Category: Ongoing research projects

The YRSA Project – suicide attempt in youth

The rate of suicide attempt in adolescents has been increasing for the last decades, especially in young girls. Suicide attempt is the best-established risk factor for subsequent death by suicide, therefore this increasing trend is alarming. Reportedly, only up to 9% of those adolescents who attempt suicide are seen at somatic hospitals, implying that up to 90% of all teenagers in a crisis situation with a suicide attempt may have not received professional help for their suicidal behavior. The YRSA project aims to document prevalences and early risk factors for suicide ideation and -attempt in both those seen at somatic hospitals for suicide attempt and in those who self-reported suicide attempt but do not seek somatic treatment. Further, the aim is to examine barriers and facilitators of seeking help from mental health services after a suicide attempt. The YRSA project, which combines self-reported data from the Danish National Birth Cohort with register-based data, are unique for this purpose.

Drisp: Trine Madsen

The YAM project will be conducted in Danish schools.

DRISP and The Research Unit in the Child & Adolescent Mental Health Center have received a grant from The Novo Nordisk Foundation to test the school initiative Youth Aware of Mental Health (YAM) in Danish schools.

The project is a cross-sectoral collaboration between the Social and Healthcare Sectors to investigate whether insight and knowledge about mental health vulnerability and self-harm can be prevented among students in 9th grade in Danish schools.

The YAM intervention is a 5-week evidence-based program that encourages young people to learn about mental health well-being, encountering role play and discussions on topics related to their everyday mental health. The intervention is manual-based and will be facilitated by trained YAM Instructors.

Several schools have already expressed their interest in the project, which will be conducted as a cluster randomized feasibility study in 8-10 schools across the country. The aim is to investigate whether the intervention can be implemented in Danish schools on a larger scale.

We are looking very much forward to getting started.

Read more here

(https://www.y-a-m.org)

Drisp: Britt Morthorst

People with sleep disorders and rates of suicide

People with sleep disorders or poor sleep quality have an increased risk of psychiatric disorders. Sleep disorders may also be associated with suicide but the evidence regarding this has so far been limited to small studies.

The aim of the research project was to analyze the relationship between sleep disorders, treatment with sleeping pills (e.g. benzodiazepines and melatonin) and suicide using register-based data. In separate statistical analyses, it has, for instance, been investigated whether people with sleep disorders have higher rates of suicide when compared to people without sleep disorders.

Findings from the first study showed that males who had been diagnosed with a sleep disorder had a 1.5 times higher suicide rate versus males with no sleep disorder. A 2.2 times higher suicide rate was observed for females with sleep disorders when compared to the background population. In addition, the findings revealed that the majority of people with sleep disorders who died by suicide also had a mental disorder, which potentially could explain the increased suicide risk. Patients with narcolepsy were found to have a higher suicide rate when compared to the background population. This has not previously been documented.

You can find the scientific study here:

https://academic.oup.com/sleep/article/45/5/zsac069/6550645?login=false

In separate study, it was examined whether melatonin, a treatment for sleep disorders, was associated with an increased rate of suicide attempts and suicide. People who had redeemed prescriptions for melatonin were subsequently found to have a higher rate of suicide attempts and suicide than people not in treatment with melatonin. About 90% of the people treated with melatonin who had a suicide attempts also had a psychaitric disorder. This supports the hypothesis that people who suffer from insomnia or sleep disorders often also experience psychological stress and this relationship may increase risk of suicidal behavior. This study was the first to assess the link between treatment with melatonin and suicide.

You can find the published study here:
https://jcsm.aasm.org/doi/10.5664/jcsm.10118

The study was supported by a research scholarship from the Lundbeck Foundation.

Partner:

  • Adam Spira, PhD, Department of Mental Health, Johns Hopkins Bloomberg School of PublicHealth, Baltimore, USA.
  • Prof Keith Hawton, Centre for Suicide Research, University of Oxford

Risk for suicide attempt in the offspring of parents with suicide attempt.

