2023] [Accepted: 02/27/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Because of the pivotal role that family members play in caring for their suicidal relative, insight into their experiences is necessary to develop good support for them. AIM This systematic review aimed to aggregate qualitative research examining the experiences of family members living with their suicidal relative, and their impact on daily life. METHODS Systematic searches, covering the period 2000-2022, were conducted in Medline, Embase, PsycINFO, Ovid Nursing database and CINAHL. The JBI-QARI meta-aggregation approach and the PRISMA guidelines were followed. RESULTS Eleven studies met the inclusion criteria. Six themes were identified: The hard job of managing the risk of suicide; contributing to the relative's survival; struggling with professional care; being in a lonely position; pressure on relationships; and disruption of well-being. DISCUSSION The constant worry of losing their relative and ever-present vigilance dominates their lives in such a way that their well-being may be decreased. Professionals often overlook family members, which leads to feelings of powerlessness and loneliness. IMPLICATIONS FOR PRACTICE Collaborating with families in treatment, allowing them to share information and supporting them in the care at home may lead to better outcomes for both the family and their suicidal relative.
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Affiliation(s)
- Christina Hennipman-Herweijer
- Center for Research and Innovation in Christian Mental Health Care Eleos/de Hoop, Hoevelaken, The Netherlands
- Eleos Mental Health Care, Bosch en Duin, The Netherlands
- Nursing Sciences, Program in Clinical Health Sciences, Utrecht University, Utrecht, The Netherlands
| | - Joke van Nieuw Amerongen-Meeuse
- Center for Research and Innovation in Christian Mental Health Care Eleos/de Hoop, Hoevelaken, The Netherlands
- Department of Religion and Theology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Hanneke Schaap-Jonker
- Center for Research and Innovation in Christian Mental Health Care Eleos/de Hoop, Hoevelaken, The Netherlands
- Department of Religion and Theology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Nynke Boonstra
- Nursing Science in Mental Health Care, UMC Utrecht, Utrecht, The Netherlands
- NHL Stenden University of Applied Science, Leeuwarden, The Netherlands
- KieN Early Intervention Service, Leeuwarden, The Netherlands
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Lascelles KM, Davey Z, Jackson D, Aveyard H. Experiences and needs of adult informal carers of adults at risk of suicide: A systematic review with mixed methods analysis. J Adv Nurs 2024; 80:1686-1718. [PMID: 38010822 DOI: 10.1111/jan.15940] [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: 03/24/2023] [Revised: 09/29/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023]
Abstract
AIM To systematically review and synthesize primary research on experiences and needs of adult informal caregivers of adults at risk of suicide. DESIGN Systematic review with a data-based convergent synthesis. DATA SOURCES MEDLINE, PsychINFO and CINAHL were searched in April 2022 and February 2023. English language research focusing on experiences of adult carers of adults was included. METHODS Articles were screened by title (n = 9077) and abstract (n = 132) with additional articles (n = 6) obtained via citation and hand searching. Thirty-one included studies were quality assessed using the Mixed Methods Appraisal Tool and study data were systematically extracted prior to thematic synthesis. RESULTS Five interconnected themes resulted: transitions; living with fear and uncertainty; changing relationships; interface with healthcare professionals and services; what carers need and want. Caring impacts mental, physical and social wellbeing. Relationships are affected in ways which might not be evident when caring for a minor. Repeated suicidal behaviour is particularly challenging with ongoing hypervigilance contributing to burden, burnout and interpersonal strain. Poor carer support exacerbates negative effects; carers need to feel informed, educated, involved and holistically supported. CONCLUSION Timely support for carers is essential. Interventions should address emotional responses, relational changes and effective care recipient support. Longitudinal research is required to understand effects of ongoing caring where there are multiple suicide attempts. IMPLICATIONS Nurses can provide carers with early support and information and longer term psychosocial interventions. If carers are adequately equipped and supported patient safety and wellbeing will be improved. IMPACT Findings of this systematic review include relational changes due to carer hypervigilance reducing autonomy and living with the possibility of suicide. Clinician awareness of the potential for relational shifts will help them prepare and support carers. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution.
