| 1. |
- Antretter, E, et al.
(author)
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The factorial structure of the Suicide Intent Scale : a comparative study in clinical samples from 11 European regions.
- 2008
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In: International Journal of Methods in Psychiatric Research. - : Wiley. - 1049-8931 .- 1557-0657. ; 17:2, s. 63-79
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Journal article (peer-reviewed)abstract
- Although the Suicide Intent Scale (SIS) is a widely used instrument in research on suicidal behavior, comparative research on the latent structure of the SIS has been neglected. To determine whether a general factor model of the SIS is supported, alternative factor models of the SIS were evaluated comparatively in 11 clinical samples. The SIS was applied as part of a structured clinical interview to patients after an episode of non-fatal suicidal behavior. The samples were drawn from 11 study centers within the frame of the WHO/EURO multicenter study on suicidal behavior. Three different two-factor and two three-factor models of the SIS were examined in each sample using principal component analysis with orthogonal Procrustes rotation. The factorial structure of the 'subjective part' of the SIS (items 9-14) was strongly supported, whereas an acceptable model fit for the 'objective part' was not found. Possible future revisions of 'objective' SIS items may be worth consideration. As a limitation, the results of the study might not generalize to other samples that use different definitions of non-fatal suicidal behavior.
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| 2. |
- Beckman, K., et al.
(author)
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Impulsive suicide attempts among young people-A prospective multicentre cohort study in Sweden
- 2019
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In: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327 .- 1573-2517. ; 243, s. 421-426
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Journal article (peer-reviewed)abstract
- Background: We aimed to compare the prevalence of impulsive suicide attempts (ISA) among young adults and those over 25 who present at hospital in connection with attempted suicide. We also aimed to identify factors associated with ISA in young adults and to assess medical severity as well as the probability of repeated suicide attempts in this age group. Method: A prospective multicentre cohort study included hospital known cases of suicide attempt (N = 666). The prevalence of ISA was compared between young adults (18-25) and adults aged > 26. We used logistic regression models to identify factors associated with ISA, associations of ISA with high medical severity and prediction of new fatal or non-fatal suicide attempts within 6 months. Results: 43.7% of the young patients had made an ISA, and 30.2% among those aged > 26 (p = 0.001). Among the young, substance use disorder was associated with ISA; crude odds ratio (OR) 2.0 (1.0-4.2), and adjusted OR 2.1 (0.99-4.4). Affective disorder and unemployment/sickness absence implied lower odds of ISA. ISA resulted in injuries of high medical severity as often as more planned attempts and non-fatal or fatal repetition within 6 months was equally common (30%) in both groups. Limitations: The study was set in psychiatric emergency services, which limits the generalizability. Conclusions: Clinicians should acknowledge that suicide attempts among youth often occur without previous planning and may result in medically severe injuries. The probability of new fatal or non-fatal suicide attempts should be kept in mind also after an impulsive suicide attempt.
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| 3. |
- Bille-Brahe, U, et al.
(author)
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A repetition-prediction study of European parasuicide populations : a summary of the first report from part II of the WHO/EURO Multicentre Study on Parasuicide in co-operation with the EC concerted action on attempted suicide.
- 1997
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In: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447. ; 95:2, s. 81-6
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Journal article (peer-reviewed)abstract
- One of the aims of the European Study on Parasuicide, which was initiated by the Regional Office for the European Region of the World Health Organization in the mid-1980s, was to try to identify social and personal characteristics that are predictive of future suicidal behaviour. A follow-up interview study (the Repetition-Prediction Study) was designed, and to date 1145 first-wave interviews have been conducted at nine research centres, representing seven European countries. The present paper provides an abridged version of the first report from the study. The design and the instrument used (The European Parasuicide Study Interview Schedules, EPSIS I and II) are described. Some basic characteristics of the samples from the various centres, such as sex, age, method of suicide attempt, and history of previous attempts, are presented and compared. The male/female sex ratio ranged from 0.41 to 0.85; the mean age range for men was 33-45 years and that for women was 29-45 years. At all of the centres, self-poisoning was the most frequently employed method. On average, more than 50% of all respondents had attempted suicide at least once previously. The representativeness of the samples is discussed. There were differences between the centres in several respects, and also in some cases the representativeness of the different samples varied. Results obtained from analyses based on pooled data should therefore be treated with caution.
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| 4. |
- Bille-Brahe, U, et al.
(author)
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A repetition-prediction study on European parasuicide populations. Part II of the WHO/Euro Multicentre Study on Parasuicide in cooperation with the EC Concerted Action on Attempted Suicide.
- 1996
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In: Crisis. - 0227-5910 .- 2151-2396. ; 17:1, s. 22-31
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Journal article (peer-reviewed)abstract
- One of the aims of the inter-European study on parasuicide, which was initiated by WHO/Euro in the mid-1980s, was to try and identify social and personal characteristics predictive of future suicidal behavior. A follow-up interview study (the Repetition-Prediction Study) was designed, and so far 1145 interviews have been carried out at nine research centers, representing seven European countries. The study and the instrument used (the European Parasuicide Study Interview Schedules, EPSIS I and II) are described here. Some basic characteristics of the material from the various centers are presented and compared, and the representativeness of the samples are discussed. There were differences between the centers in several respects. Results from analyses based on pooled data have to be treated with some caution because of the possible lack of representativeness.
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| 5. |
- Bille-Brahe, U, et al.
(author)
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The WHO-EURO Multicentre Study : risk of parasuicide and the comparability of the areas under study.
- 1996
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In: Crisis. - 0227-5910 .- 2151-2396. ; 17:1, s. 32-42
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Journal article (peer-reviewed)abstract
- The 15 areas under study in the WHO/Euro Multicentre Study on Parasuicide vary considerably with regard to socio-economic factors, culture, life-styles, etc. In this paper, the authors discuss whether the traditional high risk factors for suicidal behavior (such as unemployment, abuse, divorce, etc.) take on different weights depending on local societal and cultural settings. Results from analyzing covariations between various background factors characteristic of the different areas under study and the frequency of attempted suicide showed weak or insignificant correlations, indicating that high-risk factors can only be identified from international pooled data with great care.
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| 6. |
- Caldera, Trinidad, et al.
(author)
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Parasuicide in a low income country : results from a three year hospital surveillance in Nicaragua.
- 2004
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In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 32:5, s. 349-355
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Journal article (peer-reviewed)abstract
- Aims: A study was undertaken to assess the incidence of parasuicide in Nicaragua, to identify groups at risk, and to describe the characteristics of parasuicides, such as methods used and seasonal and diurnal patterns. Method: All hospital-admitted parasuicide cases in the area of León, Nicaragua, were assessed over a three-year period using standardized instruments. Results: Two hundred and thirty-three parasuicide cases were identified in the catchment area giving a parasuicide rate of 66.3/100,000 inhabitants per year based on the population 10 years and older. Corresponding figure for 15 years and older was 71.3. A majority were females (68.8%), who were significantly younger than the males (mean 20.8 years vs. mean 24.6 years). The highest rates were found in the age group 15 - 19 years with a female rate three times higher than the male rate (302.9 vs. 98.9). Pesticides, a highly lethal substance, were used as method in 19.1% of the attempts. Consistent seasonal variation with peaks in May - June and September - October were found over the years. Among parasuicide cases, 46.5% had been in contact with the healthcare system within 6 months before attempting suicide. Conclusions: Parasuicides represent a significant health problem among young people in Nicaragua. Preventive efforts should be directed especially towards the life situation for young girls, limitation of availability of suicide means, increased awareness in schools concerning suicidal problems, as well as improved management of patients with mental health problems within primary healthcare.
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| 7. |
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| 8. |
- Chotai, Jayanti, et al.
