Interventions

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

DiaS-project

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:

https://onlinelibrary.wiley.com/doi/abs/10.1002/da.22472

Self-help Online against Suicidal Thoughts

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

Partner:

Livslinien

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

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

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

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