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Affiliation(s)
| | - Zoe Davey
- Oxford Institute of Nursing Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Debra Jackson
- University of Sydney, Sydney, New South Wales, Australia
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Reina-Aguilar P, Díaz-Jiménez RM, Caravaca-Sánchez F. Suicide Risk among University Students in Spain: Implications for Social Work. SOCIAL WORK 2023; 68:299-306. [PMID: 37421652 DOI: 10.1093/sw/swad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 07/10/2023]
Abstract
Suicide is a phenomenon that affects university students all over the world, and although vulnerability has been revealed in universities, there are still few studies that include large populations, a large number of universities and students pursuing different degrees. The study presented here aims to detect the risk of suicide in Spanish university students pursuing different areas of study. A total of 2,025 students from 16 Spanish universities and 17 degree programs completed an online questionnaire assessing support and suicide risk factors. The results indicate that 29.2 percent of the university students had experienced suicidal ideation in their lifetime. Logistic regression analysis showed that this risk was associated with depressive symptomatology and having suffered sexual violence. In contrast, self-esteem, life satisfaction, and perceived support were shown to be protective factors. Suicide risk affects one in three students. The present study includes particular implications for decision makers in the university community and other related governmental bodies, as well as for social work.
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Affiliation(s)
- Pastora Reina-Aguilar
- MSW, is a substitute teacher, Department of Social Work and Social Services, Faculty of Social Sciences, Pablo de Olavide University, Sevilla, Spain
| | - Rosa María Díaz-Jiménez
- PhD, is full university lecturer, Department of Social Work and Social Services, Faculty of Social Sciences, Pablo de Olavide University, Sevilla, Spain
| | - Francisco Caravaca-Sánchez
- PhD, is assistant professor, Department of Social Work and Social Services, Faculty of Social Sciences, Pablo de Olavide University, Sevilla, Spain
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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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Juel A, Erlangsen A, Berring LL, Larsen ER, Buus N. Re-constructing parental identity after parents face their offspring's suicidal behaviour: An interview study. Soc Sci Med 2023; 321:115771. [PMID: 36801752 DOI: 10.1016/j.socscimed.2023.115771] [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: 09/12/2022] [Revised: 12/28/2022] [Accepted: 02/10/2023] [Indexed: 02/13/2023]
Abstract
INTRODUCTION Parents are affected when their offspring engages in non-fatal suicidal behaviour. Although research exists on parents' mental and emotional state when they realise this behaviour, relatively little attention has been devoted to exploring how their parental identity is affected. PURPOSE To explore how parents re-constructed and negotiated their parental identity after realising that their offspring was suicidal. METHOD A qualitative exploratory design was adopted. We conducted semi-structured interviews with 21 Danish parents who self-identified as having offspring at risk of suicidal death. Interviews were transcribed, analysed thematically and interpreted by drawing on the interactionist concepts of negotiated identity and moral career. FINDINGS Parents' perspectives on their parental identity were conceptualised as a moral career encompassing three distinct stages. Each stage was negotiated through social interaction with other people and the wider society. Entry into the first stage, disrupted parental identity, occurred when parents realised that they could lose their offspring to suicide. At this stage, parents trusted their own abilities to resolve the situation and keep their offspring safe and alive. This trust was gradually undermined by social encounters, which caused career movement. In the second stage, impasse, parents lost faith in their ability to help their offspring and to change the situation. Whereas some parents gradually resigned entirely to impasse, others regained their trust in their own abilities through social interaction in the third stage, restored parental agency. CONCLUSION Offspring's suicidal behaviour disrupted parents' self-identity. Social interaction was fundamental if parents were to re-construct their disrupted parental identity. This study contributes with knowledge about the stages characterising the reconstructive process of parents' self-identity and sense of agency.