(author)
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Season of birth variations in dimensions of functioning evaluated by the diagnostic interview for borderline patients
- 2000
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In: Neuropsychobiology. - : S. Karger AG. - 0302-282X .- 1423-0224. ; 41:3, s. 132-138
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Journal article (peer-reviewed)abstract
- In view of recent reports showing that cerebrospinal fluid (CSF) levels of monoamine metabolites exhibit season of birth variations, and that they are also associated with section II (impulse action patterns) of the diagnostic interview for borderline patients (DIB), we analyzed two samples of data to investigate the relationship between the season of birth and the DIB. The first sample comprised 202 patients participating in psychobiological research in Stockholm, and the second sample comprised 130 patients who had committed suicide in Västerbotten in northern Sweden. Those with intermediate score for section II (impulse action patterns) were significantly more likely to have been born during the season October to January in the pooled data, and this tendency persisted in separate analyses for the two samples and for the two diagnostic groups mood disorders and schizophrenia, respectively. Those with high score for section IV (psychosis) were significantly more likely to have been born during February to April in the pooled sample and in the nonschizophrenic group. In the group with schizophrenia, those born during February to April had significantly high scores for section III (affects). These results throw further light on the role of season of birth in suicidology and in psychiatric morbidity.
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| 9. |
- Chotai, Jayanti, et al.
(author)
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Season of birth variations in suicide methods in relation to any history of psychiatric contacts support an independent suicidality trait.
- 2002
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In: Journal of Affective Disorders. - 0165-0327 .- 1573-2517. ; 69:1-3, s. 69-81
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Journal article (peer-reviewed)abstract
- BACKGROUND: Due to reports on season of birth variations in suicidal behaviour as well as in cerebrospinal fluid levels of monoamine metabolites, we investigated season of birth variations in suicide methods for completed suicides in relation to any history of psychiatric contacts. Relationships with the psychiatric diagnoses for those with psychiatric contacts were also studied. METHODS: Sociodemographic variables and suicide methods were examined for all the 693 suicide victims during 1961-1980 in Västerbotten, Sweden. Information on any history of psychiatric contacts was obtained from psychiatric in-patient and out-patient records. RESULTS: Gender differences in the choice of suicide method were found in the group without any history of psychiatric contacts, but not in those with such a history. Only those without a history of psychiatric contacts showed season of birth variations for suicide methods -- those born during February to April were significantly more likely, and those born during October to January significantly less likely, to have preferred hanging rather than poisoning or petrol gases. These associations were stronger for the determined suicides, for males, and for urban residence. Suicide victims with a history of psychiatric contacts were significantly younger than those without. LIMITATIONS: No psychological autopsies for those without psychiatric contacts. No information on eventual contacts with general practitioners. No measures of monoamine neurotransmitters were available. CONCLUSIONS: Season of birth association for suicide methods is likely to be mediated by a suicidality trait independently of specific major psychiatric disorders. Monoamine neurotransmitters, particularly serotonin, are likely to underlie such a trait.
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| 10. |
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| 11. |
- De Leo, D, et al.
(author)
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Attempted and completed suicide in older subjects : results from the WHO/EURO Multicentre Study of Suicidal Behaviour.
- 2001
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In: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 16:3, s. 300-10
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Journal article (peer-reviewed)abstract
- Stockholm (Sweden), Pontoise (France) and Oxford (UK) had the highest suicide attempts rates. In most centres, the majority of elderly who attempted suicide were widow(er)s, often living alone, who used predominantly voluntary drug ingestion. Non-fatal suicidal behaviour decreased with increasing age, whereas suicide rates rose. The ratio between fatal and non-fatal behaviours was 1:2, that for males/females almost 1:1. In the years considered, substantial stability in suicide and attempted suicide rates was observed. As their age increased, suicidal subjects displayed only a limited tendency to repeat self-destructive acts. Moreover, there was little correlation between attempted suicide and suicide rates, which carries different clinical implications for non-fatal suicidal behaviour in the elderly compared with younger subjects in the same WHO/EURO study.
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| 12. |
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| 13. |
- De Leo, D, et al.
(author)
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Repetition of suicidal behaviour in elderly Europeans : a prospective longitudinal study.
- 2002
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In: Journal of Affective Disorders. - 0165-0327 .- 1573-2517. ; 72:3, s. 291-5
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Journal article (peer-reviewed)abstract
- The aim of this study was to assess any predictive factors for repeated attempted suicide and completed suicide in a 1-year follow-up on a sample of elderly European suicide attempters (60 years and over). From 1990 to 1993, 63 subjects completed the first interview and were recontacted after 1 year. At follow-up, eight subjects (12.7%) had taken their lives and seven (11.1%) had repeated at least one suicide attempt. On comparison of repeaters and non-repeaters, differences emerged in terms of death of the father in childhood and for mean Suicidal Intent Score. At the end of follow-up period, repeaters reported a more frequent desire to repeat suicidal behaviour and judged their mental health and social assistance received to be worse. Suicides and non-repeaters differed especially in relation to death of father during childhood and number of contacts with General Practitioner. Interpretation of the results must take into account the smallness of the test sample, the difficulties in obtaining complete data for the follow-up interview, the lack of a control group and a diagnosis formulated in a hospital consultation setting. The study confirms, however, the high risk of repetition of suicidal behaviour in the elderly. In old age suicidal ideation is often sustained over long periods of time and requests for help are addressed to relatives and GPs. An interesting finding is the more frequent death of the father during childhood among repeaters.
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| 14. |
- Fransson, Filip, et al.
(author)
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Kidney function in patients with bipolar disorder with and without lithium treatment compared with the general population in northern Sweden : results from the LiSIE and MONICA cohorts
- 2022
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In: Lancet psychiatry. - : Elsevier. - 2215-0374 .- 2215-0366. ; 9:10, s. 804-814
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Journal article (peer-reviewed)abstract
- Background: The clinical relevance of lithium nephropathy is subject to debate. Kidney function decreases with age and comorbidities, and this decline might lead to attribution bias when erroneously ascribed to lithium. We aimed to investigate whether patients with bipolar or schizoaffective disorder had faster decline in estimated glomerular filtration rate (eGFR) compared with the general population, whether observed differences in the steepness of the decline were attributable to lithium, and whether such changes depended on the length of lithium exposure.Methods: In this cross-sectional cohort study, we used clinical data from the Lithium–Study into Effects and Side-effects (LiSIE) retrospective cohort study, which included patients with bipolar disorder or schizoaffective disorder whose medical records were reviewed up to Dec 31, 2017, and the WHO Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, covering a representative sample of the general population in northern Sweden aged 25–74 years. The primary outcome was the age-associated decline of creatinine-based eGFR, assessed using linear regression. We adjusted for sex and grouped for different lengths of lithium exposure (never or <1 year, 1–5 years, >5–10 years, and >10 years). For patients with moderate-to-severe kidney disease we identified the underlying nephropathy in the case records.Findings: From LiSIE, we included 785 patients (498 [63%] female and 287 [37%] male), with a mean age of 49·8 years (SD 13·2; range 25–74). From MONICA, we included 1549 individuals (800 [52%] female and 749 [48%] male), with a mean age of 51·9 years (13·8; 25–74). No ethnicity data were collected. Adjusted for duration of lithium exposure, eGFR declined by 0·57 mL/min/1·73 m2/year (95% CI 0·50–0·63) in patients with bipolar disorder or schizoaffective disorder and by 0·57 mL/min/1·73 m2/year (0·53–0·61) in the reference population. Lithium added 0·54 mL/min/1·73 m2 (0·43–0·64) per year of treatment (p<0·0001). After more than 10 years on lithium, decline was significantly steeper than in all other groups including the reference population (p<0·0001). Lithium nephropathy was judged to be the commonest cause of moderate-to-severe chronic kidney disease, but comorbidities played a role. The effect of lithium on eGFR showed a high degree of inter-individual variation.Interpretation: Steeper eGFR decline in patients with bipolar disorder or schizoaffective disorder can be attributed to lithium, but the trajectory of kidney function decline varies widely. Comorbidities affecting kidneys should be treated assertively as one possible means to affect the trajectory. In patients with a fast trajectory, a trade-off is required between continuing lithium to treat mental health problems and discontinuing lithium for the sake of renal health.Funding: Norrbotten County Research and Learning Fund Sweden, Visare Norr (Northern County Councils Regional Federation Fund), Swedish Kidney Foundation (Njurfonden), Swedish Kidney Association (Njurförbundet), Norrbotten section.Translation: For the Swedish translation of the Summary see Supplementary Materials section.
