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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

Lithium is the best treatment for people with bipolar disorder in terms of a lower risk of suicide.

A study by Cecilie Fitzgerald and colleagues from DRISP in collaboration with international experts documents that lithium is the best treatment for people with bipolar disorder when it comes to preventing suicidal behavior. Although newer commercial drugs have been developed and marketed, lithium remains superior for this patient group. This is important evidence because people with bipolar disorder have an 18-fold higher risk of suicide when compared to other people in the general population.

The study was published in the renowned scientific journal, British Journal of Psychiatry. It used complete and nationwide data on all people diagnosed with bipolar disorder in Denmark during 1995-2016 and investigated which type of treatment were most effective at preventing suicidal behavior and psychiatric readmission. The findings revealed that people who were in ongoing treatment with lithium had a 26% lower suicide rate when compared to periods of not being in treatment. People treated with lithium had a 33% lower risk of suicide when compared to people treated with valproate.

In total, 33,337 people with bipolar disorder were included in the analyses, and a 60% lower suicide rate was found among those treated with lithium compared to periods without treatment. In addition, the study found fewer psychiatric readmissions among people treated with lithium compared to people who were not in treatment.

The study can be found here: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/effectiveness-of-medical-treatment-for-bipolar-disorder-regarding-suicide-selfharm-and-psychiatric-hospital-admission-between-and-withinindividual-study-on-danish-national-data/FFDA12AAC21C6722D5B9F6EF94621349

DRISP: Cecilie Aalling, Merete Nordentoft, Annette Erlangsen

Partners:

Prof Keith Hawton, Centre for Suicide Research, University of Oxford
Michael Eriksen Benros, Psykiatrisk Center København

PhD defense in DRISP

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!

Science: Suicide—turning the tide

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

WHO and DRISP – an analysis of the Eastern Mediterranean Region

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:

In more than half of the studied countries, data on suicide was either insufficient or of poor quality, making it challenging to monitor the incidence of suicide.
From 2000 to 2019, there was a 7.6% decrease in the suicide rate in the region, primarily among women.
In more than half of the countries, suicide is still considered a criminal act. This is problematic as it can potentially imply that individuals at risk of suicide might not seek help.

The situational analysis can be found here:
https://www.emro.who.int/images/stories/mnh/documents/situation_analysis_emro.pdf

Erlangsen et al, 2023_Archives Download

Netflix series ’13 Reasons why’

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

DRISP student receive prize

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.

Cause-specific life years lost among persons with mental disorders

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:

Per Kragh Andersen, PhD, DMSc, Section of Biostatistics, University of Copenhagen, Denmark
Thomas Munk Laursen, PhD, Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Denmark
Anita Toender, Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Denmark
Vladimir Canudas Romo, PhD, Max-Planck Odense Center on the Biodemography of Aging, Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Denmark

Heart diseases and suicide

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:

Benjamin Drejer Petersen, University of Southern Denmark
Elsebeth Stenager, University of Southern Denmark

Autism spectrum disorders and suicidal behaviour

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:

Kairi Kõlves, Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
Stephen James Wood, University of Melbourne, Melbourne, Australia

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.

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