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

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

Lyme disease and risk of suicidal behaviour suicidal adfærd

The Borrelia bacterium, which exists in ticks, can develop into an infectious disease in humans when bitten. This disease is known as lyme disease (or Lyme Borreliosis) Infections have previously been associated with an increased risk of suicidal behavior. Trine Madsen from DRISP has, in collaboration with colleagues, investigated whether Lyme Borreliosis was linked to increased prevalence of psychiatric diseases and suicidal behavior.

Using register data for all persons living in Denmark from 1994 to 2016 (n=6,945,837), patients diagnosed with Lyme Borreliosis were identified based on hospital diagnoses. Their risk of developing psychiatric diseases and suicidal behavior was analyzed.

The results showed that persons who developed Lyme Borreliosis (i.e., an infection after a tick bite) had a 1.3-fold higher rate of psychiatric diseases, as well as a 2-fold higher rate of suicide attempts and a 1.75-fold higher suicide rate when compared to the background population. The highest risk of developing a psychiatric disease was observed within the first 6 months after persons developed Lyme Borreliosis. If the person had had multiple incidents of Lyme Borreliosis, this was associated with an increasing risk of suicide attempts.

In conclusion, the study showed that persons diagnosed with Lyme Borreliosis at Danish hospitals have an increased prevalence of psychiatric diseases, suicide attempts and suicide.

You can find the study here: https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2021.20091347




DRISP: Trine Madsen, Merete Nordentoft & Annette Erlangsen

Partners:

  • Michael Eriksen Benros, Research Unit, Mental Health Centre Copenhagen
  • Brian A. Fallon, MD, Center for Neuroinflammatory Disorders and Biobehavioral Medicine and director of the Lyme and Tick-Borne Diseases Research Center at Columbia University, USA

Combat exposure and risk of suicide attempt in previously deployed soldiers

Traumatizing events such as exposure to war can affect mental health. After World War I, the term “shell shock” was used to describe the shock effect that individuals who experienced the war may suffer. Although there is an increased awareness of adverse effects for deployed soldiers, stories of individual events, which seem to question the support that provided to veteran soldiers, often find their way to media reports.

To gain deeper insights into the stress experienced by deployed combat soldiers, DRISP has conducted a research project together with the Danish Veteran Center.

The study included more than 12,000 Danish veterans deployed on an international mission in the years 1997-2016 and who participated in a questionnaire survey after returning home. In the survey, they were asked about the level of combat exposure and experiences of the consequences of war. Figures from national registers administered by Statistics Denmark and the Danish Health Authority showed that a total of 83 veterans had had a suicide attempt after returning home. The findings of the study showed that veterans with a higher level of combat exposure have an 8% higher risk of suicide attempt after returning home compared to veterans with a lower level of combat exposure. The findings also confirmed that the increased risk of suicide attempt applied to veterans who, in addition to combat exposure, had symptoms of PTSD and/or depression. No association was found between having witnessed the consequences of war and suicide attempt.

The results point to the importance of attention towards those who have been exposed to combat and subsequently develop PTSD or depression, as this group were at greater risk of later suicide attempt.

You can find the study here: https://www.psychiatrist.com/jcp/trauma/combat-exposure-risk-suicide-attempt-danish-army-military-personnel/



Partners:

Trajectories of suicidal ideations in different patient populations

In growth mixture modelling analyses we have examined the heterogeneity of trajectories of suicidal ideations. We have examined this in people with different diagnosis such as first episode psychosis, bipolar disorders and depression. Overall all these studies have found that between 10-20% of patients seem to have chronic suicidal ideations even after treatment has started.
The study has been published in Journal of Affective disorders.

DRISP: Trine Madsen

Partners:

  • Andy Nierenberg, Harvard Medical School, Boston, Massachusetts
  • Ad Kerkhof, Vrije Universiteit, Amsterdam, Netherlands
  • Ole Mors, Aarhus University Hospital, Risskov, Psychosis Research Unit, Aarhus, Denmark
  • Ole Köhler-Forsberg, Department of Clinical Medicine, Aarhus University Hospital, Denmark

Traumatic brain injury (TBI) and risk of suicidal behaviour

We found that the risk of suicide is almost twice as high in people who experienced a TBI compared with people who had no TBI records. The risk was especially high in the first period after the TBI incident and oncreased by number of experienced TBI’s.

Internationale media
Washington Post
Reuters
ABC News
The Telegraph (britiskmedie)


The study has been published in JAMA.

DRISP: Trine Madsen, Merete Nordentoft & Annette Erlangsen

Partners:

  • Michael Eriksen Benros Research Unit, Mental Health Centre Copenhagen

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

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