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| 15. |
- Haglund, A., et al.
(author)
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Interpersonal violence and the prediction of short-term risk of repeat suicide attempt
- 2016
-
In: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 6
-
Journal article (peer-reviewed)abstract
- In this multi-center cohort study, suicide attempters presenting to hospital (N = 355, 63% women) were interviewed using the Karolinska Interpersonal Violence Scale (KIVS) and followed-up by medical record review. Main outcome was non-fatal or fatal repeat suicide attempt within six months. Also, repeat attempt using a violent method was used as an additional outcome in separate analyses. Data were analyzed for the total group and for men and women separately. Repeat attempts were observed within six months in 78 persons (22%) and 21 (6%) of these used a violent method. KIVS total score of 6 or more was associated with repeat suicide attempt within six months (OR = 1.81, CI 1.08-3.02) and predicted new attempts with a sensitivity of 62% and a specificity of 53%. A three-fold increase in odds ratio was observed for repeat attempt using a violent method (OR = 3.40, CI 1.22-9.49). An association between exposure to violence in adulthood and violent reattempt was seen in women (OR = 1.38, CI 1.06-1.82). The overall conclusions are that information about interpersonal violence may help predict short-term risk for repeat suicide attempt, and that structured assessment of interpersonal violence may be of value in risk assessment after attempted suicide.
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| 16. |
- Hawton, K, et al.
(author)
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Relation between attempted suicide and suicide rates among young people in Europe.
- 1998
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In: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 52:3, s. 191-4
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Journal article (peer-reviewed)abstract
- Rates of attempted suicide and suicide in the young covary. The recent increase in attempted suicide rates in young male subjects in several European countries could herald a further increase in suicide rates.
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| 17. |
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| 18. |
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| 19. |
- Herrera Rodríguez, Andrés, 1966-
(author)
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Heaven can wait : studies on suicidal behaviour among young people in Nicaragua
- 2006
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Doctoral thesis (other academic/artistic)abstract
- In developed countries, suicidal behaviour is recognised as a significant public health problem among young people, but there are few studies from developing countries on this subject. The present thesis aims at estimating the extent of the problem and at exploring factors related to suicidal behaviour among young people in a developing country, Nicaragua, using a combined quantitative and qualitative approach. Three studies were conducted between 1999 and 2006. In the first study, all hospital admitted suicide attempt cases in the area of León were assessed over a three year period. Secondly, a qualitative study using individual in-depth interviews was conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. Thirdly, a study using the Attitudes Towards Suicides (ATTS) questionnaire was conducted in a community based sample of 278 young people aged 15-24 years to assess own suicidal behaviours, attitudes towards suicide as well as exposure to suicidal behaviour among significant others. The hospital surveillance showed that suicide attempt rates were highest among females in the age group 15-19 years with a female rate three times that of males (302.9 versus 98.9 per 100,000 inhabits per year). Drug intoxication and pesticides were the most commonly used methods for the attempts. A consistent seasonal variation with peaks in May-June and September-October was found in each of the three years, possibly related to exam periods in schools. Findings in the qualitative approach led to a tentative model for pathways to suicidal behaviour based on four main categories: Structuring conditions, triggering events, emotions and action taken. Dysfunctional families, lack of confidential and trustworthy contacts and interpersonal conflicts followed by emotions of shame and anger were some important components in the model. The community studies showed that suicidal expressions (life-weariness, death wishes, suicidal ideation, suicide plans and suicide attempts) were common among young people where more than 44.8% of males and 47.4% of females reported some kind of suicidal expression. Gender differences were small. Exposure to suicidal behaviour among others was associated with higher levels of self-reported suicidal behaviour. The attitude study showed that boys had less pro-preventive attitudes than girls, possibly indicating their higher risk for completed suicide. Exposure to suicidal behaviour and own suicidal behaviour showed an association with specific patterns of attitudes. The findings should be taken into consideration when planning for prevention of suicidal behaviour among young people in a developing country like Nicaragua.
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| 20. |
- Hultén, A, et al.
(author)
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Recommended care for young people (15-19 years) after suicide attempts in certain European countries.
- 2000
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In: European Child and Adolescent Psychiatry. - 1018-8827 .- 1435-165X. ; 9:2, s. 100-8
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Journal article (peer-reviewed)abstract
- Data on recommended care for young people aged 15-19 years after attempted suicide from nine European research centres during the period 1989-1992 were analysed in terms of gender, history of previous suicide attempt and methods used. Altogether 438 suicide attempts made by 353 boys and 1,102 suicide attempts made by 941 girls were included. Analyses of the total data from all centres showed that young people with a history of previous suicide attempt and those using violent methods had significantly higher chance of being recommended aftercare than first-time attempters or those choosing self-poisoning. There were no significant differences of being recommended care between genders. Logistic regression analyses of the material were performed and the results were similar. Both having previous attempted suicide (odds ratio 2.0, 95% CI 1.53-2.61) and using "hard" methods (odds ratio 1.71, 95% CI 1.49-1.96) were significantly associated with increased possibility of being recommended aftercare. When individual centres were analysed, large disparities of recommended care after suicide attempts were found and there were no uniform criteria of recommending care for young suicide attempters in Europe.
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| 21. |
- Idenfors, Hans, 1979-, et al.
(author)
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Are non-psychiatric hospitalisations before self-harm associated with an increased risk for suicide among young people?
- 2019
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In: Journal of Psychosomatic Research. - : Elsevier BV. - 0022-3999 .- 1879-1360. ; 120, s. 96-101
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Journal article (peer-reviewed)abstract
- Objective: This study aimed to investigate any increased risk for suicide in young people with admission for self-harm and if the risk is further increased due to somatic inpatient admissions before a first act of self-harm.Methods: This register study included 16,235 cases in the ages 16–24, with a first admission for self-harm, and 32,465 matched controls. All admissions and diagnoses were recorded from the year preceding cases first admission for self-harm. Subjects were followed until death or end of study, registering the cause of death for all deceased. Group differences were analysed using survival analysis with death by suicide as primary outcome.Results: In cases with a previous somatic admission, the risk for death by suicide during the study period was higher than in cases without a somatic admission (457 and 316 suicides per 100,000 people and year, respectively, p = 0.01). For cases with a somatic admission, the hazard ratio was 1.43 (95% confidence interval 1.04–1.98) compared with those without somatic admissions (controlled for age, sex and psychiatric admission). Survival of cases with a previous somatic admission compared with those without was 98.4% versus 99.2% after the first year, 97.8% versus 98.9% after the second year, and 95.5% versus 96.9% after the tenth year.Conclusions: This study suggests that admission for physical illness before self-harm is associated with a higher risk for suicide among young people, and that their contact with healthcare due to physical problems could provide an opportunity to detect suicide risk.
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| 22. |
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| 23. |
- Idenfors, Hans, 1979-, et al.
