Monitoring

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

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

Relative affected by suicidal behaviour in Denmark

International research has demonstrate that a substantially share of the population have experienced to lose a next of kin to suicide. This study examines how many Danes have been affected by a suicide attempt. The aim of this on-going study is the assess how large a share of the Danish population have been affected by suicidal behaviour. The project has received support from the Partnership for Suicide Prevention, Danish Health Authority.

DRISP: Trine Madsen, Anne Ranning, Annette Erlangsen

Partners

Karine Hvidkjaer, medicinstuderende ved Københavns Universitet
Elene Fleischer, PhD Netværk for selvmordsramte (www.nefos.dk)
Jens Peter Eckardt,chefanalytiker, Bedre Psykiatri

Call volume to a national suicide hotline, the Lifeline

It is estimated that between 50-60% of the people who call helplines for suicide prevention are in an acute crisis, and up to 56% have had a previous suicide attempt. It is therefore important to answer these calls.

The counselors of the Danish telephone helpline for suicide prevention, “Livslinien,” answer more than 14,000 calls per year. However, many calls still go unanswered. DRISP is collaborating with the Danish telephone helpline in an ongoing research project to investigate how many calls are answered and at what times of day the peaks.

In a first research project, the number of calls and characteristics of the people who called Livslinien were investigated. Data on all answered calls in the period 2018-2019 were analyzed. The data material consisted of records that counselors make after each counseling session and included socio-demographic information as well as an assessment of the person’s suicide risk.

Ove a 2-year period, a total of 42,393 calls were answered. In more than half of all calls, the person seeking counseling was evaluated to be at risk of suicide – and in 37% of all calls, the person was considered to be at high risk of suicide.

The study also showed that women, younger people, those with a history of previous suicide attempts, and those who reported problems related to self-harm, mental illness, sexual abuse, substance abuse, and physical health problems were more likely to be considered at risk of suicide, as evaluated by counselors.

The results of the study highlight the importance of helplines for suicide prevention and the need to ensure that these are adequately staffed in order to meet the demand.

You can read the study here: https://www.tandfonline.com/doi/abs/10.1080/13811118.2022.2084005

The project has received funding from the Suicide Prevention Partnership, the Danish Health Authority.

DRISP: Annette Erlangsen

Partners:

Livslinien

Bereaved by suicide and affected by suicide: how many receive help?

Every year about 600 suicide deaths and 11,000 suicide attempts are recorded in Denmark. Next to each suicidal act are numerous relatives and other next of kin who are deeply affected. Specialised support for bereaved and affected is being provided by volunteer organisations and it is unclear how many receive help. This research project will seek to map how many bereaved by suicide and affected by suicidal behaviour receive support from Nefos, one of the Danish volunteer organisations.

The project has received support from the Partnership for Suicide Prevention, Danish Health Authority

DRISP: Annette Erlangsen

Partner:

Elene Fleischer, PhD Netværk for selvmordsramte (NEFOS)

Clinical development project

The aim is to implement three questionnaires regarding protective and risk factors in suicide behavior in the treatment of children and adolescents. The implementation will contribute with a quality boost to the clinical work in the Suicide Prevention Clinic for children and adolescents by structured collecting and using tested scales to assess children and adolescents’ suicide risk, experience of mental stress as well as own strengths and weaknesses (resilience). The three scales that are to be used are: K10 (the experience of psychological stress), READ (resilience) and Columbia (the frequency and the intensity of suicide behavior). For the time being this is a clinical development project that may lead to a research project on a later stage.

DRISP: Britt Morthorst

Partners:

Child and Adolescent Mental Health Services in the Capital Region of Denmark
Center for Suicide Prevention, Region South 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

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