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Erlangsen A, Madsen T, Nordentoft M. Keeping Track and Providing Tools for Future Crisis Management: Suicide Attempt and Self-Harm Presentations at Emergency Departments. Am J Psychiatry 2024; 181:696-698. [PMID: 39086285 DOI: 10.1176/appi.ajp.20240524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Affiliation(s)
- Annette Erlangsen
- Danish Research Institute for Suicide Prevention and Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen (Erlangsen, Madsen, Nordentoft); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Erlangsen); Section of Epidemiology, Faculty of Health and Medical Sciences (Madsen), and Department of Clinical Medicine (Nordentoft), University of Copenhagen, Copenhagen
| | - Trine Madsen
- Danish Research Institute for Suicide Prevention and Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen (Erlangsen, Madsen, Nordentoft); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Erlangsen); Section of Epidemiology, Faculty of Health and Medical Sciences (Madsen), and Department of Clinical Medicine (Nordentoft), University of Copenhagen, Copenhagen
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention and Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen (Erlangsen, Madsen, Nordentoft); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Erlangsen); Section of Epidemiology, Faculty of Health and Medical Sciences (Madsen), and Department of Clinical Medicine (Nordentoft), University of Copenhagen, Copenhagen
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Mortier P, Amigo F, Bhargav M, Conde S, Ferrer M, Flygare O, Kizilaslan B, Latorre Moreno L, Leis A, Mayer MA, Pérez-Sola V, Portillo-Van Diest A, Ramírez-Anguita JM, Sanz F, Vilagut G, Alonso J, Mehlum L, Arensman E, Bjureberg J, Pastor M, Qin P. Developing a clinical decision support system software prototype that assists in the management of patients with self-harm in the emergency department: protocol of the PERMANENS project. BMC Psychiatry 2024; 24:220. [PMID: 38509500 PMCID: PMC10956300 DOI: 10.1186/s12888-024-05659-6] [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: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Self-harm presents a significant public health challenge. Emergency departments (EDs) are crucial healthcare settings in managing self-harm, but clinician uncertainty in risk assessment may contribute to ineffective care. Clinical Decision Support Systems (CDSSs) show promise in enhancing care processes, but their effective implementation in self-harm management remains unexplored. METHODS PERMANENS comprises a combination of methodologies and study designs aimed at developing a CDSS prototype that assists clinicians in the personalized assessment and management of ED patients presenting with self-harm. Ensemble prediction models will be constructed by applying machine learning techniques on electronic registry data from four sites, i.e., Catalonia (Spain), Ireland, Norway, and Sweden. These models will predict key adverse outcomes including self-harm repetition, suicide, premature death, and lack of post-discharge care. Available registry data include routinely collected electronic health record data, mortality data, and administrative data, and will be harmonized using the OMOP Common Data Model, ensuring consistency in terminologies, vocabularies and coding schemes. A clinical knowledge base of effective suicide prevention interventions will be developed rooted in a systematic review of clinical practice guidelines, including quality assessment of guidelines using the AGREE II tool. The CDSS software prototype will include a backend that integrates the prediction models and the clinical knowledge base to enable accurate patient risk stratification and subsequent intervention allocation. The CDSS frontend will enable personalized risk assessment and will provide tailored treatment plans, following a tiered evidence-based approach. Implementation research will ensure the CDSS' practical functionality and feasibility, and will include periodic meetings with user-advisory groups, mixed-methods research to identify currently unmet needs in self-harm risk assessment, and small-scale usability testing of the CDSS prototype software. DISCUSSION Through the development of the proposed CDSS software prototype, PERMANENS aims to standardize care, enhance clinician confidence, improve patient satisfaction, and increase treatment compliance. The routine integration of CDSS for self-harm risk assessment within healthcare systems holds significant potential in effectively reducing suicide mortality rates by facilitating personalized and timely delivery of effective interventions on a large scale for individuals at risk of suicide.
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Grants
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- ESF+; CP21/00078 ISCIII-FSE Miguel Servet co-funded by the European Social Fund Plus
- PI22/00107 ISCIII and co-funded by the European Union
- PI22/00107 ISCIII and co-funded by the European Union
- PI22/00107 ISCIII and co-funded by the European Union
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- FI23/00004 PFIS ISCIII
- FI23/00004 PFIS ISCIII
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- ERAPERMED2022 the Health Research Board Ireland
- ERAPERMED2022 the Health Research Board Ireland
- no. 2022-00549 the Swedish Innovation Agency
- no. 2022-00549 the Swedish Innovation Agency
- project no. 342386 the Research Council of Norway
- project no. 342386 the Research Council of Norway
- project no. 342386 the Research Council of Norway
- the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- CIBER of Epidemiology & Public Health
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Affiliation(s)
- Philippe Mortier
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain.