(author)
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Non-psychiatric inpatient care preceding admission for self-harm in young people
- 2016
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In: Journal of Psychosomatic Research. - : Elsevier BV. - 0022-3999 .- 1879-1360. ; 88, s. 8-13
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Journal article (peer-reviewed)abstract
- ObjectiveMany young people contact health services before they harm themselves intentionally. However, they often seek care for non-suicidal or non-psychiatric causes despite having suicidal thoughts. We investigated the non-psychiatric hospital diagnoses received by young people during the year before their first admission to hospital for self-harm.MethodsFrom a national register, we selected people who were hospitalised for an episode of self-harm during the period 1999-2009, at which time they were aged 16 to 24. We compared them with matched controls regarding the probability for being admitted with different diagnoses during the year preceding the self-harm admission.ResultsThe study included 48,705 young people (16,235 cases and 32,470 controls). Those admitted for self-harm were more likely than controls to have been hospitalised for non-psychiatric reasons, which included symptomatic diagnoses such as abdominal pain, syncope/collapse, unspecified convulsions, and chest pain. Certain chronic somatic illnesses were also overrepresented, such as epilepsy, diabetes mellitus type 1, and asthma.ConclusionsSymptomatic diagnoses were more common in those who had been admitted for self-harm. It is possible that psychiatric problems could have been the cause of the symptoms in some of these admissions where no underlying illness could be found, and if this was not uncovered it might lead to a delay in suicide risk assessment. For several chronic illnesses, when admitted to hospital, a psychiatric evaluation might be indicated.
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| 24. |
- Idenfors, Hans, et al.
(author)
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Professional care after deliberate self-harm : a qualitative study of young people's experiences
- 2015
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In: Patient Preference and Adherence. - 1177-889X. ; 9, s. 199-207
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Journal article (peer-reviewed)abstract
- Background: Deliberate self-harm (DSH) is increasingly common among young people. At the same time, treatment and support after DSH are often hampered by low compliance. Aim: To explore young people's perceptions of care and support during a 6-month period following their first contact for DSH. Methods: We conducted nine semistructured interviews with young people aged 16-24 years 6 months after their first contact for DSH. The interviews were analyzed using qualitative content analysis. Results: Three main themes were extracted from the interviews. "Am I really in good hands?" describes whether the participants felt they were being listened to and taken seriously and whether they could rely on the competence of the professionals and the appropriateness of treatment, including keeping agreements and communication with other relevant agencies. "Help should match life circumstances" comprises how basic practicalities such as travel possibilities affect treatment and concomitant assistance in everyday living. Financial matters and jobseeking were perceived as necessary for optimal treatment and well-being. "Making yourself better" includes participants' efforts to manage on their own, through realizing their own responsibility to be engaged and actively take part in treatment planning. Conclusion: Flexibility and responsiveness to young people's own views and specific needs in treatment arrangements are of crucial importance. The significance of basic practical help cannot be underestimated and should not be overlooked.
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| 25. |
- Idenfors, Hans, et al.
(author)
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Professional Care as an Option Prior to Self-Harm A Qualitative Study Exploring Young People's Experiences
- 2015
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In: Crisis. - : Hogrefe Publishing. - 0227-5910 .- 2151-2396. ; 36:3, s. 179-186
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Journal article (peer-reviewed)abstract
- Background: Deliberate self-harm (DSH) is a growing problem among young people and is a major risk factor for suicide. Young adults experiencing mental distress and suicidal ideation are reluctant to seek help, requiring new strategies to reach this group. Aims: The present study explored young people's views of professional care before first contact for DSH, and factors that influenced the establishing of contact. Method: Interviews with 10 young individuals, shortly after they had harmed themselves, were analyzed using qualitative content analysis. Results: The participants emphasized the importance of receiving more knowledge on where to turn, having different help-seeking options, and receiving immediate help. Family and friends were vital for support and making health care contact. The quality of the professional contact was stressed. Several reasons for not communicating distress were mentioned. Two themes were identified: "A need for a more flexible, available and varied health care" and "A struggle to be independent and yet being in need of reliable support." Conclusion: These findings suggest that easy and direct access to professional help is a decisive factor for young people experiencing psychological problems and that health services must find new ways of communicating information on seeking mental health help.
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| 26. |
- Idenfors, Hans, 1979-
(author)
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Young people's contact with healthcare before and after suicidal behaviour
- 2016
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Doctoral thesis (other academic/artistic)abstract
- BackgroundSelf-harm is a major and growing public health issue among young people worldwide. Self-harm is an important risk factor for suicide, which is one of the leading causes of death for young people. Although suicide rates are declining overall, this trend is not seen in young people. Young people with mental distress and/or suicidal thoughts are reluctant to seek help, and often drop out of treatment initiated after a self-harm episode. Many young people who self-harm have had contact with healthcare before their first self-harm episode, but often for reasons other than suicidal thoughts or psychiatric problems. In this context, physical illness is associated with increased risk for self-harm and suicide among young people. The present thesis investigated how young people perceived the help and support they received before and after an episode of self-harm. A further aim was to map the inpatient somatic healthcare contacts young patients had before an episode of self-harm, and determine any relationship to risk for self-harm and suicide.MethodFour studies were conducted using qualitative and quantitative methods. Participants were people aged 16-24 years. The definition of self-harm was based on the intentional self-harm criteria in the International Classification of Diseases, tenth revision, which includes all forms of self-harm without ascribing suicidal intent. In the first two studies, 10 respective 9 participants with a first healthcare contact for self-harm were interviewed during 2009-2011. The interviews covered participants’ knowledge and experience of professional care before their healthcare contact for self-harm. Participants were interviewed a second time 6 months later about their experiences with professional care during the period since their initial interview. Qualitative content analysis was used for all interviews. For the next two studies, we selected 16,235 participants with a first hospitalisation for self-harm during 1999-2009 from the Swedish National Inpatient Register. These cases were compared with matched controls to determine the odds of having been admitted with a non-psychiatric diagnosis during the year preceding the self-harm admission. To assess risk for suicide, data were retrieved from the Swedish Cause of Death Register for all deceased participants until 2013, and group differences were determined using survival analysis.ResultsIn the first interview, participants described how they wanted more information on where they could turn for professional help. They also wanted different help-seeking pathways and emphasised the importance of the quality of professional contact. After 6 months, participants stressed the importance of being able to rely on professionals and treatment. Their life circumstances significantly affected their treatment, and practical help was appreciated. The register studies showed that young people admitted for self-harm were more likely to have been hospitalised with symptomatic diagnoses such as abdominal pain and syncope/collapse, and somatic illnesses such as epilepsy and diabetes mellitus type 1. A higher proportion of cases (4.5%; women 2.6%, men 8.8%) died during the study period than controls (0.3%; women 0.2%, men 0.6%) (p<0.001). For both cases and controls, a higher proportion of those with a previous somatic admission died from suicide during the study period than those without a somatic admission (cases: 4.2% vs. 2.8%, p<0.05). For cases with a somatic admission, the hazard ratio was 1.43 (95% confidence interval 1.04-1.98) compared with those without somatic admissions (controlled for age, sex and psychiatric admission). Survival of cases with a previous somatic admission compared with those without was 98.4% versus 99.2% after the first year, 97.8% versus 98.9% after the second year, and 95.5% versus 96.9% after the tenth year.ConclusionThese findings suggest that healthcare providers need to find new ways to reach young people at risk for suicidal behaviour. Access to professional help should be easy and direct. Treatment for young people after self-harm should be flexible, and be receptive to input from the patient. The importance of and need for basic practical help should not be overlooked. Somatic healthcare contact provides an opportunity for intervention, particularly as psychiatric problems can manifest as physical symptoms, and physical illness is a risk factor for self-harm and suicide.
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| 27. |
- Ineland, Lisa, et al.
(author)
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Attitudes towards mental disorders and psychiatric treatment : changes over time in a Swedish population
- 2008
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In: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 62:3, s. 192-197
-
Journal article (peer-reviewed)abstract
- Over the years a lot of research of attitudes towards mental disorders, towards people with mental illness and towards psychiatric services and treatment have shown a persistent negative attitude. There are, however, few studies on changes over time. The aim of this study was to compare responses to a questionnaire on attitudes towards mental disorders and psychiatric patients and the perception of psychiatric treatment in a community in northern Sweden in 1976 and 2003. In 1976 a random sample of 391 persons 18-70 years of age were asked and in 2003 a new sample of 500 persons from the same community were approached with the same questions. There are considerable changes over time. In 2003, almost 90% agree to the statement that mental illness harms the reputation more than physical illness, compared with 50% in 1976. In 2003, 51% agreed to the statement "Most people with mental disorders commit violent acts more than others" compared with 24% in 1976. There is an apparent ambivalence towards psychiatric treatment. Whilst 88% would advice a person with mental problems to contact a psychiatrist, still 26% would not like themselves to be referred to a psychiatrist. We argue that improving treatment methods is as important as changing attitudes through accurate information.
