Psychiatric research

Website for parents of children with suicide attempt

In collaboration with people with lived experiences, DRISP has developed a website for parents of children with suicide attempt (www.selvmordsforsøg.dk). The website is now finalised and freely available for all. On the website, users will find video clips with parents (re-recorded by actors) talking about their personal experiences, an ‘advice robot’ Roberta, Q&A, supporting statements, and information on available resources, such as helplines and NGOs. The website is available in Danish and does have some comparison to the one offered by the US-based healthtalk (https://healthtalk.org/introduction/self-harm-parents-experiences/)

In one of the video clips, a mother tells about how she has chosen to talk to her daughter about her suicidal thoughts: “I have had to ask my daughter directly how progressed these thoughts were, i.e. how she envisioned acting on the thoughts, and doing so without me getting angry or extremely sad”.

The wesite is avilable in Danish only

http://www.selvmordsforsøg.dk

DRISP: Anette Juel Kynde, Annette Erlangsen, Jette LS Larsen

Suicidal thought- and behavior among Danish adolescents

Up to one-third of Danish adolescents have experienced suicidal thoughts. This was shown in a study from DRISP, which has recently been published in European Child and Adolescent Psychiatry.

The study was based on questionnaire data from over 47,000 participants aged 18 years in the Danish National Birth Cohort. The findings revealed that 36% of girls and 28% of boys had experienced suicidal thoughts, and one in four of these had made suicide plans. Additionally, 6% of girls and 3% of boys had attempted suicide before turning 18 years. A significant portion of those—especially the boys—did not go to the hospital after the suicide attempt. In fact, among those 5.7% who reported having had a suicide attempt, only 1.7% had been recorded with a hospital contact. In previous studies, this difference has been compared to ‘the hidden part of the iceberg’, i.e. located below the surface of the sea and, thus, not visible.

Furthermore, suicide attempts were more frequent among adolescents with lower parental income.

“It is highly concerning that in a normal class, 2-3 adolescents would have experiences of serious suicidal behavior. We do not know whether these adolescents receive the help they need, especially those who do not present at the hospital after a suicide attempt,” states Ph.D-student Stine Danielsen who conducted the study. These results empathize the need for increased awareness and efforts toward mental health and suicidal behavior among adolescents. Universal prevention strategies tar¬geting adolescents with suicidality in community-based efforts, such as school interventions, may reach those who do not present in the healthcare system.

The study also provided validation for an algorithm, which identifies adolescents with a hospital-recorded suicide attempt, as a major share of these also had self-reported a suicide attempt. The algorithm was developed to identify suicide attempts in Danish registers may therefore be considered as reliable for identification of suicide attempts among adolescents.

DRISP:

Stine Danielsen, Merete Nordentoft, Annette Erlangsen, Trine Madsen

Link to the study:

https://link.springer.com/article/10.1007/s00787-024-02503-w

Collaborative partners:

• Katrine Strandberg-Larsen, University of Copenhagen

• Keith Hawton, University of Oxford

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

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

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

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

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

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

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

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