In this
DRISP: Anne Ranning, Annette Erlangsen, Trine Madsen, Merete Nordentoft
Partners:
- Center for Register-based Research
Tag: Psychiatric 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
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 associated with psychiatric hospitalization
People with mental illness have an increased risk of suicide. Previous Danish studies have shown that the risk is elevated in the period shortly after admission and especially after discharge from psychiatric hospital. Trine Madsen from DRISP has in an updated analyses investigated whether this is still the case or whether the recent decades of efforts in the field have led to an improved situation for people with mental vulnerability.
Register data for the entire Danish population aged 15 years or older in the period 1995-2016 were included in the analysis.
Men and women who were in inpatient treatment for a psychiatric disorder had a suicide rate of 237 and 322 per 100,000, respectively, compared to men and women who had never been inpatients. In the first week after discharge, the suicide rate was 225 and 425 times higher for men and women, respectively, when compared to those who had never been admitted. About 6% of all suicides amongst males and 13% amongst females occurred during the first week of a psychiatric admission or discharge. The study also showed that the suicide rate amongst admitted patients fell by 2.5% per year until 2009, after which the rate rose by 7.5% per year.
The study’s conclusion was that – despite falling suicide rates – the period around admission and discharge from a psychiatric hospital is still associated with an extremely high risk of death by suicide.
You can find the study here: https://onlinelibrary.wiley.com/doi/full/10.1111/acps.13221
DRISP: Trine Madsen, Merete Nordentoft & Annette Erlangsen
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
Neurological disorders and suicide
Neurological disorders have severe impacts on people’s lives in terms of both disability and dependency and have been linked to suicide. Yet, a comprehensive overview was lacking. This study examined whether people with specific neurological disorders die by suicide more often than other people. The study was based on the register data covering the entire population of Denmark during 1980-2016.
The findings from study, which was published in JAMA, shows that people with neurological disorders have a 75% higher suicide rate than people with no neurological disorders. Still, suicide deaths are rare events. While the suicide rate for the general population was around 20 per 100,000, the rate for people with neurological disorders is around 40 per 100,000 person-years. One out of 150 persons diagnosed with a neurological disorder dies by suicide. For severe neurological diseases, such as Huntington’s, one out of 61 diagnosed went on to die by suicide. This study is the most comprehensive assessment of neurological disorders’ link to suicide conducted to date.
The study shows that people who have been diagnosed with amyotrophic lateral sclerosis (ALS) or Huntington’s disease have a particular high risks, as the suicide rate associated with these disorders is 4-5 times higher than in the general population. People who have been exposed to traumatic brain injury, multiple sclerosis, or epilepsy have a suicide rate, which is double the level of the one found among those with no such disorders.
People with dementia were found to have a 2-3 time higher suicide rate during the first three months after being diagnosed. On the other hand, people who had been diagnosed with dementia more than a year ago were found to have a lower suicide rate than the general population.
– This is the first time we have examined this many different neurological disorders to gain a more detailed understanding of when risk of suicide is pronounced. These insights can help us shape dedicated preventive effort says Dr. Annette Erlangsen, lead author and senior researcher at Danish Research Institute for Suicide Prevention (DRISP). The project has received support from the Psychiatric Research Foundation, Region of Southern Denmark.
Link to study:
https://jamanetwork.com/journals/jama/article-abstract/2760389
DRISP: Annette Erlangsen, Merete Nordentoft
Partners:
- Egon Stenager, Department of Neurology, Sønderborg, Hospital of Southern Jutland, Denmark
- Yeates Conwell, Center for the Study and Prevention of Suicide, University of Rochester Medical Center, USA
- Per Krag Andersen, Section of Biostatistics, University of Copenhagen, Denmark
- Keith Hawton, Centre for Suicide Research, University of Oxford, United Kingdom
- Michael Eriksen Benros, Research Unit, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Elsebeth Stenager, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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
Cause-specific life years lost among persons diagnosed with schizophrenia: Is it getting better or worse?
People with schizophrenia have an increased risk of premature mortality compared to the general population. This study aimed to quantify which types of causes of death contributed to
The study has been published in Schizophrenia Research
https://www.sciencedirect.com/science/article/pii/S0920996418306339#f0005
DRISP: Annette Erlangsen & Merete Nordentoft
Partners:
- Thomas Munk Laursen, National Center for Register-based Research, Aarhus Denmark (first author on study)
- Oleguer Plana-Ripoll, The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
- Per Kragh Andersen, Section of Biostatistics, University of Copenhagen
- John J McGrath, Queensland Brain Institute, University of Queensland
- Anita Toender, National Center for Register-based Research, Aarhus Denmark
- Vladimir Canudas-Romo, School of Demography, Australian
Psycho-social speech therapy in the Danish Suicide Prevetion Clincs
Although deliberate self-harm is a strong predictor of suicide, evidence for effective interventions is missing. The aim of this study was to examine whether psychosocial therapy after self-harm was linked to lower risks of repeated self-harm, suicide, and general mortality.
Our findings show a lower risk of repeated deliberate self-harm and general mortality in recipients
The project was supported by Danish Health Insurance Foundation; the Research Council of Psychiatry, Region of Southern Denmark; the Research Council of Psychiatry, Capital Region of Denmark; and the Strategic Research Grant from Health Sciences, Capital Region of Denmark.
The project in the media
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New York Times
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Bloomberg News
The study was published in Psychological Medicine and Lancet Psychiatry.