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| 28. |
- Jacobsson, Lars, et al.
(author)
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On suicide and suicide prevention as a public health issue.
- 1999
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In: Medicinski arhiv. - 0350-199X. ; 53:3, s. 175-7
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Journal article (peer-reviewed)abstract
- Suicide is becoming one of the major causes of death especially amongst men. In Europe suicide is the second most common cause of death in the ages of 15-44 years. For women in the same age group suicide is the fourth most common cause of death. Suicide causes a lot of suffering not only in the victim but also in persons close to him. As the causative factors are complex, and suicide also costs the community a lot of money suicide and self destructive behavior must be considered an important public health issue. A couple of models which are helpful when trying to develop treatment and preventive strategies for suicided persons are presented. The basic principles for contemporary suicide prevention programmes are also described.
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| 29. |
- Jessen, G, et al.
(author)
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Attempted suicide and major public holidays in Europe : findings from the WHO/EURO Multicentre Study on Parasuicide.
- 1999
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In: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447. ; 99:6, s. 412-8
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Journal article (peer-reviewed)abstract
- There appears to be a transposition of a significant number of suicide attempts from before (and during) a major public holiday until after it. The division of holidays into non-working and working days showed that a 'holiday effect' could only be found around major public holidays, particularly Christmas, Easter and Whitsun. These findings support the theory of the 'broken-promise effect' for major public holidays.
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| 30. |
- Kaatari, Hans, 1952-
(author)
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Symbolfunktion och mening : En undersökning av den psykoanalytiska psykoterapins artegna väsen
- 2008
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Doctoral thesis (other academic/artistic)abstract
- This work in two parts – entitled Symbolic Function and Meaning: An Investigation of the Species-Specific Essence of Psychoanalytic Psychotherapy – could be characterized as an interpretation of the above-mentioned therapy and the meaning of its particular experience. In the first part, besides a licentiate thesis, four topics are examined: the therapeutic framework, the transference – especially in neurotic form – and its interpretation, psychotherapy with borderline patients, and therapy with psychotics. This has been done by combining studies of literature with analyses of the transference meaning of a number of illuminative clinical examples or vignettes – anecdotes, i.e. narratives with a significant point – the main part of which are the outcome of the author’s own activity in the form of participant observation as a psychotherapist. The general conclusion is that promoting the symbolic function is the essential ingredient in the psychoanalytic form of therapy – its very rationality – and how it effectuates its unique therapeutic potentiality; a characterization which, despite obvious differences in the adequacy of symbolic functioning, is valid irrespective of whether the patient is diagnosed as neurotic, borderline or psychotic. In the second part – essentially of a theoretical nature in contrast to the preceding one – the study is influenced by philosophical hermeneutics, and in this process assimilates its particular conceptuality. The continued analysis of the research object shows that it is misleading, in view of its ontology, to conceptualize it in medical terms as treatment. Aimed at promoting the symbolic function by the transference being interpreted, psychoanalytic psychotherapy instead operates in an ethical dimension and is rather what Aristotle terms a praxis, on the one hand; on the other hand, it is moreover implicitly human science action research into intersubjective appropriation of meaning. In this latter respect, the investigation highlights the fact that the very special interview method in the form of free associations, with their reflexivity, gives the psychoanalytic form of psychotherapy the potential to be not only a qualitative research method but also simultaneously metaresearch. The analyses of the transference meaning of clinical anecdotes in the first part have thereby been able to be methodologically clarified retroactively as psychoanalytic metaresearch.
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| 31. |
- Kaiser, Niclas, et al.
(author)
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Depression and anxiety in the reindeer-herding Sami population of Sweden
- 2010
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In: International Journal of Circumpolar Health. - : Informa UK Limited. - 1239-9736 .- 2242-3982. ; 69:4, s. 383-393
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Journal article (peer-reviewed)abstract
- Objectives. The objective of this study was to investigate symptoms and predicting factors of depression and anxiety among reindeer-herding Sami in Sweden. Study design. A total of 319 reindeer-herding Sami (168 men, 151 women) were compared with urban and rural reference populations comprising 1,393 persons (662 men, 731 women). Methods. A cross-sectional questionnaire study on mental health, which included the Hospital Anxiety and Depression Scale (HADS). Data were analysed with regard to population, gender, age group, education and work-related stress. Results. The Sami population disclosed higher mean values for both depression and anxiety than the reference groups, with Sami men reporting the highest rates. Work-related stress was associated with anxiety and depression in the Sami group. Conclusions. By comparing Sami men and women with reference groups of men and women living in urban and rural areas in northern Sweden, this study identified that reindeer-herding Sami men require special attention with regard to mental health problems.
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| 32. |
- Kaiser, Niclas, 1973-, et al.
(author)
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Depression and anxiety in the reindeer-herding Sami population of Sweden
- 2010
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In: International Journal of Circumpolar Health. - Oulu : International Association of Circumpolar Health Publishers. - 1239-9736 .- 2242-3982. ; 69:4, s. 383-393
-
Journal article (peer-reviewed)abstract
- Objectives. The objective of this study was to investigate symptoms and predicting factors of depression and anxiety among reindeer-herding Sami in Sweden. Study design. A total of 319 reindeer-herding Sami (168 men, 151 women) were compared with urban and rural reference populations comprising 1,393 persons (662 men, 731 women). Methods. A cross-sectional questionnaire study on mental health, which included the Hospital Anxiety and Depression Scale (HADS). Data were analysed with regard to population, gender, age group, education and work-related stress. Results. The Sami population disclosed higher mean values for both depression and anxiety than the reference groups, with Sami men reporting the highest rates. Work-related stress was associated with anxiety and depression in the Sami group. Conclusions. By comparing Sami men and women with reference groups of men and women living in urban and rural areas in northern Sweden, this study identified that reindeer-herding Sami men require special attention with regard to mental health problems.
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| 33. |
- Kaiser, Niclas, 1973-, et al.
(author)
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Experiences of Being a Young Female Sami Reindeer Herder : A Qualitative Study from the Perspective of Mental Health and Intersectionality
- 2015
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In: Journal of Northern Studies. - : Umeå University. - 1654-5915 .- 2004-4658. ; 9:2, s. 55-72
-
Journal article (peer-reviewed)abstract
- Objectives: To explore experiences of what it means to be a young, female Sami reindeer herder in Sweden, a group occupying a unique position in Swedish Sami life, with special focus on intersectionality and exposure to risk factors regarding mental (ill) health.Methods: A qualitative content analysis of semi-structured interviews with 13 strategically selected female reindeer herders (18–35 years old).Results: The participants described a reindeer-herding lifestyle that they find joyful and vital, but is also conflictual and harsh. Genderspecific issues were raised, for example that they unfortunately and unnecessarily have a place other than the heart of reindeer herding reserved for them.Conclusions: The results of this study suggest that the position of women reindeer herders is paradoxical. This position implies not only a pride in Sami culture but also a risk of developing mental health problems which should be addressed in relation to gender, the reindeer-herding lifestyle and ethnicity.
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| 34. |
- Kaiser, Niclas, et al.
