Completed research projects

Suicide rates in Nordic prisons 1999-2016

International research has shown an increased suicide rate among people in prison. However, studies have yet to address age structural differences. In this longitudinal the suicide rates among male prisoners is compared to the general population in three Nordic countries, Denmark, Iceland, and Norway, while adjusting for age differences.

Findings from the study shows that men in prison have a 7-fold higher suicide rate compared to the background population in Denmark, Iceland, and Norway and when accounting for age differences. For females, a rate 18-fold higher suicide rate was found among those in prison when compared to the general population. Over the 17-year study period, the suicide rate of people in prison decreased from 129 per 100,000 in 1999 to 70 per 100,000 in 2016. This decline was steeper that the decline observed for the suicide rate in the general population in the Nordic countries.

Link to study

https://www.tandfonline.com/doi/abs/10.1080/13811118.2020.1746943

DRISP: Britt Morthorst, Charlotte Mühlmann, Trine Madsen, Merete Nordentoft
og Annette Erlangsen

Partners

Lars Mehlum, Professor, National Centre for Suicide Research and Prevention, Institute of Clinical Medicine Oslo, Norway
Aiguröur Pàlsson, MD, Unit of Forensic Psychiatry, Iceland
Högni Óskarsson, md, Humus inc., Iceland Yngve Hammerlin, MD, Correctional Service of Norway Staff Academy, Norway

Bereaved by suicide: psychological mechanism

Losing a loved one to suicide can be a traumatic and stressful experience, and studies show that bereaved by suicide themselves have an increased risk of stress-related illnesses and suicidal behavior. To determine the burden related to being bereaved, Annette Erlangsen at DRISP is involved in an international research project with researchers from University College London.

The study examined register data on 32,248 individuals living in Denmark who died by suicide in Denmark between 1980 and 2016, as well as identifying their relatives in the form of parents, children, siblings, and partners.

Having lost a loved one to suicide was associated with a 2.8 times higher risk of suicide compared to people who had not lost a loved one. The study also showed that 0.69% of all suicides in Denmark could be prevented if all factors that increase the risk of suicide among relatives of people who have died by suicide could be addressed. This corresponds to 60% of suicides among bereaved by suicide.

Bereaved by suicide have an increased risk of developing suicidal behavior themselves, and, although these suicides only account for a relatively small proportion of the total number of suicides, it is important to provide support to this group.

The project has received funding from the American Foundation for Suicide Prevention. You can find the study here: https://onlinelibrary.wiley.com/doi/10.1111/acps.13493

DRISP: Annette Erlangsen

Partner:

Dr Alexandra Pitman, Senior Clinical Lecturer, UCL Division of Psychiatry (projektansvarlig)
Dr Gemma Lewis, Research Associate in Psychiatric Epidemiology, UCL Division of Psychiatry
Professor Julie Cerel, Professor, College of Social Work, University of Kentucky

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

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 excess mortality. The findings showed that, compared to the general population, a large improvement in life years lost with respect to suicide and accidents was found in those with schizophrenia. However, this improvement was offset by an increasing number of life years lost in deaths from diseases and medical conditions.
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 of psychosocial therapy after short-term and long-term follow-up, and a protective effect for suicide after long-term follow-up, which favour the use of psychosocial therapy interventions after deliberate self-harm.
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

Information
TV2
Politiken
Kristeligt Dagblad
Jyllandsposten
DR

Abroad
New York Times
BBC
The Washington Post
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 shown an aggregation of suicidal behaviour in families. The aim of this study was to conduct a genome-wide association study (GWAS) and estimate single nucleotide polymorphisms (SNP) heritability for suicide attempt in a national sample of individuals with and without mental disorders. This is the largest sample investigated to date, significant SNP associations to suicide attempt were identified. The findings furthermore indicated that genetic transmission of suicide attempt is not solely explained by diagnosed mental disorders.
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 behaviour. To estimate the association between hospitalization with infection and the risk of death by suicide. An increased risk of death by suicide was found among individuals hospitalized with infection in prospective and dose-response relationships. These findings indicate that infections may have a relevant role in the pathophysiological mechanisms of suicidal behaviour.
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

WHO-media guidelines

Media reporting of suicidal behavior can be beneficial as well as harmful. Dramatic and sensational descriptions may lead to increased suicidal behavior in the population while objective reporting with focus on where to seek help (hopeful stories) can be preventive. WHO has in collaboration with international experts developed a set of media guide lines with recommendations on how to present suicidal events in online as well as written media.

DRISP: Britt Morthorst

WHO-medieguidelines Download

Partners:

National Health Authorities in Denmark

Paracetamol-project (Danish Pack size restriction)

Paracetamol is reported to be the most frequently used drug for overdoses in European countries. An international concern has emerged and interventions, such as age and pack size restriction on non-opioid analgesics sold OTC in pharmacies, have been implemented.
The method applied was a nationwide register study investigating the trend in hospital admissions for non-opioid analgesic poisonings before and after the implementation of age and pack size restriction in Denmark in 2011 and 2013, respectively. The trend in rates of severe poisonings was also investigated using nationwide laboratory data as blood tests taken routinely during admission in the period 2011-2013. After the age and the pack size restriction we found significantly reduced numbers of non-opioid analgesics poisonings. Also, the number of severe poisonings treated in Danish hospitals decreased after the pack size restriction indicating reduced risk of liver injury.
We concluded that a significant reduction in trends of poisoning by non-opioid analgesics treated in hospitals and fewer severe poisonings was observed after the legislative changes in Denmark.