In this study we use data from Danish, nationwide registers to investigate risk of suicide attempt in individuals whose parents have attempted suicide. Results show that parental suicide attempt is associated with a 3-fold increased risk of suicide attempt in the offspring. Risks are highest if the parent attempted suicide during early childhood of the offspring. Risks were slightly higher for children of mothers than fathers with suicide attempt. Suicide attempt in a stepparent was associated with a 1,7 fold risk of suicide attempt in the stepchild. Analyses are adjusted for important socioeconomic confounders.

DRISP: Anne Ranning, Annette Erlangsen, Trine Madsen, Merete Nordentoft

Partners:

  • Center for Register-based Research

iCare: Psychoeducation for parents of children with suicide attempt

Each year, there are approximately 11,000 suicide attempts in Denmark, mainly among young people under the age of 25. Clinicians who provide support to young people after suicide attempt are often consulted by the young person’s parents who are keen to support their child. To provide better information to parents, DRISP has developed a website for this target group and in collaboration with parents with lived experiences. This website is now testing to determine whether parents find it useful. In connection with the project, several qualitative studies have been conducted, which are described here below.

Study 1: Existing evidence regarding the experiences of relatives caring for people with suicide attempts was reviewed. A total of 12 studies on the subject were included and a meta-ethnographic synthesis was conducted. The results showed that relatives of people with suicide attempts often pass through four unique phases, which each represent different perspectives and emotions. It was also found that interaction with other relatives who experienced comparable challenges made it easier for relatives to pass through these phases and helped them to find themselves in new and challenging situations.

The study can be found here:
https://www.sciencedirect.com/science/article/pii/S0020748920302790

Study 2: Interviews were conducted with 21 Danish parents of children with suicidal behavior. The results of the study showed that parents’ perceived that their identity was affected by their children’s suicidal acts. The perceived identity of the parents passed through up to three interrelated phases. Each phase reflected a different perspective of their identity and was developed in social interaction with other people. It was also found that not all parents were able to re-establish their parenting agency.

This study can be found here: https://www.sciencedirect.com/science/article/pii/S002074892030279

DRISP: Jette Louise Skovgaard Larsen, Anette Juel Kynde, Britt Morthorst, Annette Erlangsen


Partners

  • Elene Fleischer, PhD Netværk for selvmordsramte (www.nefos.dk)
  • Niels Buus, Mental Health Nursing, Sydney Nursing School, University of Sydney
  • Jan-Henrik Winsløw, Enhed for Selvmordsforebyggelse, Region Nordjylland
  • Prof Keith Hawton, Centre for Suicide Research, University of Oxford

National E-learning

A national development of competence project in suicide prevention for professions working with suicidal people in the mental health services and municipalities. The project began in 2017 as a collaboration between the Regions in Denmark and funded by The National Partnership in Suicide prevention under The National Board of Health. The product was a E-learning program and is implemented in alle Regions. In 2022 the project was funded again and its was led to a further development of two new cases regarding the somatic ill patient and psychotic patient, which will be implemented in autumn 2023.

https://www.regionh.dk/e-learning/paa_tegnebraettet/Sider/selvmordsforebyggelse.aspx

DRISP: Kate Andreasson Aamund

App for people with self-harm – MYPLAN Zero Self-Harm

Some people intentionally harm themselves to relieve mental pain. It may be difficult to stop this behavior once it has been initiated. There are, unfortunately, few treatment options for people with self-harm. One recommended approach is to develop strategies in the form of a safety plan, which can be activated if the urge for self-harm arises.

The Zero Self-Harm app was developed as an extension of the MYPLAN app. People with lived experiences, in the form of current and past self-harm, were included in the development process through focus group interviews. The app helps the user to identify warning signs and to develop strategies to cope with future crises.