(author)
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Experiences of being a young male Sami reindeer herder : a qualitative study in perspective of mental health
- 2013
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In: International Journal of Circumpolar Health. - : CoAction Publishing. - 1239-9736 .- 2242-3982. ; 72:20926
-
Journal article (peer-reviewed)abstract
- Objectives. To explore experiences of what it is to be a young male Sami reindeer herder in Sweden, a group with previously known stigma and specific health issues, and to understand experiences in perspective of mental health.Methods. A qualitative content analysis was employed. Data were collected by in-depth interviews with 15 strategically selected reindeer herders aged 18–35 years old.Results. The analysis resulted in 5 sub-themes: (a) being “inside” or “outside” is a question of identity; (b) a paradox between being free/bound; (c) an experience of various threats and a feeling of powerlessness; (d) specific norms for how a “real” reindeer herder should be; and (e) the different impacts and meanings of relations. The overarching theme is summarized thus: being a young reindeer herder means so many (impossible) dreams and conditions. Overall, the experience of the informants was that being a reindeer herder is a privileged position that also implies many impossibilities and unjust adversities they have no control over, and that there is nothing they can do but “bite the bullet or be a failure.”Conclusions. Knowledge about this group's experiences can be used to understand difficulties faced by young reindeer herders and its consequences regarding mental health problems. This also implies a need for a broader perspective when discussing future interventions aimed at preventing mental health problems in this group.
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| 35. |
- Kaiser, Niclas, et al.
(author)
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Hazardous drinking and drinking patterns among the reindeer-herding Sami population in Sweden
- 2011
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In: Substance Use & Misuse. - : Informa UK Limited. - 1082-6084 .- 1532-2491. ; 46:10, s. 1318-1327
-
Journal article (peer-reviewed)abstract
- The objective of this study was to investigate hazardous drinking among reindeer-herding Sami in Sweden. A cross-sectional questionnaire study was conducted in 2007, which included the Alcohol Use Disorder Identification Test. A total of 319 reindeer-herding Sami were compared with urban and rural reference populations of 1,393 persons. Data were analyzed with regard to population, gender, age group, education, anxiety, depression, and work-related stress. The Sami population did not report a higher prevalence of hazardous drinking compared with the reference groups; however, subgroups of Sami men with symptoms of depression were revealed as at risk, in contrast to Sami women who were not found to be at risk at all. Limitations of the study are discussed.
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| 36. |
- Kaiser, Niclas, 1973-
(author)
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Mental health problems among the Swedish reindeer-herding Sami population : in perspective of intersectionality, organisational culture and acculturation
- 2011
-
Doctoral thesis (other academic/artistic)abstract
- The overall objective of the thesis was to investigate aspects of mental health among Swedish Sami reindeer herders and to deepen the understanding of the experience of the living conditions of young Sami reindeer-herding men. Theories of intersectionality, organisational culture and acculturation were used. Methods A questionnaire covering different aspects of mental health was distributed to the Sami population, including the Hospital Anxiety and Depression Scale (HADS), the Alcohol Use Disorder Identification Test, selected parts of the Attitudes Towards Suicide questionnaire (ATTS) and the Job Control Questionnaire (JCQ). 15 interviews with young male reindeer-herders were conducted and analysed according to qualitative content analysis. Results A higher load of anxiety and depression was found in the Sami population, most evident regarding anxiety and among middle aged reindeer-herding men. Regarding alcohol risk consumption reindeer-herding Sami do not in general drink more than a geographically matched reference population, but reindeer-herding men reported a higher proportion of hazardous drinkers, and of teetotallers and periodic drinkers. The reindeer-herding population reported significantly higher exposure to suicide and suicidal behaviour among significant others. Reindeer-herds also reported higher prevalence of different types of suicidal problems. The main theme that emerged in qualitative analysis was ‘Being a young reindeer herder means so many (impossible) dreams and conditions’, and the five subthemes were ‘Being inside or outside is a question of identity’, ‘There is a paradox between being free/unfree’, ‘An experience of different threats and a feeling of powerlessness’, ‘Specific norms for how a ‘real’ reindeer-herder should be’ and ‘The different impacts and meanings of relations’. Conclusions The thesis hypothesizes that the reindeer-herding right as an including, excluding and enclosing historically induced border plays an important part when trying to understand the mental health problems in the group. At present, the situation within reindeer-herding is strained because of practical obstacles and feelings of unfairness and uninfluencability. Furthermore, lack of social support, except from the closest part of the family, and experiences of multi-layered conflicts. This – together with norms of reindeer-herding and reindeer-herders that e.g. say that the reindeer herder is a man who doesn’t show weakness – plays a role in the present mental health problems of the Swedish reindeer-herding population. This applies especially to young and middle-aged reindeer-herding men.
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| 37. |
- Kaiser, Niclas, et al.
(author)
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Suicidal expressions among the Swedish reindeer-herding Sami population
- 2012
-
In: Suicidology Online. - 2078-5488. ; :3, s. 102-113
-
Journal article (peer-reviewed)abstract
- The objective of this study was to investigate suicidal expressions among reindeer-herding Sami in Sweden. Subjects: A total of 315 reindeer-herding Sami (167 men, 148 women) were compared with geographically matched reference populations comprising 1354 persons (652 men, 702 women). Methods: A questionnaire measuring different aspects of suicidal behaviour, such as exposure to suicide and suicidal ideation in significant others, own suicidal problems and attitudes towards suicide, was distributed to members of Sami villages through community leaders and to the reference group by post. Data were analysed with regard to population, gender, age group, mental health, alcohol use, work strain and formal education. Results: Comparison between groups did not reveal any differences in attitudes towards suicide; however, it did show significantly higher exposure to both suicide and suicidal behaviour in significant others in the Sami group. Compared to the reference group, both Sami women and especially Sami men reported a higher prevalence of various types of suicidal problems, particularly suicidal ideation. In addition, anxiety and alcohol use were associated with suicidal expressions in the Sami group. Conclusion: The study identifies reindeer-herding Sami men and women to be at particular risk for suicidal expressions. Specific attention should be paid to young and middle-aged Sami men with hazardous alcohol consumption and anxiety.
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| 38. |
- Knizek, Birthe Loa, et al.
(author)
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County council politicians' attitudes toward suicide and suicide prevention : a qualitative cross-cultural study.
- 2008
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In: Crisis. - 0227-5910 .- 2151-2396. ; 29:3, s. 123-30
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Journal article (peer-reviewed)abstract
- The purpose of the present study was to compare county council politicians' attitudes toward suicide and suicide prevention in five European countries. A questionnaire was distributed and here the responses to the open-ended questions are analyzed qualitatively. Considerable differences were found in what the politicians in the five countries believed to be the most important causes of suicide and how suicide can be prevented. There were also differences in to what degree the politicians revealed a judgmental attitude toward suicide, which seemed to be related to the magnitude of the problem in the respective countries. A certain implicit inconsistency in the logic directing the politicians' responses was found when their views on causes to suicide and suicide prevention strategies were compared. The responses indicate a need for increased consciousness and knowledge about suicide and suicide prevention among politicians in all the five countries. This is important since they are responsible for initiating and funding suicide preventive efforts.
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| 39. |
- Lindgren, Britt-Marie, et al.
(author)
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Does a new spatial design in psychiatric inpatient care influence patients’ and staff’s perception of their care/working environment? : A study protocol of a pilot study using a single-system experimental design
- 2018
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In: Pilot and Feasibility Studies. - : Springer Science and Business Media LLC. - 2055-5784. ; 4
-
Journal article (peer-reviewed)abstract
- Background: Research shows that worn-out physical environments are obstacles to psychiatric inpatient care. Patients want better relationships with staff and things to do; staff want an environment that offers hope, a calm atmosphere, and joint activities. A county council in northern Sweden and Philips Healthcare partnered to create solutions to the environmental challenges of psychiatric inpatient care. One ward at a county psychiatric clinic was selected for a pilot project to test solutions that could improve the care environment for patients, staff, and relatives. The aim of the overall project is to evaluate the effects of a newly designed psychiatric inpatient ward on patients and staff in terms of quality of care and stress. In this study, we focus on the feasibility through testing questionnaires and exploring barriers to recruiting staff and patients.Methods: This study had a single-system experimental design, comparing a psychiatric unit pre- and post-implementation of the novel spatial design, using repeated measures with the same questionnaires twice a week during baseline and intervention phases. Primary outcomes were quality interactions (patients) and perceived stress (staff). Secondary outcomes were levels of anxiety and depression (patients), and stress of conscience (staff). A process evaluation was aimed to describe contextual factors and participant experiences of the new design. Data was collected using questionnaires and semi-structured individual interviews with patients and focus group discussions with staff. Both visual and statistical methods were used to analyse the quantitative data and content analysis for the qualitative data.Discussion: The findings will contribute insights into whether and how a new spatial design might contribute to quality interactions and reduced stress. This is relevant both nationally and internationally, as similar interventions are needed but sparse. The findings will be disseminated through peer-reviewed publications and conference presentations.Trial registration: ClinicalTrials.gov, NCT03140618, registered 4 May 2017.
