| 1. |
- 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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| 2. |
- Hägg, Göran M., et al.
(author)
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Adapting the force characteristics of a staple gun to the human hand
- 2015
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In: Applied Ergonomics. - : Elsevier. - 0003-6870 .- 1872-9126. ; 50, s. 133-138
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Journal article (peer-reviewed)abstract
- Three prototype staple guns with modified force characteristics were compared with a commercially available standard staple gun with a linearly increasing force resistance during squeezing. The force characteristics of the prototypes were more or less adapted to the force characteristics of the human hand, and in one of the staple guns the general force level was also reduced by one third. Evaluation instruments were electromyography of the forearm flexors and extensors, subjective rating of forearm exertion and subjects' free comments about the four tools. Twelve professional craftsmen were recruited as test subjects. The results show significantly lower readings for two of the three prototypes compared with the standard gun in electromyography as well as subjective ratings. The squeezing times are also reduced for two of the prototypes. It is concluded that the choice of force characteristics of a staple gun is important both to minimize forearm muscular exertion and to increase tool efficiency.
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| 3. |
- 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
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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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| 4. |
- Olsson, Petter, et al.
(author)
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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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In: BMC Psychiatry. - : BioMed Central. - 1471-244X. ; 22:1
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Journal article (peer-reviewed)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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| 5. |
- Olsson, Petter, et al.
(author)
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Clinical characteristics and 6-month follow-up of adults with and without alcohol use disorder who self-harm
- 2024
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In: Frontiers in Psychiatry. - : Frontiers Media S.A.. - 1664-0640. ; 15
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Journal article (peer-reviewed)abstract
- Background: Alcohol use disorder (AUD) is associated with suicidal behavior, but prospective clinical studies are lacking. Aim: To compare clinical characteristics and 6-month outcomes in persons with and without AUD who self-harm.Methods: 804 adults (mean age 33, age range 18-95, 541 women and 263 men, 666 with suicide attempts and 138 with non-suicidal self-injuries at index) at three Swedish university hospitals took part in a research interview that included the Mini International Neuropsychiatric Interview (MINI). Subsequent non-fatal suicidal behavior within six months was identified by record review; suicides were identified by national register.Results: At index, 39% of the men and 29% of the women had AUD. Over two thirds of these cases (69%) were identified by the MINI, but not by clinical AUD diagnosis. While trait impulsivity was more common among persons with AUD than those without (56% vs 36%, P adj = <.001), impulsivity in connection with the index attempt was noted in half of the participants in each group (48% vs 52%, P adj = 1). Subsequent suicidal behavior (fatal/non-fatal) occurred in 67 persons with AUD (26%) and in 98 without AUD (18%), a 60% higher risk among persons with AUD (OR = 1.60, 95% [CI 1.13-2.28], P =.009). Four persons with AUD (2%) and six without (1%) died by suicide within 6 months.Conclusion: Almost a third of patients presenting at psychiatric emergency settings after self-harm fulfilled criteria for AUD, but clinicians often missed this diagnosis. Risk for subsequent suicidal behavior was elevated in patients with AUD. Educational interventions to improve recognition of alcohol use disorder may aid clinicians in the assessment and management of patients who present with self-harm.
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| 6. |
- Waern, Margda, 1955, et al.
(author)
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Overlapping Patterns of Suicide Attempts and Non-suicidal Self-Injuries in Adults: A Prospective Clinical Cohort Study
- 2022
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In: Journal of Clinical Psychiatry. - : Physicians Postgraduate Press, Inc. - 0160-6689 .- 1555-2101. ; 83:6
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Journal article (peer-reviewed)abstract
- Objective: An overlap of non-suicidal self-injuries (NSSIs) and suicide attempts (SAs) is observed in young cohorts, but there are few robust prospective studies for adults. We compared 1-year outcomes in adults with different self-harm patterns: NSSI only, NSSI + SA, and SA only.Methods: 793 patients (67% women) consecutively presenting with NSSI (17%) or SA (83%) at 3 Swedish hospitals took part in face-to-face interviews. Past and current self-harm was characterized by the Columbia-Suicide Severity Rating Scale. Clinical records and national register data were employed to determine 1-year outcomes.Results: At inclusion, over half of the participants had engaged in both NSSI and SA; 41% had SA only and 5%, NSSI only. During follow-up, non-fatal SAs were observed in approximately onethird of the total group (n = 269). Suicides occurred in 2% of those with NSSI + SA; the same proportion was seen in the SA only group. No suicides were observed in those with NSSI only. In a multiple logistic regression analysis, the NSSI + SA pattern was associated with a more than 3-fold risk of subsequent fatal/ non-fatal suicidal behavior compared to "pure" NSSI; risk was not elevated in those with "pure" SA. Neither sex nor age group predicted subsequent suicidal behavior.Conclusions: Switching between behaviors with and without suicidal intent was common in this adult clinical cohort. Risk of subsequent suicidal behavior was tripled in the combined group. Clinicians who assess adults with NSSI must evaluate not only current but also previous episodes when assessing future risk of suicidal behavior.
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| 7. |
- Wiktorsson, Stefan, 1955, et al.
(author)
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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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In: The American journal of geriatric psychiatry. - : Elsevier. - 1064-7481 .- 1545-7214. ; 30:3, s. 342-351
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Journal article (peer-reviewed)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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