| 1. |
- Amin, Ridwanul, et al.
(författare)
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Healthcare use before and after suicide attempt in refugees and Swedish-born individuals
- 2021
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer. - 0933-7954 .- 1433-9285. ; 56:2, s. 325-338
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: There is a lack of research on whether healthcare use before and after a suicide attempt differs between refugees and the host population. We aimed to investigate if the patterns of specialised (inpatient and specialised outpatient) psychiatric and somatic healthcare use, 3 years before and after a suicide attempt, differ between refugees and the Swedish-born individuals in Sweden. Additionally, we aimed to explore if specialised healthcare use differed among refugee suicide attempters according to their sex, age, education or receipt of disability pension.METHODS: All refugees and Swedish-born individuals, 20-64 years of age, treated for suicide attempt in specialised healthcare during 2004-2013 (n = 85,771 suicide attempters, of which 4.5% refugees) were followed 3 years before and after (Y - 3 to Y + 3) the index suicide attempt (t0) regarding their specialised healthcare use. Annual adjusted prevalence with 95% confidence intervals (CIs) of specialised healthcare use were assessed by generalized estimating equations (GEE). Additionally, in analyses among the refugees, GEE models were stratified by sex, age, educational level and disability pension.RESULTS: Compared to Swedish-born, refugees had lower prevalence rates of psychiatric and somatic healthcare use during the observation period. During Y + 1, 25% (95% CI 23-28%) refugees and 30% (95% CI 29-30%) Swedish-born used inpatient psychiatric healthcare. Among refugees, a higher specialised healthcare use was observed in disability pension recipients than non-recipients.CONCLUSION: Refugees used less specialised healthcare, before and after a suicide attempt, relative to the Swedish-born. Strengthened cultural competence among healthcare professionals and better health literacy among the refugees may improve healthcare access in refugees.
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| 2. |
- Amin, Ridwanul, et al.
(författare)
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Suicide attempt and suicide in refugees in Sweden - a nationwide population-based cohort study
- 2021
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Ingår i: Psychological Medicine. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 51:2, s. 254-263
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Despite a reported high rate of mental disorders in refugees, scientific knowledge on their risk of suicide attempt and suicide is scarce. We aimed to investigate (1) the risk of suicide attempt and suicide in refugees in Sweden, according to their country of birth, compared with Swedish-born individuals and (2) to what extent time period effects, socio-demographics, labour market marginalisation (LMM) and morbidity explain these associations.METHODS: Three cohorts comprising the entire population of Sweden, 16-64 years at 31 December 1999, 2004 and 2009 (around 5 million each, of which 3.3-5.0% refugees), were followed for 4 years each through register linkage. Additionally, the 2004 cohort was followed for 9 years, to allow analyses by refugees' country of birth. Crude and multivariate hazard ratios (HRs) with 95% confidence intervals (CIs) were computed. The multivariate models were adjusted for socio-demographic, LMM and morbidity factors.RESULTS: In multivariate analyses, HRs regarding suicide attempt and suicide in refugees, compared with Swedish-born, ranged from 0.38-1.25 and 0.16-1.20 according to country of birth, respectively. Results were either non-significant or showed lower risks for refugees. Exceptions were refugees from Iran (HR 1.25; 95% CI 1.14-1.41) for suicide attempt. The risk for suicide attempt in refugees compared with the Swedish-born diminished slightly across time periods.CONCLUSIONS: Refugees seem to be protected from suicide attempt and suicide relative to Swedish-born, which calls for more studies to disentangle underlying risk and protective factors.
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| 3. |
- Amin, Ridwanul, et al.