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| 40. |
- Lindh, A. U., et al.
(author)
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Predicting suicide: A comparison between clinical suicide risk assessment and the Suicide Intent Scale
- 2020
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In: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327 .- 1573-2517. ; 263, s. 445-449
-
Journal article (peer-reviewed)abstract
- Background: How suicide risk should be assessed is under discussion with arguments for both actuarial and clinical approaches. The aim of the present study was to compare the predictive accuracy of a clinical suicide risk assessment to that of the Suicide Intent Scale (SIS) in predicting suicide within one year of an episode of self-harm with or without suicidal intent. Methods: Prospective clinical study of 479 persons assessed in a psychiatric emergency department after an episode of self-harm. The clinical risk assessment and the SIS rating were made independently of each other. Suicides within one year were identified in the National Cause of Death Register. Receiver operating characteristic (ROC) curves were constructed, optimal cut-offs were identified and accuracy statistics were calculated. Results: Of 479 participants, 329 (68.7%) were women. The age range was 18-95 years. During one-year follow up, 14 participants died by suicide. The area under the curve (AUC) for the clinical risk assessment and the SIS score were very similar, as were the accuracy statistic measures at the optimal cut-offs of the respective methods. The positive predictive value (PPV) of each assessment method was 6%. Limitations: The clinical suicide risk assessment is not standardized. The number of suicides is small, not allowing for stratification by e.g. gender or diagnosis. Conclusion: Predictive accuracy was similar for a clinical risk assessment and the SIS, and insufficient to guide treatment allocation.
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| 41. |
- Lindh, A. U., et al.
(author)
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Short term risk of non-fatal and fatal suicidal behaviours: the predictive validity of the Columbia-Suicide Severity Rating Scale in a Swedish adult psychiatric population with a recent episode of self-harm
- 2018
-
In: Bmc Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 18
-
Journal article (peer-reviewed)abstract
- Background: The Columbia-Suicide Severity Rating Scale (C-SSRS) is a relatively new instrument for the assessment of suicidal ideation and behaviour that is widely used in clinical and research settings. The predictive properties of the C-SSRS have mainly been evaluated in young US populations. We wanted to examine the instrument's predictive validity in a Swedish cohort of adults seeking psychiatric emergency services after an episode of self-harm. Methods: Prospective cohort study of patients (n = 804) presenting for psychiatric emergency assessment after an episode of self-harm with or without suicidal intent. Suicidal ideation and behaviours at baseline were rated with the C-SSRS and subsequent non-fatal and fatal suicide attempts within 6 months were identified by record review. Logistic regression was used to evaluate separate ideation items and total scores as predictors of non-fatal and fatal suicide attempts. Receiver operating characteristics (ROC) curves were constructed for the suicidal ideation (SI) intensity score and the C-SSRS total score. Results: In this cohort, the median age at baseline was 33 years, 67% were women and 68% had made at least one suicide attempt prior to the index attempt. At least one non-fatal or fatal suicide attempt was recorded during follow-up for 165 persons (20.5%). The single C-SSRS items frequency, duration and deterrents were associated with this composite outcome; controllability and reasons were not. In a logistic regression model adjusted for previous history of suicide attempt, SI intensity score was a significant predictor of a non-fatal or fatal suicide attempt (OR 1.08; 95% CI 1.03-1.12). ROC analysis showed that the SI intensity score was somewhat better than chance in correctly classifying the outcome (AUC 0.62, 95% CI 0.57-0.66). The corresponding figures for the C-SSRS total score were 0.65, 95% CI 0.60-0.69. Conclusions: The C-SSRS items frequency, duration and deterrents were associated with elevated short term risk in this adult psychiatric cohort, as were both the SI intensity score and the C-SSRS total score. However, the ability to correctly predict future suicidal behaviour was limited for both scores.
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| 42. |
- Lindh, ÅU, et al.
(author)
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A Comparison of Suicide Risk Scales in Predicting Repeat Suicide Attempt and Suicide: A Clinical Cohort Study
- 2019
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In: The Journal of clinical psychiatry. - : Physicians Postgraduate Press. - 1555-2101 .- 0160-6689. ; 80:6
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To compare the predictive accuracy of the Suicide Intent Scale (SIS), the Suicide Assessment Scale (SUAS), the Karolinska Interpersonal Violence Scale (KIVS), and the Columbia-Suicide Severity Rating Scale (C-SSRS) for suicide attempts and suicides within 3 and 12 months of an episode of self-harm. METHODS: This prospective multicenter cohort study included patients (N = 804) aged 18-95 years with a recent episode of self-harm assessed in psychiatric emergency settings from April 2012 to April 2016. Suicide attempts and suicides were identified in medical records and in the National Cause of Death Register. Receiver operating characteristic curves were constructed, and accuracy statistics were calculated. A sensitivity of at least 80% combined with a specificity of at least 50% were considered minimally acceptable. RESULTS: At least 1 suicide attempt was recorded for 216 participants during follow-up, and 19 participants died by suicide. The SUAS and C-SSRS were better than chance in classifying the 114 suicide attempts occurring within the first 3 months; a C-SSRS score ≥ 27 yielded a sensitivity/specificity of 79.8%/51.5% (P < .001). During 1-year follow-up, the SUAS and C-SSRS also performed better than chance, but no cutoff on either instrument gave a sensitivity/specificity of ≥ 80%/≥ 50%. The SIS was the only instrument that could classify suicides correctly. At 3 months, the area under the curve (AUC) was 0.94 (95% CI, 0.89-0.99), and a score ≥ 21 predicted suicide with a sensitivity/specificity of 100%/81.9%, based on only 4 suicides. At 1-year follow-up, the AUC was 0.74 (95% CI, 0.61-0.87), and a score ≥ 17 predicted suicide with a sensitivity/specificity of 72.2%/57.9%. CONCLUSIONS: Instruments that predicted nonfatal repeat suicide attempts did not predict suicide and vice versa. With the possible exception of the prediction of suicide by the SIS in a short time frame, the specificity of these instruments was low, giving them a limited relevance in the prediction of suicidal behaviors. © Copyright 2019 Physicians Postgraduate Press, Inc.
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| 43. |
- Lipsicas, Cendrine Bursztein, et al.
(author)
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Attempted suicide among immigrants in European countries : an international perspective
- 2012
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In: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 47:2, s. 241-251
-
Journal article (peer-reviewed)abstract
- This study compares the frequencies of attempted suicide among immigrants and their hosts, between different immigrant groups, and between immigrants and their countries of origin. The material, 27,048 persons, including 4,160 immigrants, was obtained from the WHO/EURO Multicentre Study on Suicidal Behaviour, the largest available European database, and was collected in a standardised manner from 11 European centres in 1989-2003. Person-based suicide-attempt rates (SARs) were calculated for each group. The larger immigrant groups were studied at each centre and compared across centres. Completed-suicide rates of their countries of origin were compared to the SARs of the immigrant groups using rank correlations. 27 of 56 immigrant groups studied showed significantly higher, and only four groups significantly lower SARs than their hosts. Immigrant groups tended to have similar rates across different centres. Moreover, positive correlation between the immigrant SAR and the country-of-origin suicide rate was found. However, Chileans, Iranians, Moroccans, and Turks displayed high SARs as immigrants despite low suicide rates in the home countries. The similarity of most immigrant groups' SARs across centres, and the correlation with suicidality in the countries of origin suggest a strong continuity that can be interpreted in either cultural or genetic terms. However, the generally higher rates among immigrants compared to host populations and the similarity of the rates of foreign-born and those immigrants who retained the citizenship of their country of origin point to difficulties in the acculturation and integration process. The positive correlation found between attempted and completed suicide rates suggests that the two are related, a fact with strong implications for suicide prevention.