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain.
| | - Franco Amigo
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
| | - Madhav Bhargav
- School of Public Health & National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Susana Conde
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
| | - Montse Ferrer
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Oskar Flygare
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Busenur Kizilaslan
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Laura Latorre Moreno
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
| | - Angela Leis
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Miguel Angel Mayer
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Víctor Pérez-Sola
- Neuropsychiatry and Drug Addiction Institute, Barcelona MAR Health Park Consortium PSMAR, Barcelona, Spain
- CIBER of Mental Health and Carlos III Health Institute (CIBERSAM, ISCIII), Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ana Portillo-Van Diest
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
| | - Juan Manuel Ramírez-Anguita
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ferran Sanz
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- National Bioinformatics Institute - ELIXIR-ES (IMPaCT-Data-ISCIII), Barcelona, Spain
| | - Gemma Vilagut
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
| | - Jordi Alonso
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ella Arensman
- School of Public Health & National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Manuel Pastor
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Goldman-Mellor S, Qin P. Interpersonal violent injury and subsequent risk of suicide and deliberate self-harm: a register-based national cohort study from Norway, 2010-2018. EClinicalMedicine 2024; 68:102442. [PMID: 38333541 PMCID: PMC10850407 DOI: 10.1016/j.eclinm.2024.102442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/01/2024] [Accepted: 01/11/2024] [Indexed: 02/10/2024] Open
Abstract
Background Interpersonal violence is a leading cause of morbidity, with potentially severe adverse consequences for the mental health of the injured persons. The extent to which violent injury is associated with subsequent suicidal behavior, however, remains unclear. This study aimed to examine how violent injury was associated with subsequent deliberate self-harm and death by suicide. Methods This retrospective cohort study used nationwide longitudinal registry data from Norway to identify all individuals presenting to emergency services in 2010-2018 with a violence-related injury, along with sex- and age-matched control individuals from the general population. The primary outcomes were any emergency visit for deliberate self-harm (DSH) and suicide death, observed through 31 December 2018. Rates of each outcome were compared between violence-injured patients and comparison individuals using stratified multivariable Cox regression models, controlling for sociodemographic characteristics as well as history of psychiatric treatment and DSH. Secondary analyses tested for moderation by sex, age, and prior psychiatric treatment. Findings Violence-injured patients (n = 28,276) had substantially higher rates of DSH (946.7 per 100,000 person-years) and suicide death (74.5 per 100,000) when compared to controls (n = 282,760; 90.0 and 15.2 per 100,000, respectively). The hazard ratios (HRs) remained significantly higher even after accounting for covariates (HRadj for DSH: 5.11; 95% CI: 4.62, 5.66; HRadj for suicide: 2.40; 95% CI: 1.78, 3.24). Sex differences in this association were negligible, but the association between violence injury and DSH increased with age. Violence-injured patients with prior psychiatric treatment had the highest risk of suicidal behavior. Interpretation Violence-injured patients experience significantly excess rates of suicidal behavior, a finding with potential to inform both clinical intervention and population-level suicide prevention strategies. Funding Fulbright Norway Scholarship.
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Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health, University of California, Merced, 5200 N. Lake Rd., Merced, CA, USA
- Health Sciences Research Institute, University of California, Merced, 5200 N. Lake Rd., Merced, CA, USA
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Kim HH, Lee JH, Song IH, Park YR. Characteristics and risk factors of suicide among people who attempted self-harm in South Korea: A longitudinal National Cohort Study in South Korea. Psychiatry Res 2023; 330:115613. [PMID: 38000207 DOI: 10.1016/j.psychres.2023.115613] [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] [Received: 04/27/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
Although self-harm is known as a significant risk factor for suicide, there are insufficient studies on the characteristics of people who self-harmed and the factors affecting suicide using a national dataset in Asia. This study aimed to identify demographic, clinical, and socioeconomic factors of individuals who attempted self-harm concerning suicide mortality. By analyzing the Korean National Health Insurance Service data from 2002 to 2020, we compared the people who attempted self-harm to the general population and explored factors affecting suicide by using the Cox proportional hazards model. Older age, female sex, lower socioeconomic status, and psychiatric conditions were associated with higher self-harm attempts. Suicide was more prevalent among males with mild disabilities, using fatal self-harm methods, and higher Charlson Comorbidity Index (CCI) scores. Socioeconomic factors that were significantly related to self-harm attempt were relatively less significant in the suicide survival analysis, while male gender, older age, fatal self-harm methods, high CCI scores, psychiatric diagnosis, and drinking habits were significantly associated with lower suicide survival rates. These results showed that demographic, clinical and socioeconomic factors affecting self-harm differ from those affecting actual suicidal death after self-harm. These insights may assist in developing targeted prevention strategies for specific populations.