(författare)
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Trajectories of antidepressant use before and after a suicide attempt among refugees and Swedish-born individuals : a cohort study
- 2021
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Ingår i: International Journal for Equity in Health. - : BioMed Central. - 1475-9276. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To identify key information regarding potential treatment differences in refugees and the host population, we aimed to investigate patterns (trajectories) of antidepressant use during 3 years before and after a suicide attempt in refugees, compared with Swedish-born. Association of the identified trajectory groups with individual characteristics were also investigated.METHODS: All 20-64-years-old refugees and Swedish-born individuals having specialised healthcare for suicide attempt during 2009-2015 (n = 62,442, 5.6% refugees) were followed 3 years before and after the index attempt. Trajectories of annual defined daily doses (DDDs) of antidepressants were analysed using group-based trajectory models. Associations between the identified trajectory groups and different covariates were estimated by chi2-tests and multinomial logistic regression.RESULTS: Among the four identified trajectory groups, antidepressant use was constantly low (≤15 DDDs) for 64.9% of refugees. A 'low increasing' group comprised 5.9% of refugees (60-260 annual DDDs before and 510-685 DDDs after index attempt). Two other trajectory groups had constant use at medium (110-190 DDDs) and high (630-765 DDDs) levels (22.5 and 6.6% of refugees, respectively). Method of suicide attempt and any use of psychotropic drugs during the year before index attempt discriminated between refugees' trajectory groups. The patterns and composition of the trajectory groups and their association, discriminated with different covariates, were fairly similar among refugees and Swedish-born, with the exception of previous hypnotic and sedative drug use being more important in refugees.CONCLUSIONS: Despite previous reports on refugees being undertreated regarding psychiatric healthcare, no major differences in antidepressant treatment between refugees and Swedish-born suicide attempters were found.
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| 4. |
- Fazel, Seena, et al.
(författare)
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Risk of death by suicide following self-harm presentations to healthcare : development and validation of a multivariable clinical prediction rule (OxSATS)
- 2023
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Ingår i: BMJ Mental Health. - : BMJ Publishing Group Ltd. - 2755-9734. ; 26:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Assessment of suicide risk in individuals who have self-harmed is common in emergency departments, but is often based on tools developed for other purposes. OBJECTIVE: We developed and validated a predictive model for suicide following self-harm.METHODS: We used data from Swedish population-based registers. A cohort of 53 172 individuals aged 10+ years, with healthcare episodes of self-harm, was split into development (37 523 individuals, of whom 391 died from suicide within 12 months) and validation (15 649 individuals, 178 suicides within 12 months) samples. We fitted a multivariable accelerated failure time model for the association between risk factors and time to suicide. The final model contains 11 factors: age, sex, and variables related to substance misuse, mental health and treatment, and history of self-harm. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis guidelines were followed for the design and reporting of this work.FINDINGS: An 11-item risk model to predict suicide was developed using sociodemographic and clinical risk factors, and showed good discrimination (c-index 0.77, 95% CI 0.75 to 0.78) and calibration in external validation. For risk of suicide within 12 months, using a 1% cut-off, sensitivity was 82% (75% to 87%) and specificity was 54% (53% to 55%). A web-based risk calculator is available (Oxford Suicide Assessment Tool for Self-harm or OxSATS).CONCLUSIONS: OxSATS accurately predicts 12-month risk of suicide. Further validations and linkage to effective interventions are required to examine clinical utility.CLINICAL IMPLICATIONS: Using a clinical prediction score may assist clinical decision-making and resource allocation.
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| 5. |
- Karanti, Alina (Aikaterini), et al.
(författare)
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Characteristics of bipolar I and II disorder: A study of 8766 individuals.
- 2020
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Ingår i: Bipolar disorders. - : Wiley. - 1399-5618 .- 1398-5647. ; 22:4, s. 392-400
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Tidskriftsartikel (refereegranskat)abstract
- Large-scale studies on phenotypic differences between bipolar disorder type I (BDI) and type II (BDII) are scarce.Individuals with BDI (N=4806) and BDII (N=3960) were compared with respect to clinical features, illness course, comorbid conditions, suicidality, and socioeconomic factors using data from the Swedish national quality assurance register for bipolar disorders (BipoläR).BDII had higher rate of depressive episodes and more frequent suicide attempts than BDI. Furthermore, the BDII group were younger at first sign of mental illness and showed higher prevalence of psychiatric comorbidity but were more likely to have completed higher education and to be self-sustaining than the BDI group. BDII more frequently received psychotherapy, antidepressants, and lamotrigine. BDI patients had higher rate of hospitalizations and elated episodes, higher BMI, and higher rate of endocrine, nutritional, and metabolic diseases. BDI were more likely to receive mood stabilizers, antipsychotic drugs, electroconvulsive therapy, and psychoeducation.These results demonstrate clear differences between BDI and II and counter the notion that BDII is a milder form of BDI, but rather a more complex condition with regard to clinical course and comorbidity.
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| 6. |
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| 7. |
- Milerad, Josef, et al.
