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 RanningAnnette ErlangsenTrine Madsen, Merete Nordentoft

Partners:

  • Center for Register-based Research

iCare: Psychoeducation for parents of children

Approximately, 11,000 self-harm episodes occur on a yearly basis in Denmark. Of these, the majority are among youth below the age of 25 years. The Suicide Prevention Clinics experience that parents often request information on how they can best help their child after a self-harm episode. The aim of this project is to 1) in collaboration with parents to develop a webpage for this group, 2) to test whether the webpage can help reduce the stress burden that parents experience in a randomised trial, 3) to examine whether parents of children who self-harm have a higher rate of stress-related response when compared to parents not exposed. The project has received 3.7 DKR from the Danish TRYG Foundation

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

Suicide risk associated with psychiatric hospitalization

To examine the trend and excess risk of suicide in suicidal high-risk phases, namely among psychiatric inpatients and recently discharged patients. We will examine the risk in these high-risk phases according to sex, age-groups and psychiatric diagnoses.


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

Suicidal behaviour among persons with ADHD

Persons diagnosed with ADHD have been found to have an increased risk of suicidal behaviour but the pathway remains to be thoroughly explored. The aim of this study was to determine whether persons with ADHD were more likely to present with suicidal behaviour, ie. suicide attempts, and deaths by suicide if they had a comorbid psychiatric disorder.

The findings of the study revealed that having a comorbid disorder was associated with a significantly higher rate of suicidal behavior; comorbid schizophrenia or substance abuse disorder were associated with the largest increase.

The project was carried out in cooperation with Prof Søren Dalgaard from Aarhus University and has received support from the Danish Lundbeck Foundation.

Published in British Journal of Psychiatry.

https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/suicidal-behaviour-among-persons-with-attentiondeficit-hyperactivity-disorder/6CECF48A64E415C871D233B2607114ED



DRISP: Cecilie Aaling, Annette Erlangsen, Merete Nordentoft

Partners:

  • Professor Søren Dalsgaard, DM National Centre for Register-based Research, Department of Economics and Business, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark

The SAFE project

The period immediately after a psychiatric discharge is associated with very high suicide risk. With the SAFE project, carried out at the Psychiatric Center Copenhagen in the period March 2018 to May 2020, the purpose is to examine whether the risk of suicidal behavior can be reduced by introducing a more systematic discharge process. The SAFE project implements three procedures 1) before the patient is discharged, there is face-to-face contact with the outpatient unit that will follow up on the patient after discharge 2) involvement of relatives before discharge or during the week after discharge 3) the outpatient team makes a home visit in the first week after discharge where a suicide risk assessment is carried out and a crisis plan is updated.

DRISP: Trine Madsen, Eybjørg A Heygum Egilsdóttir, Annette Erlangsen, Merete Nordentoft