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Affiliation(s)
- Hye Hyeon Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea; Division of Biomedical Informatics, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jin Hyuk Lee
- Department of Social Welfare, Ewha Womans University, Seoul, South Korea
| | - In Han Song
- Health & Mental Health Lab, Yonsei University Graduate School of Social Welfare, Seoul, South Korea; Institute for Convergence Science Academy, Yonsei University, Seoul, South Korea.
| | - Yu Rang Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea; Institute for Convergence Science Academy, Yonsei University, Seoul, South Korea; Graduate School of Medical Science, Brain Korea 21 FOUR Project, Yonsei University College of Medicine, Seoul, South Korea.
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5
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Seljenes Bøe A, Mehlum L, Melle I, Qin P. Psychiatric disorders among adult deliberate self-harm patients and subsequent risk of dying by suicide, mental and behavioural disorders and other external causes. J Psychiatr Res 2023; 165:83-90. [PMID: 37481790 DOI: 10.1016/j.jpsychires.2023.07.011] [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: 04/27/2023] [Revised: 06/24/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Deliberate self-harm (DSH) treated in general hospital is a well-established risk factor for suicide and other cause mortality. However, few studies have used population data to investigate the differential impact of specific psychiatric disorders on the risk of subsequent suicide, by sex and age of the patient in the context of previous DSH episodes. METHOD All patients aged 18 and older treated for DSH in general hospitals during the period 2008-2018 were identified through national registers. Cox proportional hazards regression was used to ascertain the associated risk of death by suicide, mental and behavioural disorder and other external causes. RESULTS The cohort consisted of 39 479 patients of which 878 died by suicide, 461 by mental and behavioural disorders and 1037 by other external causes. Overall, schizophrenia spectrum disorders, affective disorders and personality disorders increased the risk of suicide. Large gender and age differences were identified in the risk of suicide associated with personality disorders and affective disorders. Alcohol use disorders and dementia increased the risk of dying by mental and behavioural disorders and alcohol use disorders and other substance use disorders increased the risk of death by external causes. CONCLUSION Schizophrenia spectrum disorders, affective disorders and personality disorders increased the risk of suicide among DSH patients, but the effect varied by gender, age and history of previous DSH. Psychiatric evaluation of all DSH patients and treatment tailored to the patient's specific needs is essential to reduce the risk of premature death.
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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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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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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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Bøe AS, Mehlum L, Melle I, Qin P. Clinical determinants of hospital treated deliberate self-harm repetition: A time to recurrent event analysis. Acta Psychiatr Scand 2022; 146:557-567. [PMID: 36177728 PMCID: PMC9828803 DOI: 10.1111/acps.13503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/07/2022] [Accepted: 09/19/2022] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Psychiatric disorders are strongly associated with hospital treated deliberate self-harm (DSH). However, the effect of specific disorders on risk for DSH repetition in sex-age-subgroups is understudied. The present study aims to assess the influence of various specific psychiatric disorders on risk for subsequent DSH repetition by way of time to recurrent event analysis on a national cohort of DSH patients. MATERIAL AND METHODS Individuals aged 18 and older presenting to somatic hospital for DSH during the period 2008-2018 was identified through national registers. A parametric shared frailty survival analysis was used to investigate the impact of various psychiatric disorders on risk of DSH repetition. RESULTS The cohort consisted of 39,508 individuals of which 8634 (21.8%) presented with 24,028 repeated episodes of hospital treated DSH. Borderline personality disorder increased the risk of DSH repetition in females (adjusted HR 1.49, CI 1.41-1.57), while alcohol use disorder (HR 1.12, CI 1.04-1.19) and substance use disorders (adjusted HR 1.22, CI 1.14-1.32) increased the risk of repetition in males. The strongest impact of psychiatric disorder on risk of repetition was found among the elderly. Previous history of DSH was associated with the highest increased risk of repetition. CONCLUSION Prior history of DSH was strongly associated with DSH repetition, but the influence of psychiatric disorder varied significantly by specific diagnoses and by sex and age of the patients. Efforts to prevent DSH repetition should be age and gender specific and designed to meet the needs of people with different specific psychiatric disorders.