Link to the study: https://www.sciencedirect.com/science/article/pii/S016503271932957X

The project in the media
Politiken

DRISP: Britt Morthorst

Partners:

Frank Eriksson, PhD, Associate Professor, Institute of Biostatistics, University of Copenhagen
Keith Hawton, Centre for Suicide Research, University of Oxford, United Kingdom

The AID-trial

The aim was to investigate the effect of assertive outreach focusing on problem-solving and escort to after-treatment compared to standard treatment in patients with a current suicide attempt measures as subsequent suicidal events within a year from index attempt. The study was an RCT (n=243) offering 8-10 home consolations in six months consisting of supportive consultations and escort to all kinds of after-treatment (e.g. GPs, alcohol units, somatic and psychiatric treatment and social services) in addition to safety planning, family support and crisis intervention. The study period was 207-2010. Results showed no difference in the repetition frequency between groups (17% equally). Also, there were no difference in the use of health care or social service use. The conclusion was that assertive outreach was not recommend compared to standard treatment in Denmark where standard treatment is already of high quality due to suicide preventions clinics.

https://clinicaltrials.gov/ct2/show/NCT00700089

DRISP: Britt Morthorst

Partners:

Representatives with health care and social services in the Capital Region of Denmark.

Joinpoint regression analysis of suicides in Denmark during 1980-2015

Is the suicide rate in Denmark increasing or decreasing? Effective suicide prevention requires vigilant monitoring of suicide trends. The aim of this study was to assess the change in the Danish suicide rate over time using joinpoint regression analysis. The suicide rate fell sharply between 1980 and 1999 in Denmark, but since then the decrease has been modest, especially since 2007. Further reduction in the suicide rate requires new and effective measures. The study is published in Danish Medical Bulletin

DRISP: Susanne Dyvesether, Annette Erlangsen & Merete Nordentoft

Partners:

Julie L Forman, Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

Workplace bullying and suicidal behaviour

Workplace bullying can be considered a stressful event, but there is little knowledge about its association with suicidal behavior. The aim of this research project was to investigate whether people who had experienced workplace bullying had a higher risk of suicidal behavior than people who had not been exposed to it.

In several large Danish surveys, more than 98,000 employees had been asked about experiences of workplace bullying. These data were linked to registry data, so that researchers could examine how many of the respondents were recorded with suicidal behavior over the subsequent 10 years from 2004-2014. The findings showed that over 10% of the people who had reported experienced workplace bullying. People who had been exposed to workplace bullying had a 1.6 times higher risk of suicidal behavior when compared to those who had not experienced bullying. The study was one of the few, which have documented this association in data where it could be determined that the bullying had been reported prior to the observed suicidal behavior.

The project has received funding from the Psychiatric Research Foundation, Region of Southern Denmark.

You can find the study here: https://www.sjweh.fi/article/4034

DRISP: Annette Erlangsen

Partners:

Paul Maurice Conway, Institut for Psykologi, Københavns Universitet
Thomas Clausen, Det Nationale Forskningscenter for Arbejdsmiljø, København
Annie Høgh, Institut for Psykologi, Københavns Universitet
Elsebeth Stenager, Department of Regional Health Research, University of Southern

Suicide among persons in same- sex and opposite-sex marriages in Denmark and Sweden

People belonging to sexual minority groups have higher levels of suicidality than heterosexuals. However, findings regarding suicide death are sparse. Using national data from Denmark and Sweden, this study investigated whether individuals entering a same-sex marriage have higher suicide rates than those entering opposite-sex marriage.

The findings revealed that people in same-sex marriages have a 1.5-fold higher suicide rate when compared to people living in opposite-sex marries. Over the periods 1989-2002 and 2003-16, the rate of suicides among people in same-sex unions fell by 46%, compared to a decline of about 28% in the number of suicides by people in heterosexual relationships.

“Although suicide rates in the general populations of Denmark and Sweden have been decreasing in recent decades, the rate for those living in same-sex marriage declined at a steeper pace, which has not been noted previously,” the study, which followed 28,000 people in same-sex partnerships for an average of 11 years, concludes Annette Erlangsen, the lead author, suggested that along with other gay rights legislation, same-sex marriage may have reduced feelings of social stigmatisation among some homosexual people. “Being married is protective against suicide,” she told Thomson Reuters Foundation

Link to study

https://www.theguardian.com/world/2019/nov/14/suicide-rates-fall-after-gay-marriage-laws-in-sweden-and-denmark

DRISP: Annette Erlangsen, Merete Nordentoft

Partners:

Ann Haas, PhD, American Foundation for Suicide Prevention, New York, USA
Gunnar Andersson, PhD, Stockholm University Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
Sven Drefahl, PhD, Stockholm University Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
Charlotte Björkenstam, PhD, Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA