Registerbaseret forskning

The YRSA Project – suicide attempt in youth

The rate of suicide attempt in adolescents has been increasing for the last decades, especially in young girls. Suicide attempt is the best-established risk factor for subsequent death by suicide, therefore this increasing trend is alarming. Reportedly, only up to 9% of those adolescents who attempt suicide are seen at somatic hospitals, implying that up to 90% of all teenagers in a crisis situation with a suicide attempt may have not received professional help for their suicidal behavior. The YRSA project aims to document prevalences and early risk factors for suicide ideation and -attempt in both those seen at somatic hospitals for suicide attempt and in those who self-reported suicide attempt but do not seek somatic treatment. Further, the aim is to examine barriers and facilitators of seeking help from mental health services after a suicide attempt. The YRSA project, which combines self-reported data from the Danish National Birth Cohort with register-based data, are unique for this purpose.

Drisp: Trine Madsen

People with sleep disorders and rates of suicide

People with sleep disorders or poor sleep quality have an increased risk of psychiatric disorders. Sleep disorders may also be associated with suicide but the evidence regarding this has so far been limited to small studies.

The aim of the research project was to analyze the relationship between sleep disorders, treatment with sleeping pills (e.g. benzodiazepines and melatonin) and suicide using register-based data. In separate statistical analyses, it has, for instance, been investigated whether people with sleep disorders have higher rates of suicide when compared to people without sleep disorders.

Findings from the first study showed that males who had been diagnosed with a sleep disorder had a 1.5 times higher suicide rate versus males with no sleep disorder. A 2.2 times higher suicide rate was observed for females with sleep disorders when compared to the background population. In addition, the findings revealed that the majority of people with sleep disorders who died by suicide also had a mental disorder, which potentially could explain the increased suicide risk. Patients with narcolepsy were found to have a higher suicide rate when compared to the background population. This has not previously been documented.

You can find the scientific study here:

https://academic.oup.com/sleep/article/45/5/zsac069/6550645?login=false

In separate study, it was examined whether melatonin, a treatment for sleep disorders, was associated with an increased rate of suicide attempts and suicide. People who had redeemed prescriptions for melatonin were subsequently found to have a higher rate of suicide attempts and suicide than people not in treatment with melatonin. About 90% of the people treated with melatonin who had a suicide attempts also had a psychaitric disorder. This supports the hypothesis that people who suffer from insomnia or sleep disorders often also experience psychological stress and this relationship may increase risk of suicidal behavior. This study was the first to assess the link between treatment with melatonin and suicide.

You can find the published study here:
https://jcsm.aasm.org/doi/10.5664/jcsm.10118

The study was supported by a research scholarship from the Lundbeck Foundation.

Partner:

Adam Spira, PhD, Department of Mental Health, Johns Hopkins Bloomberg School of PublicHealth, Baltimore, USA.
Prof Keith Hawton, Centre for Suicide Research, University of Oxford

Lithium is the best treatment for people with bipolar disorder in terms of a lower risk of suicide.

A study by Cecilie Fitzgerald and colleagues from DRISP in collaboration with international experts documents that lithium is the best treatment for people with bipolar disorder when it comes to preventing suicidal behavior. Although newer commercial drugs have been developed and marketed, lithium remains superior for this patient group. This is important evidence because people with bipolar disorder have an 18-fold higher risk of suicide when compared to other people in the general population.

The study was published in the renowned scientific journal, British Journal of Psychiatry. It used complete and nationwide data on all people diagnosed with bipolar disorder in Denmark during 1995-2016 and investigated which type of treatment were most effective at preventing suicidal behavior and psychiatric readmission. The findings revealed that people who were in ongoing treatment with lithium had a 26% lower suicide rate when compared to periods of not being in treatment. People treated with lithium had a 33% lower risk of suicide when compared to people treated with valproate.

In total, 33,337 people with bipolar disorder were included in the analyses, and a 60% lower suicide rate was found among those treated with lithium compared to periods without treatment. In addition, the study found fewer psychiatric readmissions among people treated with lithium compared to people who were not in treatment.

The study can be found here: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/effectiveness-of-medical-treatment-for-bipolar-disorder-regarding-suicide-selfharm-and-psychiatric-hospital-admission-between-and-withinindividual-study-on-danish-national-data/FFDA12AAC21C6722D5B9F6EF94621349

DRISP: Cecilie Aalling, Merete Nordentoft, Annette Erlangsen

Partners:

Prof Keith Hawton, Centre for Suicide Research, University of Oxford
Michael Eriksen Benros, Psykiatrisk Center København

Cause-specific life years lost among persons with mental disorders

The aim was to quantify the life years lost with respect to cause of death and differences over time between people with and without mental disorders.
This study noted a difference of 10.2 and 7.3 excess life years lost for males and females with mental disorders, respectively. While the overall excess in life years lost between those with and without mental disorders did not change during 1995-2014 However, the excess suicide mortality among persons with mental disorders declined over this period .

The study is published in Lancet Psychiatry.

DRISP: Annette Erlangsen, Merete Nordentoft

Partners:

Per Kragh Andersen, PhD, DMSc, Section of Biostatistics, University of Copenhagen, Denmark
Thomas Munk Laursen, PhD, Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Denmark
Anita Toender, Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Denmark
Vladimir Canudas Romo, PhD, Max-Planck Odense Center on the Biodemography of Aging, Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Denmark

Heart diseases and suicide

Approximately, 11% of Europeans suffer from cardiovascular diseases. Although somatic disorders are linked to suicidal behavior, updated studies on heart diseases and suicide are needed. This study examines whether individuals diagnosed with cardiovascular diseases have higher suicide rates than individuals without cardiovascular diseases. Danish register data for
the period 1980-2016 was used for the analyses.
Several specific disorders, such as heart failure, cardiomyopathy, and acute myocardial infarction were found to be associated with elevated rates of suicide. Particularly, cardiac arrest with successful resuscitation was linked to a 4-fold higher suicide rate. Additionally, the
first time after diagnosis was associated with higher suicide rates. The results underscore the importance of being attentive towards psychological distress in individuals with heart disease.

Link to study:

https://onlinelibrary.wiley.com/doi/abs/10.1111/joim.13025?af=R

Partners:

Benjamin Drejer Petersen, University of Southern Denmark
Elsebeth Stenager, University of Southern Denmark

Autism spectrum disorders and suicidal behaviour

About 1% in the general population have autism-related conditions. The onset is often in childhood and may have an impact on the child’s upbringing and socialization. Although autism-related conditions have been linked to suicidal behavior, little is known regarding which characteristics are associated with suicidal behavior in this subgroup.

In this research project, DRISP, in collaboration with international researchers, sought to identify social and disease-related predictors of suicidal behavior among people with autism.

Danish registry data covering the entire Danish population (6,559,266 persons) in the period 1995-2016 were included in the analyses. The results showed that people with autism-related disorders had a more than 3-fold higher rate of both suicide attempts and suicide than people without these disorders. The excess risk of suicidal behavior among people with autism could be observed across all age groups.

People with autism who also had psychiatric disorders were found to have a significantly increased risk and this group accounted for 90% of those who had suicide attempts or died by suicide. The results suggest that people with autism who also have psychiatric disorders should be a target group for suicide preventive efforts.

The project received funding from the Helse Foundation.

You can read the study here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774853

Partners:

Kairi Kõlves, Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
Stephen James Wood, University of Melbourne, Melbourne, Australia