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Affiliation(s)
- Anne Seljenes Bøe
- The National Centre for Suicide Research and PreventionInstitute of Clinical Medicine, University of OsloOsloNorway
| | - Lars Mehlum
- The National Centre for Suicide Research and PreventionInstitute of Clinical Medicine, University of OsloOsloNorway
| | - Ingrid Melle
- Division of Mental Health and AddictionOslo University Hospital and Institute of Clinical MedicineOsloNorway
| | - Ping Qin
- The National Centre for Suicide Research and PreventionInstitute of Clinical Medicine, University of OsloOsloNorway
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Shafiee M, Mahboubi M, Shanbehzadeh M, Kazemi-Arpanahi H. Design, development, and evaluation of a surveillance system for suicidal behaviors in Iran. BMC Med Inform Decis Mak 2022; 22:180. [PMID: 35818024 PMCID: PMC9275034 DOI: 10.1186/s12911-022-01925-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is a serious cause of morbidity and mortality in Iran and worldwide. Although several organizations gather information on suicide and suicide attempts, there is substantial misperception regarding the description of the phenomenon. This study proposes the minimum data set (MDS) for suicidal behaviors surveillance. METHODS A literature review was first conducted to achieve a thorough overview of suicide-related items and map the existing evidence supporting the development of the MDS. The data items included in the literature review were then analyzed using a two-round Delphi technique with content validation by an expert panel. The suicidal behaviors surveillance system was then established based on the confirmed MDS, and ultimately, its performance was assessed by involving the end-users. RESULTS The panel of experts consisted of 50 experts who participated in the Delphi phase and validity content review. Of these, 46% were men, and their mean age and average work experience were (36.4, SD ± 6.4) and (12.32, SD ± 5.2) years, respectively. The final MDS platform of our study contained 108 items classified into eight main categories. A web-based system with a modular and layered architecture was developed based on the derived MDS. CONCLUSION The developed system provides a framework for recording suicidal behaviors' data. The integration of multiple suicide-related information systems at the regional and national levels makes it possible to assess the long-term outcomes and evolutions of suicide prevention interventions.
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Affiliation(s)
- Mohsen Shafiee
- Department of Nursing, Abadan University of Medical Sciences, Abadan, Iran
| | - Mohammad Mahboubi
- Department of Public Health, Abadan University of Medical Sciences, Abadan, Iran
| | - Mostafa Shanbehzadeh
- Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Hadi Kazemi-Arpanahi
- Department of Health Information Technology, Abadan University of Medical Sciences, Abadan, Iran. .,Department of Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran.
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Lunde KB, Mehlum L, Melle I, Qin P. Psychiatric admissions after hospital presented deliberate self-harm in the young: A national study. J Psychiatr Res 2022; 151:575-582. [PMID: 35636035 DOI: 10.1016/j.jpsychires.2022.05.020] [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: 12/11/2021] [Revised: 05/01/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022]
Abstract
Follow-up psychiatric care is crucial for young adults presenting to hospitals because of deliberate self-harm (DSH). However, who receives such care is not sufficiently understood. We therefore investigated the clinical and sociodemographic correlates of admissions to psychiatric inpatient treatment immediately following general hospital treatment of DSH in this age band. All episodes of hospital presented DSH among patients aged 18-35 years during the period 2008-2018 were identified from the Norwegian Patient Register. The outcome was admissions to psychiatric inpatient treatment immediately after discharge from the general hospital. The correlates of such admissions were calculated using binomial generalized estimating equation. Of 26.166 identified DSH episodes, 21.4% were admitted to psychiatric inpatient treatment. Admissions were most common for patients with a history of psychiatric treatment and a recorded diagnosis of psychosis-, mood- or personality disorders. Adjusted for other psychiatric factors, alcohol- or substance misuse diagnoses and repeated presentations of DSH were inversely associated with admissions to psychiatric inpatient treatment. Young adults admitted to psychiatric inpatient treatment following DSH have a high burden of psychiatric morbidity and risk factors for suicide. However, the inverse association seen for two important risk factors for suicide, alcohol- or substance misuse and repeated DSH, warrants further attention.
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Affiliation(s)
- Ketil Berge Lunde
- National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway.