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Affiliation(s)
- A Juel
- Psychiatric Research Unit, Psychiatry Region Zealand, Fælledvej 6, 4, 4200 Slagelse, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 4, 2900, Hellerup, Denmark Copenhagen, Denmark; Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense, Denmark.
| | - A Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 4, 2900, Hellerup, Denmark Copenhagen, Denmark; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, S850, Baltimore, MD 21205, USA; Center of Mental Health Research, Building 63, The Australian National University, Canberra ACT 2601, Australia; Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 4, 2900 Hellerup, Denmark.
| | - L L Berring
- Psychiatric Research Unit, Psychiatry Region Zealand, Fælledvej 6, 4, 4200 Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense, Denmark.
| | - E R Larsen
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense, Denmark; Mental Health Department Odense, University Clinic, Mental Health Service, J. B. Winsløws Vej 18, 5000 Odense, Denmark.
| | - N Buus
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense, Denmark; School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health, Monash University, Clayton, Victoria, Australia.
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Marshall CA, Crowley P, Carmichael D, Goldszmidt R, Aryobi S, Holmes J, Easton C, Isard R, Murphy S. Effectiveness of Suicide Safety Planning Interventions: A Systematic Review Informing Occupational Therapy. Can J Occup Ther 2022; 90:208-236. [PMID: 36324257 DOI: 10.1177/00084174221132097] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background. Suicide safety planning (SSP) is a suicide prevention approach that involves developing a collaborative plan between a service provider such as an occupational therapist and a person who is at risk of suicide. Purpose. To synthesize effectiveness studies on SSP. Method. Using the Joanna Briggs Institute methodology, we conducted a systematic review of effectiveness studies including a: (1) title and abstract screening; (2) full-text review; (3) critical appraisal; and (4) narrative synthesis. Findings. We included 22 studies. Critical appraisal scores ranged from 38.5 to 92.3 (m = 63.7). The types of interventions included were: standard and enhanced SSP (n = 11); electronically delivered SSP (n = 5); and SSP integrated with other approaches (n = 6). Only three studies identified meaningful activity as a component of SSP. Evidence across a range of studies indicates that SSP is effective for reducing suicide behavior (SB) and ideation (SI). While some studies have demonstrated effectiveness for reducing symptoms of mental illness, promoting resilience and service use, the number of studies exploring these outcomes is currently limited. Implications. Occupational therapists support individuals expressing SI, and SSP is a necessary skill for practice.
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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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Predictors of prolonged grief in an internet-based grief therapy for people bereaved by suicide. J Psychiatr Res 2022; 149:162-167. [PMID: 35278780 DOI: 10.1016/j.jpsychires.2022.02.023] [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: 09/28/2021] [Revised: 02/07/2022] [Accepted: 02/28/2022] [Indexed: 11/21/2022]
Abstract
Internet-based cognitive-behavioural grief therapy (ICBGT) has proven to be effective for people bereaved by suicide, however the extent to which patients can benefit from therapy seems to differ. This study investigates predictors of initial grief as well as change in grief severity following treatment in an ICBGT for people bereaved by suicide. Data was gathered from a randomized control trial including 57 people participating in a 5-week intervention. Change in grief symptoms was calculated using absolute change scores of grief. In order to examine best overall combination of independent variables, best subset regressions were conducted. Higher levels of pre-test grief were associated with worse sleep quality (β = 0.32, p = .002), lower self-esteem (β = -0.37, p = .002), lower support seeking (β = -0.38, p = .006), and a higher need for social support (β = 0.28, p = .028). A greater reduction in grief severity was associated with higher self-efficacy (β = -0.49, p = .001), higher attachment anxiety (β = -0.31, p = .017) and higher pre-test grief symptoms (β = -0.39, p = .006). Attention should be paid to the intensity of grief, the attachment style and a positive self-image, as these variables seem to influence the extent, to which patients' symptoms of PGD subside following ICBGT. To specifically target factors of patients that require improvement, further studies are needed.
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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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