DRISP: Annette Erlangsen & Merete Nordentoft
Partners:
- Elizabeth A Stuart, Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Ping Qin, National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway
- Elsebeth Stenager, Department of Psychiatry, University of Southern Denmark, Odense, Region of Southern Denmark, Denmark
- Leaders of the Danish Suicide Prevention Clinics
Genetics of suicide attempts in individuals with and without mental disorders
Family studies
The study was published in Molecular Psychiatry.
The project was funded by the iPSYCH-grant from the Danish Lundbeck Foundation
DRISP: Annette Erlangsen & Merete Nordentoft
Partners:
- Vivek Appadurai, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
- Yunpeng Wang, PhD, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
- Gustavo Turecki, MD, PhD, McGill Group for Suicide Studies, Douglas Hospital Research Centre, Department of psychiatry, McGill University, Montreal, Canada
- Ole Mors, PhD, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
- Thomas Werge, PhD, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
- Preben B Mortensen, DrMedSc, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
- Anna Starnawska, PhD, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
- Anders D Børglum, PhD, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
- Andrew Schork, MS, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
- Ron Nudel, DPhil, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
- Marie Bækvad-Hansen, PhD, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
- Jonas Bybjerg-Grauholm, MSc, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
- David M Hougaard, DrMedSc, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
- Wesley K Thompson, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
- Esben Agerbo, DrMedSc The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
Infections and suicide
Findings suggest that infections might be linked to the development of psychiatric disorders and suicidal
The study was published in JAMA Psychiatry.
The project has received support from the Lundbeck Foundation.
DRISP: Annette Erlangsen, Trine Madsen, og Merete Nordentoft
Partners:
- Michael E. Benros , PhD, Mental Health Centre Copenhagen, Capital Region of Denmark, Denmark
- Holger J. Sørensen, MD,Mental Health Centre Copenhagen, Capital Region of Denmark, Denmark
- William W. Eaton, PhD, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Teodor T. Postolache, MD, Mood and Anxiety Disorders Program, Department of Psychiatry, School of Medicine, University of Maryland, Baltimore
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
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
DRISP: Britt Morthorst
Partners:
- Child and Adolescent Mental Health Services in the Capital Region of Denmark
- Center for Suicide Prevention, Region South Denmark
Suicidal behaviour among persons with ADHD
Persons diagnosed with ADHD have been found to have an increased risk of suicidal behaviour but the pathway remains to be thoroughly explored. The aim of this study was to determine whether persons with ADHD were more likely to present with suicidal behaviour, ie. suicide attempts, and deaths by suicide if they had a comorbid psychiatric disorder.
The findings of the study revealed that having a comorbid disorder was associated with a significantly higher rate of suicidal behavior; comorbid schizophrenia or substance abuse disorder were associated with the largest increase.
The project was carried out in cooperation with Prof Søren Dalgaard from Aarhus University and has received support from the Danish Lundbeck Foundation.
Published in British Journal of Psychiatry.
DRISP: Cecilie Aaling, Annette Erlangsen, Merete Nordentoft
Partners:
- Professor Søren Dalsgaard, DM National Centre for Register-based Research, Department of Economics and Business, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
The SAFE project
In a recently conducted study at the Capital Region Psychiatry, Trine Madsen and colleagues from DRISP examined the effectiveness of the ‘Systematic Safer Discharge Procedure,’ known as the SAFE intervention. The aim was to evaluate whether an intervention to reduce risks of suicidal behavior after discharge from psychiatric hospitalization was effective. Previous Danish research findings have shown high suicide rates in the immediate period after being discharge from psychiatric hospitalization. During the first week after discharge, the suicide rate was more than 200-fold higher than the rate of the general population. International studies have shown that brief interventions offered immediately after discharge can be effective in preventing suicide, and this approach was provided in the SAFE intervention.
The study covered 15,208 discharges of individuals aged 18 and older over a 2-year period from 2018 to 2020. At the Mental Health Center Copenhagen, three systematic procedures were implemented to support individuals being discharged: 1) face-to-face meetings between patients and outpatient staff before discharge, 2) face-to-face meetings between patients and the same outpatient staff during the first week after being discharge, and 3) involvement of relatives.
The results did not show any significant difference in suicidal behavior between patients discharged from the Mental Health Center Copenhagen, i.e. the site of the SAFE intervention, and patients discharged from four other psychiatric centers in the Capital Region, which served as comparison groups. During the first six months after discharge, a total of 570 suicide attempts and 25 suicides were recorded. The suicide attempt rate in the first 6 months after discharge was 11,652 per 100,000 person-years at the SAFE intervention site, compared to 10,530 at the other psychiatric centers. In other words, no significant difference in suicidal behavior (OR=1.1; 95% CI: 0.9-1.4) or death by suicide (OR=1.3; 95% CI: 0.6-2.8) was observed after six months of follow-up.
An important caveat about the study was that F-ACT teams were simultaneously established at several of the centers serving as comparison groups. F-ACT teams visited patients within 2 days after discharge. Thus, a similar preventive effort was ongoing at the other centers, which may have contaminated the effect of the SAFE intervention. Although the SAFE intervention did not demonstrate an effect, the high rates of suicidal behavior in the first six months after discharge in both the intervention and comparison groups suggest that preventive efforts should include support for longer time than just the first week after discharge. The study emphasizes the importance of understanding and addressing the needs of individuals after being discharged from psychiatric care.
The study was supported by The Trygfoundation, and the SAFE intervention was funded by the Danish Health Authority.
You can find the study here.
DRISP: Trine Madsen, Eybjørg A Heygum Egilsdóttir, Annette Erlangsen, Merete Nordentoft