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| 44. |
- Lipsicas, Cendrine Bursztein, et al.
(author)
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Immigration and recommended care after a suicide attempt in Europe : equity or bias?
- 2014
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In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 24:1, s. 63-65
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Journal article (peer-reviewed)abstract
- This report describes the investigation of care recommendations in the medical system across European countries to immigrants who attempted suicide. Data from seven European countries with 8865 local and 2921 immigrant person-cases were derived from the WHO/EURO Multicentre Study on Suicidal Behaviour and ensuing MONSUE (Monitoring Suicidal Behaviour in Europe) project. The relationship between immigrant status and type of aftercare recommended was analysed with binary logistic regression, adjusting for gender, age, method of attempt and the Centre collecting the data. Clear disparities were identified in the care recommendation practices toward immigrants, compared with hosts, over and above differing policies by the European Centres.
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| 45. |
- Lipsicas, Cendrine Bursztein, et al.
(author)
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Repetition of attempted suicide among immigrants in Europe
- 2014
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In: Canadian journal of psychiatry. - : SAGE Publications. - 0706-7437 .- 1497-0015. ; 59:10, s. 539-547
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To compare frequencies of suicide attempt repetition in immigrants and local European populations, and the timing of repetition in these groups.METHOD: Data from 7 European countries, comprising 10 574 local and 3032 immigrant subjects, were taken from the World Health Organization European Multicentre Study on Suicidal Behaviour and the ensuing Monitoring Suicidal Behaviour in Europe (commonly referred to as MONSUE) project. The relation between immigrant status and repetition of suicide attempt within 12-months following first registered attempt was analyzed with binary logistic regression, controlling for sex, age, and method of attempt. Timing of repetition was controlled for sex, age, and the recommended type of aftercare.RESULTS: Lower odds of repeating a suicide attempt were found in Eastern European (OR 0.50; 95% CI 0.41 to 0.61, P < 0.001) and non-European immigrants (OR 0.68; 95% CI 0.51 to 0.90, P < 0.05), compared with the locals. Similar patterns were identified in the sex-specific analysis. Eastern European immigrants tended to repeat their attempt much later than locals (OR 0.58; 95% CI 0.35 to 0.93, P < 0.05). In general, 32% of all repetition occurred within 30 days. Repetition tended to decrease with age and was more likely in females using harder methods in their index attempt (OR 1.29; 95% CI 1.08 to 1.54, P < 0.01). Large variations in the general repetition frequency were identified between the collecting centres, thus influencing the results.CONCLUSIONS: The lower repetition frequencies in non-Western immigrants, compared with locals, in Europe stands in contrast to their markedly higher tendency to attempt suicide in general, possibly pointing to situational stress factors related to their suicidal crisis that are less persistent over time. Our findings also raise the possibility that suicide attempters and repeaters constitute only partially overlapping populations.
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| 46. |
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| 47. |
- McAuliffe, Carmel, et al.
(author)
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Problem-solving ability and repetition of deliberate self-harm : a multicentre study.
- 2006
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In: Psychological Medicine. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 36:1, s. 45-55
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Journal article (peer-reviewed)abstract
- Background. While recent studies have found problem-solving impairments in individuals who engage in deliberate self-harm (DSH), few studies have examined repeaters and non-repeaters separately. The aim of the present study was to investigate whether specific types of problem-solving are associated with repeated DSH. Method. As part of the WHO/EURO Multicentre Study on Suicidal Behaviour, 836 medically treated DSH patients (59% repeaters) from 12 European regions were interviewed using the European Parasuicide Study Interview Schedule (EPSIS II) approximately 1 year after their index episode. The Utrecht Coping List (UCL) assessed habitual responses to problems. Results. Factor analysis identified five dimensions – Active Handling, Passive-Avoidance, Problem Sharing, Palliative Reactions and Negative Expression. Passive-Avoidance – characterized by a pre-occupation with problems, feeling unable to do anything, worrying about the past and taking a gloomy view of the situation, a greater likelihood of giving in so as to avoid difficult situations, the tendency to resign oneself to the situation, and to try to avoid problems – was the problem-solving dimension most strongly associated with repetition, although this association was attenuated by self-esteem. Conclusions. The outcomes of the study indicate that treatments for DSH patients with repeated episodes should include problem-solving interventions. The observed passivity and avoidance of problems (coupled with low self-esteem) associated with repetition suggests that intensive therapeutic input and follow-up are required for those with repeated DSH.
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| 48. |
- Michel, K, et al.
(author)
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Methods used for parasuicide : results of the WHO/EURO Multicentre Study on Parasuicide.
- 2000
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In: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 35:4, s. 156-63
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Journal article (peer-reviewed)abstract
- There is a need, especially for areas with high frequencies for certain methods, to understand the factors involved and to develop new and specific prevention projects and to monitor their effects. The WHO/EURO Multicentre Study on Parasuicide has proved to be a useful and reliable instrument for continuous monitoring of trends in parasuicide.
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| 49. |
- Mofidi, Naser, 1964-, et al.
(author)
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Attitudes towards suicide among Kurdish people in Iran
- 2008
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In: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 43:4, s. 291-298
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Journal article (peer-reviewed)abstract
- Background Attitudes towards suicide represent a key stage in the pathway leading to suicide. A deeper understanding of the social, psychological and treatment-related factors influencing the development of attitudes towards suicide could guide suicide prevention strategies especially in a neglected population like Kurds. Methods In a cross-sectional study in Iranian Kurdistan, 1,000 households participated in the investigation from April to May 2006 selected by a cluster random sampling process. A questionnaire on attitudes towards suicide (ATTS) was used to measure suicide related attitudes and thoughts. Results Suicide related experiences were more often reported from the wider social network (relative, friends, acquaintances) than from family members. There is a significant accumulation of suicide related experiences when a related event was reported in the close family. The level of suicide related attitudes is related to age, gender, marital status, level of education and employment status. Discussion Openness towards the topic of suicide as well as abilities to communicate about it should be improved by educating the public and additionally be promoted by changing conservative value systems.
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| 50. |
- Music, Emina, et al.
(author)
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Deliberate self-harm and ethnicity in the city of Sarajevo, Bosnia and Herzegovina
- 2015
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In: Suicidology Online. - : University of Molise. - 2078-5488. ; 6:1, s. 1-6
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Journal article (peer-reviewed)abstract
- The aim of the present study is to investigate deliberate self-harm (DSH) in Bosnia and Herzegovina (BiH), with special reference to gender, age and ethnicity. Between 2001 and 2003, known hospital cases of DSH in persons aged 15 or older in the Sarajevo area were monitored using standardised methods. In total, 1428 DSH events were registered, giving an annual mean DSH event rate of 119 per 100 000 (118 for women, 120 for men) and a DSH person rate of 110 (108 for women, 111 for men). The mean person-based DSH rate was 124 for Bosniaks (Muslims), 128 for Croats (Catolics), and 88 for Serbs (Orthodox Christians). Self-poisoning was the most commonly used method in all three ethnic groups (66%), with second-most common method self-harm by a sharp object (17%). A very low proportion used guns or explosives. The rates of DSH in Sarajevo during the study period were comparable to those of many other regions in Europe, though with a quite unique pattern of higher rates among men. We identified fluctuating but significantly not different rates between ethnic groups. The general belief that religious denomination is decisive for level of DSH-rates was not supported by the findings of this study; rather the post-war situation with huge demographic changes was reflected in the results. Disruptions to social integration as a consequence of the war are put forward as possible explanations.
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