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| 2. |
- Ambrus, Livia, et al.
(författare)
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Plasma Brain-Derived Neurotrophic Factor and Psychopathology in Attempted Suicide
- 2016
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Ingår i: Neuropsychobiology. - : S. Karger AG. - 0302-282X .- 1423-0224. ; 73:4, s. 241-248
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aims: Increasing evidence suggests a link between brain-derived neurotrophic factor (BDNF) and suicidal behaviour (SB). Furthermore, decreased peripheral BDNF levels have been associated with clinical symptoms in various psychiatric disorders as well as with personality dimensions in healthy individuals. However, the relationship between BDNF and psychopathology is poorly investigated regarding SB. Methods: Plasma BDNF concentrations were analysed in 61 recent suicide attempters. Clinical symptoms were evaluated using the Comprehensive Psychopathological Rating Scale. Personality dimensions were assessed using the Marke-Nyman Temperament Scale. Results: Plasma BDNF correlated positively and significantly with the personality dimension Solidity but not with the other personality dimensions or with clinical symptoms. Conclusion: BDNF plays an important role in the regulation of neuroplasticity and neurogenesis in humans. Our results indicate that lower BDNF concentrations are associated with higher levels of impulsiveness and changeability (low scores on the Solidity scale). Furthermore, low plasma BDNF levels may be proposed as a trait marker rather than a state marker for attempted suicide. (C) 2016 S. Karger AG, Basel
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| 3. |
- Bergqvist, Erik, et al.
(författare)
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Health care utilisation two years prior to suicide in Sweden: a retrospective explorative study based on medical records
- 2022
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective Previous literature has suggested that identifying putative differences in health care seeking patterns before death by suicide depending on age and gender may facilitate more targeted suicide preventive approaches. The aim of this study is to map health care utilisation among individuals in the two years prior to suicide in Sweden in 2015 and to examine possible age and gender differences. Methods Design: A retrospective explorative study with a medical record review covering the two years preceding suicide. Setting: All health care units located in 20 of Sweden's 21 regions. Participants: All individuals residing in participating regions who died by suicide during 2015 (n = 949). Results Almost 74% were in contact with a health care provider during the 3 months prior to suicide, and 60% within 4 weeks. Overall health care utilisation during the last month of life did not differ between age groups. However, a higher proportion of younger individuals (< 65 years) were in contact with psychiatric services, and a higher proportion of older individuals (>= 65 years) were in contact with primary and specialised somatic health care. The proportion of women with any type of health care contact during the observation period was larger than the corresponding proportion of men, although no gender difference was found among primary and specialised somatic health care users within four weeks and three months respectively prior to suicide. Conclusion Care utilisation before suicide varied by gender and age. Female suicide decedents seem to utilise health care to a larger extent than male decedents in the two years preceding death, except for the non-psychiatric services in closer proximity to death. Older adults seem to predominantly use non-psychiatric services, while younger individuals seek psychiatric services to a larger extent.
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| 4. |
- Westrin, Åsa
(författare)
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Stress-related peptides in suicide attempters
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A suicide attempt is the best known predictor of completed suicide. It has long been assumed that most suicide attempts are the results of stress. The aim of this thesis was to examine some stress related peptides and their relations to the hypothalamic pituitary adrenal (HPA) axis, diagnoses and temperament in a heterogeneous group of suicide attempters shortly after a suicide attempt and at follow up. As compared with healthy controls, the suicide attempters had increased pre- and postdexamethasone cortisol levels. They also had increased plasma delta sleep-inducing peptide (DSIP) and decreased plasma neuropeptide Y (NPY) and corticotrophin releasing hormone (CRH) in plasma. The most deviant DSIP levels were seen in major depressive disorder (MDD) patients and in patients who had attempted suicide previously (repeaters). Repeaters also showed the lowest plasma NPY levels. Furthermore, the results suggested an association between plasma NPY on the one hand and psychasthenia and irritability on the other. CRH concentrations in cerebrospinal fluid (CSF) were continuously low in the patients, whereas CSF somatostatin increased along with clinical improvement. These findings are in contrast with the low DSIP, high NPY and CRH in plasma previously noted in MDD patients by others. They are also in contrast with high CSF CRH levels which normally decrease with recovery from MDD. Our conclusion is that the stress experienced by patients with a recent suicide attempt have alterations in the stress system, which may be somewhat different from the stress system reactions seen in, e.g. general MDD patients.
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| 6. |
- Fröding, Elin, et al.
(författare)
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Suicide as an incident of severe patient harm : A retrospective cohort study of investigations after suicide in Swedish healthcare in a 13-year perspective
- 2021
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 11:3
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To explore how mandatory reporting to the supervisory authority of suicides among recipients of healthcare services has influenced associated investigations conducted by the healthcare services, the lessons obtained and whether any suicide-prevention-related improvements in terms of patient safety had followed. Design and settings Retrospective study of reports from Swedish primary and secondary healthcare to the supervisory authority after suicide. Participants Cohort 1: the cases reported to the supervisory authority in 2006, from the time the reporting of suicides became mandatory, to 2007 (n=279). Cohort 2: the cases reported in 2015, a period of well-established reporting (n=436). Cohort 3: the cases reported from September 2017, which was the time the law regarding reporting was removed, to November 2019 (n=316). Primary and secondary outcome measures Demographic data and received treatment in the months preceding suicide were registered. Reported deficiencies in healthcare and actions were categorised by using a coding scheme, analysed per individual and aggregated per cohort. Separate notes were made when a deficiency or action was related to a healthcare-service routine. Results The investigations largely adopted a microsystem perspective, focusing on final patient contact, throughout the overall study period. Updating existing or developing new routines as well as educational actions were increasingly proposed over time, while sharing conclusions across departments rarely was recommended. Conclusions The mandatory reporting of suicides as potential cases of patient harm was shown to be restricted to information transfer between healthcare providers and the supervisory authority, rather than fostering participative improvement of patient safety for suicidal patients. The similarity in outcomes across the cohorts, regardless of changes in legislation, suggests that the investigations were adapted to suit the structure of the authority's reports rather than the specific incident type, and that no new service improvements or lessons are being identified.