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- NORMENT K.G. Jebsen Centre for Psychosis Research, University of Oslo, Oslo, Norway
| | - Ping Qin
- National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway
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11
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Qin P, Stanley B, Melle I, Mehlum L. Association of Psychiatric Services Referral and Attendance Following Treatment for Deliberate Self-harm With Prospective Mortality in Norwegian Patients. JAMA Psychiatry 2022; 79:651-658. [PMID: 35583901 PMCID: PMC9118082 DOI: 10.1001/jamapsychiatry.2022.1124] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Psychiatric care following somatic treatment for deliberate self-harm (DSH) is pivotal in patients' lives both in the short and long term, but evidence to guide such care is limited. OBJECTIVE To examine follow-up psychiatric care for patients treated for DSH (ie, intentional self-injury or self-poisoning, irrespective of motivation) at hospital emergency departments and to assess the association of psychiatric referral and treatment attendance with risk of subsequent mortality in these patients. DESIGN, SETTING, AND PARTICIPANTS Retrospective data from several Norwegian registries were interlinked to follow up a national cohort of all patients with hospital-treated DSH for up to 11 years from 2008 through 2018. Data were analyzed from March to October 2021. EXPOSURES Socioeconomic characteristics, psychiatric history, and clinical features of DSH. MAIN OUTCOMES AND MEASURES Referral to psychiatric services, attendance in psychiatric treatment, and prospective mortality were the 3-stage outcomes during follow-up. Logistic regression with odds ratios and cause-specific survival analysis with hazard ratios were used to examine associations between exposures and outcomes. RESULTS The study identified 43 153 patients (24 286 [56.3%] female; median [IQR] age at index DSH, 39.0 [23.0-56.0] years) involving 69 569 DSH episodes. Of these patients, 6762 (15.7%) were referred to psychiatric services after somatic treatment for DSH, and 22 008 patients (51.0%) attended psychiatric treatment within 3 months of discharge following somatic treatment for DSH. Prior psychiatric history and psychiatric disorders comorbid with DSH were associated with both referral to and attendance in psychiatric care. During follow-up, 7041 patients died by suicide (n = 911) or other causes (n = 6130). While suicide risk was associated with male sex, age 35 to 64 years, and particularly prior and coexisting psychopathologies, other-cause mortality was associated with age 65 years and older and socioeconomic disadvantage. Patients with psychiatric referrals generally had an increased risk of suicide, but the risk was particularly high among patients who received a referral but did not subsequently attend psychiatric treatment (adjusted hazard ratio, 3.07; 95% CI, 2.28-4.12). The observed association was more pronounced during the first years of follow-up and in patients aged 10 to 34 years or 35 to 64 years and those with a clear intent of self-harm. CONCLUSIONS AND RELEVANCE This national cohort study found an association between psychiatric care attendance following treatment for DSH and prospective mortality, highlighting the importance of patient engagement in psychiatric treatment.
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Affiliation(s)
- Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Barbara Stanley
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ingrid Melle
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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12
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Shafiee M, Shanbehzadeh M, Kazemi-Arpanahi H. Establishing a minimum data set for suicide and attempted suicide registry system in Iran. BMC Public Health 2022; 22:857. [PMID: 35484542 PMCID: PMC9052659 DOI: 10.1186/s12889-022-13276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicidal behavior is a major cause of mortality and disability worldwide. Accurate and consistent collection of data on suicide, suicide ideation, and suicide attempts presents many challenges for public health practitioners, policymakers, and researchers. This study aimed to establish a minimum data set (MDS) for integrating data across suicide registries and other data sources. METHODS The MDS proposed in this study was developed in two-stepwise stages. First, an extensive literature review was performed in order to identify the potential data items. Then, we conducted a two-round Delphi stage to reach a consensus among experts regarding essential data items and a supplementary one-round Delphi stage for validating the content of the final MDS by calculating the individual item content validity index (CVI) and content validity ratio (CVR) and using other statistical tests. RESULTS After the literature review, 189 data items were extracted and sent to a panel of experts in the form of a questionnaire. In the Delphi stage and CVI calculation, 55 and 10 experts participated in kappa and CVR calculation, respectively. Finally, the MDS of the suicide registry was finalized with 84 data elements that were classified into four categories, including patient profile, socio-economic status, clinical and psychopathological status, and suicide circumstances. CONCLUSIONS The suicide MDS can become a standardized and consistent infrastructure for meaningful evaluations, reporting, and benchmarking of suicidal behaviors across regions and countries. We hope this MDS will facilitate epidemiological surveys and support policymakers by providing higher quality data capture to guide clinical practice and improve patient-centered outcomes.
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Affiliation(s)
- Mohsen Shafiee
- Department of Nursing, Abadan University of Medical Sciences, Abadan, Iran
| | - Mostafa Shanbehzadeh
- Department of Health Information Technology, Ilam University of Medical Sciences, Ilam, Iran
| | - Hadi Kazemi-Arpanahi
- Department of Health Information Technology, Abadan University of Medical Sciences, Abadan, Iran. .,Department of Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran.
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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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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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