(författare)
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Kraftsamling för ungas psykiska hälsa : Kunskapssammanfattning och förslag till interventioner från Svenska Läkarsällskapet arbetsgrupp 2021
- 2021
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Utvecklingen från mitten av 1960-talet och framåt har kännetecknats av ökad materiell levnadsstandard, stärkt rättskydd för barn, minskande somatisk ohälsa, och en kraftigt sjunkande barnadödlighet. Denna positiva utveckling i Sverige och andra höginkomstländer har inte lett till en minskning av psykiska symptom hos unga. Att barn rapporterar mer stress och psykiska symptom trots bättre levnadsförhållanden, ”välfärdsparadoxen”, har varit tydligt i Sverige. Utgångspunkten för denna översikthar varit att lyfta fram vilka livsstils- och omgivningsfaktorer som har visat sig kunna bromsa eller vända denna utveckling.Folkhälsomyndighetens undersökning “Skolbarns hälsovanor”, och liknande rapporter från WHO, Unicef samt USA:s och Kanadas folkhälsomyndigheter har påtalat tydliga samband mellan psykiska symptom hos unga i skolåldern och fysisk inaktivitet. Låg fysisk aktivitet har i sin tur ofta ett samband med att tid på digitala medier tar utrymme från sömn och hälsofrämjande aktiviteter. Det finns även belägg för att program som stärker ungas förmåga att hantera känslor, sociala relationer och fatta ansvarsfulla beslutleder till bättre skolresultat, anpassning till vuxenlivet och bidrar till bättre psykisk hälsa. Ett omfattandekunskapsunderlag talar för att skolan har en central roll när det gäller att främja psykisk hälsa. Samma gäller vikten av tidiga insatser till unga med individuella svårigheter eller problem som beror på ogynnsamma eller socialt belastade uppväxtmiljöer.Utifrån publicerade samband mellan psykiska symptom och livsstil eller livsomständigheter föreslår Svenska Läkarsällskapets arbetsgrupp fem konkreta interventioner där vi ser skolan som en viktig arena där man når alla unga i skolåldern.5 konkreta interventioner för förbättrad psykisk hälsa bland barn och unga:Regelbunden strukturerad fysisk aktivitet – gärna i anslutning till skoltid.Hjälpa unga att nå en balans mellan tid ägnad åt digitala medier och hälsofrämjande aktiviteter.“Livskunskapsprogram” som hjälp till ungdomar att stärka självkänslan, hantera stress och skapa positiva förändringar.Främja psykisk hälsa i skolmiljön genom att anpassa kunskaps- och betygskrav till ungas utveckling och förutsättningar.Satsa på program för tidig upptäckt och stöd till unga med ökad risk för sämre psykisk hälsa.För att kunna genomföra dessa insatser krävs ett nära samarbete mellan alla som verkar för ungas hälsa; professioner inom hälso- och sjukvård, elevhälsa, socialtjänst men även föräldra- och elevorganisationer. När det gäller samhällsfunktioner som hälso- och sjukvård, skola och socialtjänst behöver man undanröja organisatoriska hinder för samverkan. Olika huvudmän för samhällsfunktioner har skilda ansvarsområden och ibland olika syn på sitt uppdrag. Vi vill även understryka vikten av fler kontaktytor mellan akademisk forskning som utvärderar hälsofrämjande program och verksamheter som ska tillämpa dessa.
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| 8. |
- Olsson, Petter, et al.
(författare)
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Attention deficit hyperactivity disorder in adults who present with self-harm : a comparative 6-month follow-up study
- 2022
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Ingår i: BMC Psychiatry. - : BioMed Central. - 1471-244X. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: ADHD is common in psychiatric populations. This study aimed to compare clinical characteristics in adults with and without ADHD who presented with self-harm, and to compare later risk of suicidal behaviour within 6 months.Methods: Eight hundred four adults presented with self-harm (with and without suicidal intent) at psychiatric emergency services at three Swedish hospitals. Persons with a discharge ICD-10 diagnosis F90.0-F90.9 or a prescription for ADHD medication were considered to have ADHD (n = 93). Medical records were reviewed for evidence of subsequent suicide attempts (SA) within 6 months; suicides were identified by national register.Results: Recent relationship problems were more prevalent in the ADHD group. While the index episodes of those with ADHD were more often non-suicidal, and actual SAs more often rated as impulsive, medical lethality at presentation did not differ in attempters with and without ADHD. Subsequent SAs (fatal or non-fatal) were observed in 29% of the ADHD group and 20% in all others (P = .005). A logistic regression model showed elevated risk of suicidal behaviour during follow-up in the ADHD group (OR = 1.70, CI 1.05–2.76), although a final regression model suggested that this association was partly explained by age and comorbid emotionally unstable personality disorder.Conclusions: Findings highlight the need for clinicians to take self-harm seriously in adults with ADHD.
