On February 14, 2020, Charlotte Mühlmann successfully defended her PhD on “Internet-based self-help therapy for individuals with suicidal ideation.” Opponents were: prof. Sarah Hetrick, Department of Psychological Medicine, University of Auckland, New Zealand and prof. Heleen Riper, Section of Clinical Psychology, Vrije University Amsterdam, the Netherlands.
Well done, Charlotte!
As one of the few countries in the world, Denmark has secured a radical decline in the suicide rate over the last 40 years. Historically, the Danish suicide rate was among the highest in the world but the rate began declining in 1980 where 38 suicide deaths per 100,000 inhabitants were counted until 2007 where it had reached a level of 11 suicide deaths per 100,000; a reduction to one third of its originally level. The recipe for this success story is listed in SCIENCE.
In the same issue, a series of articles lay out recent and on-going achievements in suicide prevention.
Link to SCIENCE EDITORIAL:
https://science.sciencemag.org/content/sci/365/6455/725.full.pdf
DRISP has contributed to the international work of suicide prevention. As a consultant for WHO, Annette Erlangsen has conducted a situation analysis of suicide and attempted suicide in WHO’s Eastern Mediterranean Region (WHO EMRO) from 2000 to 2020. WHO EMRO consists of the countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates, West Bank and Gaza, and Yemen.
The analysis found that:
The situational analysis can be found here:
https://www.emro.who.int/images/stories/mnh/documents/situation_analysis_emro.pdf
A new American study has found that the suicide rate among American boys aged 10-17 years increased with 29% in the months after the release of the Netflix series ’13 Reasons why’ i 2017 in the US. International research findings have previously shown that news reports and movies where suicidal behavior is presented might inspire others, particularly vulnerable youngsters. WHO has published guidelines for media reports of suicidal behavior (https://www.who.int/mental_health/suicide-prevention/resource_booklet_2017/en/).
Britt Morthorst fro DRISP commented upon the American findings for DR News.
https://www.dr.dk/nyheder/viden/kroppen/selvmordsrate-steg-med-289-procent-efter-netflix-serie-udkom
Every year an undergraduate in medical science receives Psykiatriprisen (The Psychiatry Price), which is awarded for research in the psychiatric field. This year, Cecilie Aalling, a research year student i DRISP, participated with her paper on ‘Suicidal behaviour among persons with ADHD: A nationwide register-based study’. In the paper Cecilie compared persons with an ADHD diagnosis to the remaining population from 1995-2014 in order to find out whether this group had higher suicide rates. Furthermore, she calculated suicide rates for subgroups according to parents’ psychiatric diagnose, criminal conduct and psychiatric comorbidity. Cecilie received 3. place for this paper and she is very happy and proud.
The aim was to quantify the life years lost with respect to cause of death and differences over time between people with and without mental disorders.
This study noted a difference of 10.2 and 7.3 excess life years lost for males and females with mental disorders, respectively. While the overall excess in life years lost between those with and without mental disorders did not change during 1995-2014 However, the excess suicide mortality among persons with mental disorders declined over this period .
The study is published in Lancet Psychiatry.
DRISP: Annette Erlangsen, Merete Nordentoft
Partners:
Approximately, 11% of Europeans suffer from cardiovascular diseases. Although somatic disorders are linked to suicidal behavior, updated studies on heart diseases and suicide are needed. This study examines whether individuals diagnosed with cardiovascular diseases have higher suicide rates than individuals without cardiovascular diseases. Danish register data for
the period 1980-2016 was used for the analyses.
Several specific disorders, such as heart failure, cardiomyopathy, and acute myocardial infarction were found to be associated with elevated rates of suicide. Particularly, cardiac arrest with successful resuscitation was linked to a 4-fold higher suicide rate. Additionally, the
first time after diagnosis was associated with higher suicide rates. The results underscore the importance of being attentive towards psychological distress in individuals with heart disease.
Link to study:
https://onlinelibrary.wiley.com/doi/abs/10.1111/joim.13025?af=R
Partners:
About 1% in the general population have autism-related conditions. The onset is often in childhood and may have an impact on the child’s upbringing and socialization. Although autism-related conditions have been linked to suicidal behavior, little is known regarding which characteristics are associated with suicidal behavior in this subgroup.
In this research project, DRISP, in collaboration with international researchers, sought to identify social and disease-related predictors of suicidal behavior among people with autism.
Danish registry data covering the entire Danish population (6,559,266 persons) in the period 1995-2016 were included in the analyses. The results showed that people with autism-related disorders had a more than 3-fold higher rate of both suicide attempts and suicide than people without these disorders. The excess risk of suicidal behavior among people with autism could be observed across all age groups.
People with autism who also had psychiatric disorders were found to have a significantly increased risk and this group accounted for 90% of those who had suicide attempts or died by suicide. The results suggest that people with autism who also have psychiatric disorders should be a target group for suicide preventive efforts.
The project received funding from the Helse Foundation.
You can read the study here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774853
Partners:
In this
DRISP: Anne Ranning, Annette Erlangsen, Trine Madsen, Merete Nordentoft
Partners:
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
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
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
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
A randomized study of 108 participants with recent suicide attempt and borderline personality disorder. The participants were offered either standard treatment (CAMS) or a short dialectical behavioral therapy course from the competence center for suicide prevention in Region H Psychiatry
DRISP: Kate Andreasson Aamund; Merete Nordentoft.
The study has been published in Depression & Anxiety:
In the project Self-Help Online against Suicidal Thoughts (SOS), it was investigated whether internet-based self-help therapy could help people with suicidal thoughts. The study was led by psychologist Charlotte Mühlmann from DRISP in collaboration with colleagues and conducted as a randomized study.
Together with the Danish telephone helpline for suicide prevention (“Livslinien”), 402 adults with suicide thoughts were recruited during 2016-2018. The average age of the participants was 34 years. One third of the participants had previously had a suicide attempt, while 55% were in therapeutic or psychiatric treatment at the time they joined the study.
Half of the 402 participants were randomized to test the online program, while the other half served as a control group, i.e. did not receive the program. The findings showed that after 6 weeks, there was a significant difference; those who had received the self-help program had experienced a reduction of suicidal thoughts, feelings of hopelessness and worries when compared to the control group.
Among the participants who had access to the program, 63% experienced a clinically significant decrease in their suicidal thoughts; corresponding to 6 points on the Beck Scale for Suicidal Ideation, which was the questionnaire used for measuring suicide risk. The significant difference was also present after seven months. Among those surveyed, 78% of the participants rated the program as useful.
You can find the study here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774853
The project was supported by the Danish TrygFonden.
DRISP: Charlotte Mühlmann, Trine Madsen, Annette Erlangsen, Merete Nordentoft
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