Zero Self-Harm is currently being tested in a research project, which consists of: 1) a randomized study to investigate whether the Zero Self-Harm app may reduce self-harming behavior, and 2) a qualitative evaluation of barriers and facilitators for using the app. The RCT is expected to be initiated in the autumn of 2020 and to be completed in 2023.

The project is supported by the TRYG Foundation.

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Drisp: Lene Qvist Larsen, Annette Erlangsen, Jette Louise Skovgaard Larsen; Kate Andreasson Aamund, Merete Nordentoft, Eybjørg A Heygum Egilsdóttir; Evelyn Guerrero

Suicide risk according to highest level of psychiatric service received

Different patient groups are seen across psychiatric sectors and it is relevant to know which groups are at imminent risk of suicide. In this project, the risk of suicide is examined according to the highest level of psychiatric service received. The level will be graded according to severity as well as by type of contact, such as psychiatric admission, psychiatric ER visit, psychiatric outpatient, psychiatric medicine.

DRISP: Trine Madsen, Merete Nordentoft, Annette Erlangsen

Relative affected by suicidal behaviour in Denmark

International research has demonstrate that a substantially share of the population have experienced to lose a next of kin to suicide. This study examines how many Danes have been affected by a suicide attempt. The aim of this on-going study is the assess how large a share of the Danish population have been affected by suicidal behaviour. The project has received support from the Partnership for Suicide Prevention, Danish Health Authority.

DRISP: Trine Madsen, Anne Ranning, Annette Erlangsen


Partners

  • Karine Hvidkjaer, medicinstuderende ved Københavns Universitet
  • Elene Fleischer, PhD Netværk for selvmordsramte (www.nefos.dk)
  • Jens Peter Eckardt,chefanalytiker, Bedre Psykiatri

Call volume to a national suicide hotline, the Lifeline

It is estimated that between 50-60% of the people who call helplines for suicide prevention are in an acute crisis, and up to 56% have had a previous suicide attempt. It is therefore important to answer these calls.

The counselors of the Danish telephone helpline for suicide prevention, “Livslinien,” answer more than 14,000 calls per year. However, many calls still go unanswered. DRISP is collaborating with the Danish telephone helpline in an ongoing research project to investigate how many calls are answered and at what times of day the peaks.

In a first research project, the number of calls and characteristics of the people who called Livslinien were investigated. Data on all answered calls in the period 2018-2019 were analyzed. The data material consisted of records that counselors make after each counseling session and included socio-demographic information as well as an assessment of the person’s suicide risk.

Ove a 2-year period, a total of 42,393 calls were answered. In more than half of all calls, the person seeking counseling was evaluated to be at risk of suicide – and in 37% of all calls, the person was considered to be at high risk of suicide.

The study also showed that women, younger people, those with a history of previous suicide attempts, and those who reported problems related to self-harm, mental illness, sexual abuse, substance abuse, and physical health problems were more likely to be considered at risk of suicide, as evaluated by counselors.

The results of the study highlight the importance of helplines for suicide prevention and the need to ensure that these are adequately staffed in order to meet the demand.

You can read the study here: https://www.tandfonline.com/doi/abs/10.1080/13811118.2022.2084005

The project has received funding from the Suicide Prevention Partnership, the Danish Health Authority.

DRISP: Annette Erlangsen

Partners:

  • Livslinien

Bereaved by suicide and affected by suicide: how many receive help?

Every year about 600 suicide deaths and 11,000 suicide attempts are recorded in Denmark. Next to each suicidal act are numerous relatives and other next of kin who are deeply affected. Specialised support for bereaved and affected is being provided by volunteer organisations and it is unclear how many receive help. This research project will seek to map how many bereaved by suicide and affected by suicidal behaviour receive support from Nefos, one of the Danish volunteer organisations.