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| 9. |
- Wiktorsson, Stefan, 1955, et al.
(författare)
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Clinical Characteristics in Older, Middle-Aged and Young Adults Who Present With Suicide Attempts at Psychiatric Emergency Departments : A Multisite Study
- 2022
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Ingår i: The American journal of geriatric psychiatry. - : Elsevier. - 1064-7481 .- 1545-7214. ; 30:3, s. 342-351
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To study age group differences in clinical characteristics in older, middle-aged and younger adults with actual suicide attempts (SA).Design: Cross-sectional cohort study.Setting: 3 Swedish university hospitals.Participants: 821 persons who presented with self-harm at psychiatric emergency departments participated. Those with non-suicidal self-injury according to the Columbia Suicide Severity Rating Scale (C-SSRS) were excluded, leaving a total of 683 with an actual SA (18–44 years, n = 423; 45-64 years, n = 164; 65+, n = 96).Measurements: Suicidal behavior was characterized with the C-SSRS and the Suicide Intent Scale (SIS); symptoms associated with suicide were rated with the Suicide Assessment Scale (SUAS). Diagnoses were set using the Mini-International Neuropsychiatric Interview. Patients self-rated their symptoms with the Karolinska Affective and Borderline Symptoms Scale (KABOSS).Results: Older adults scored higher than the younger group on SIS total score and on the subjective subscale, but no age group differences were detected for the objective subscale. Half of the 65+ group fulfilled criteria for major depression, compared to 3-quarters in both the middle-aged and young groups. Anxiety disorders, as well as alcohol and substance use disorders were also less prevalent in the 65+ group, while serious physical illness was more common. Older adults scored lower on all symptom scales; effect sizes were large.Conclusions: While older adults with an SA showed higher suicide intent than young adults, they had lower scores on all ratings of psychiatric symptomatology. Low ratings might interfere with clinicians’ assessments of the needs of older adults with intentional self-harm.
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| 10. |
- Zhang, Tianyang, et al.
(författare)
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Maternal suicide attempts and deaths in the first year after cesarean delivery
- 2023
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Ingår i: Psychological Medicine. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 53:7, s. 3056-3064
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cesarean delivery (CD) has been associated with postpartum psychiatric disorders, but less is known about the risk of suicidal behaviors. We estimated the incidence and risk of suicide attempts and deaths during the first postpartum year in mothers who delivered via CD v. vaginally.METHOD: All deliveries in Sweden between 1973 and 2012 were identified. The mothers were followed since delivery for 12 months or until the date of one of the outcomes (i.e. suicide attempt or death by suicide), death by other causes or emigration. Associations were estimated using Cox proportional hazards regression models.RESULTS: Of 4 016 789 identified deliveries, 514 113 (12.8%) were CDs and 3 502 676 (87.2%) were vaginal deliveries. During the 12-month follow-up, 504 (0.098%) suicide attempts were observed in the CD group and 2240 (0.064%) in the vaginal delivery group (risk difference: 0.034%), while 11 (0.0037%) deaths by suicide were registered in the CD group and 109 (0.0029%) in the vaginal delivery group (risk difference: 0.008%). Compared to vaginal delivery, CD was associated with an increased risk of suicide attempts [hazard ratio (HR) 1.46; 95% CI 1.32-1.60], but not of deaths by suicide (HR 1.44; 95% CI 0.88-2.36).CONCLUSIONS: Maternal suicidal behaviors during the first postpartum year were uncommon in Sweden. Compared to vaginal delivery, CD was associated with a small increased risk of suicide attempts, but not death by suicide. Improved understanding of the association between CD and maternal suicidal behaviors may promote more appropriate measures to improve maternal mental well-being and further reduce suicidal risks.
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