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| 7. |
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| 8. |
- Janelidze, Shorena, et al.
(författare)
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Low IL-8 is associated with anxiety in suicidal patients: genetic variation and decreased protein levels
- 2015
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley: 12 months. - 0001-690X .- 1600-0447. ; 131:4, s. 269-278
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveRecent studies indicate that inflammation may play a role in the pathophysiology of suicidality. Interleukin-8 (IL-8) is a chemokine that in addition to its function in the immune system also exert neuroprotective properties. The involvement of this chemokine in neuropsychiatric conditions is incompletely known. MethodWe measured plasma and cerebrospinal fluid (CSF) IL-8, as well as the genotype frequency of a single nucleotide polymorphism (-251A/T, rs4073) in the promoter region of the IL8 gene, in suicide attempters (n=206) and healthy controls (n=578). ResultsPlasma and CSF levels of IL-8 were significantly lower in suicide attempters with anxiety than in healthy controls. IL-8 in both plasma and CSF correlated negatively with symptoms of anxiety. Compared with the population-based cohort, the IL-8-251T allele was more prevalent among female suicide attempters. Furthermore, suicide attempters carrying this allele showed more severe anxiety. This correlative study warrants further mechanistic studies on the effects of IL-8 in the central nervous system. ConclusionWe suggest that IL-8 might be involved in the biological mechanisms mediating resilience to anxiety. Thus, our findings highlight the chemokine IL-8 as a potential target for future development of anti-anxiety treatments and suicide prevention.
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| 9. |
- Palmqvist Öberg, Nina Margareta, et al.
(författare)
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Last general practitioner consultation during the final month of life : a national medical record review of suicides in Sweden
- 2024
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Ingår i: BMC Primary Care. - : BioMed Central (BMC). - 2731-4553. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Individuals who die by suicide often consult their general practitioners (GPs) in their final weeks of life. The aim of this study was to gain a deeper knowledge of the clinical characteristics and GP assessments and treatments among individuals who consulted their GPs during the month preceding suicide. Further, we compared these features in those with and without contact with psychiatric services (PC and NPC, respectively) during the two years that preceded the suicide.Design: A nationwide retrospective explorative study investigating medical records.Setting: Primary care in Sweden.Participants: Individuals who died by suicide in Sweden in 2015 with a GP visit within 30 days of death.Results: The study cohort corresponds to one fifth (n = 238) of all suicides that occurred in Sweden in 2015 (n = 1179), representing all those with available primary care records showing contact with a GP during the final 30 days of life (NPC: n = 125; PC: n = 113). The mean age was 58 years +/- 19. Patients in the NPC group were older (NPC: 63 years +/- 19 vs. PC: 53 years +/- 18, p < 0.0001) and presented psychiatric symptoms less often (NPC: 50% vs. PC: 67%, p < 0.006). Somatic symptoms were as common as psychiatric symptoms for the whole sample, being present in more than half of individuals. Suicide risk was noted in only 6% of all individuals. Referral to psychiatric services occurred in 14%, less commonly for the NPC group (NPC: 6% vs. PC: 22%, p < 0.001). Cardiovascular or respiratory symptoms were noted in 19%, more often in the NPC group (NPC: 30% vs. PC: 6%, p < 0.001), as were diagnoses involving the circulatory system (all 10%, NPC:14% vs. PC: 5%, p < 0.020).Conclusion: A high level of somatic symptoms was observed in primary care patients both with and without psychiatric contact, and this might have influenced GPs' management decisions. Psychiatric symptoms were noted in two thirds of those with psychiatric contact but only half of those without. While GPs noted psychiatric symptoms in over half of all individuals included in the study, they seldom noted suicide risk. These findings highlight the need for increased attention to psychiatric symptoms and suicide risk assessment, particularly among middle-aged and older individuals presenting with somatic symptoms.Strengths and limitations of this study: The National Cause of Death Register has excellent coverage of suicide deaths and access to medical records was very good. The medical record review provided detailed information regarding primary care utilization before death by suicide. Because of the lack of statistical power, due to the limited number of persons with GP contact during the last month of life, we chose not to correct for multiple comparisons. Our study approach did not capture the reasons behind GPs' documentation of elevated suicide risk. No systematic inter-rater reliability (IRR) testing was made, however, reviewers received training and continuous support from the research group.
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| 10. |
- Ventorp, Filip, et al.
(författare)
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The CD44 ligand hyaluronic acid is elevated in the cerebrospinal fluid of suicide attempters and is associated with increased blood-brain barrier permeability.
- 2016
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Ingår i: Journal of Affective Disorders. - : Elsevier BV. - 1573-2517 .- 0165-0327. ; 193, s. 349-354
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Tidskriftsartikel (refereegranskat)abstract
- The glycosaminoglycan hyaluronic acid (HA) is an important component of the extracellular matrix (ECM) in the brain. CD44 is a cell adhesion molecule that binds to HA in the ECM and is present on astrocytes, microglia and certain neurons. Cell adhesion molecules have been reported to be involved in anxiety and mood disorders. CD44 levels are decreased in the cerebrospinal fluid (CSF) of depressed individuals, and the CD44 gene has been identified in brain GWAS studies as a possible risk gene for suicidal behavior.
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