The project has received support from the Partnership for Suicide Prevention, Danish Health Authority

DRISP:  Annette Erlangsen


Partner:

  • Elene Fleischer, PhD Netværk for selvmordsramte (NEFOS)

MYPLAN – a self-help tool for management of crisis

People who have had a suicide attempt have a significantly higher risk of repeated suicidal behaviour. MYPLAN was created with the intention of being a self-help tool for management of suicidal crisis. This project consists of 1) a qualitative study of stakeholders on improvements to MYPLAN; 2) a randomized clinical trial to evaluate MYPLAN’s efficacy in reducing suicide intent among persons at risk of suicide, and 3) a person-centered evaluation of the MYPLAN to identify barriers and facilitators to its general implementation. The RCT was initiated in 2019 and is currently ongoing. Following studies have been published :
The project received support from the Danish TRYG Foundation.

Publications

https://trialsjournal.biomedcentral.com
https://www.tandfonline.com


DRISP: Charlotte Mühlmann Kate Andreassen Aamund, Jette Louise S. Larsen, Annette Erlangsen

Partners:

  • Hanne Frandsen, Mental Health Centre Copenhagen, Region H
  • Niels Buus, Mental Health Nursing, Sydney Nursing School, University of Sydney, Australia

TEENS trial

Non-suicidal self-injury (NSSI) is very prevalent among adolescents estimated to a lifetime prevalence in non-clinical samples of 17%; increasing in psychiatric populations. NSSI an important predictor of later suicidal behavior. Evidence for treatment is spares but internet-based interventions guided by a therapist have been suggested. We aim to investigate the effect of internet-based ERITA compared to weekly journaling as add-on to treatment as usual in 13-17-year-old patients with NSSI referred to child– and adolescent mental health services. This pilot feasibility study (n=25) is an RCT. The experimental interventions are add-on to treatment as usual. Primary outcome is the frequency of NSSI assessed after 12 weeks. Also, adherence to treatment will be assessed.

DRISP: Britt Morthorst

Partners:

  • Child and Adolescent Mental Health Services in the Capital Region of Denmark
  • Johan Bjureberg, PhD, Karolinska Instituttet, Stockholm, Sweden
  • Clara Hellner, MD, PhD, Karolinska Instituttet, Stockholm, Sweden

Clinical development project

The aim is to implement three questionnaires regarding protective and risk factors in suicide behavior in the treatment of children and adolescents. The implementation will contribute with a quality boost to the clinical work in the Suicide Prevention Clinic for children and adolescents by structured collecting and using tested scales to assess children and adolescents’ suicide risk, experience of mental stress as well as own strengths and weaknesses (resilience). The three scales that are to be used are: K10 (the experience of psychological stress), READ (resilience) and Columbia (the frequency and the intensity of suicide behavior). For the time being this is a clinical development project that may lead to a research project on a later stage.

DRISP: Britt Morthorst

Partners:

  • Child and Adolescent Mental Health Services in the Capital Region of Denmark
  • Center for Suicide Prevention, Region South Denmark

Association Between Spousal Suicide and Mental, Physical, and Social Health Outcomes

In this nationwide cohort study, an increased risk of mental and physical disorders, mortality, and adverse social events were noted among people bereaved by spousal suicide. Bereavement by suicide differed from bereavement by other manners of death. Surviving partners are affected on a broad range of mental, physical, and social health outcomes, suggesting a need for more proactive outreach. The findings have been published in JAMA Psychiatry.
The project was supported by the American Foundation for Suicide Prevention and the Danish Health Insurance Foundation.

DRISP: Annette Erlangsen og Merete Nordentoft

Partner:

  • Bo Runeson, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  • James M. Bolton, Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
  • Holly C. Wilcox, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
  • Julie L Forman, Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
  • Jesper Krogh, Research Unit, Mental Health Centre Copenhagen, Denmark
  • Katherine Shear, Columbia School of Social Work, Columbia University College of Physicians and Surgeons, New York, New York
  • Yeates Conwell, Center for the Study and Prevention of Suicide, Department of Psychiatry, and Office for Aging, University of Rochester Medical Center, Rochester, New York