Antipsychotics as a method of suicide: population based follow-up study of suicide in Northern Finland.

AIM: This study examined the trend and role of antipsychotics as a method of self-poisoning suicide. MATERIALS AND METHODS: The basic data covered 483 poisoning suicides, occurring between the years 1988 and 2011, in Northern Finland, of which 178 (115 men, 63 women) were completed using antipsychotics. RESULTS: During the 23-year follow-up period, second-generation antipsychotics (SGAs) overtook first-generation antipsychotics (FGAs) as a suicide method. Female victims, compared to males, had more commonly used quetiapine (17.5% vs. 6.1%, p = .016), while suicides using promazine were more common in males compared to females (36.5% vs. 22.2%, p = .049). People with unipolar depression had more frequently used SGAs (40.0%) or a combination of SGAs and FGAs (12.5%) than FGAs (19.2%) (p = .019) in their suicides. CONCLUSION: The use of SGAs in suicides is becoming increasingly common, which calls for further studies.

Affective disorders and completed suicide by self-poisoning, trend of using antidepressants as a method of self-poisoning.

The aim of this research was to study the role and trend of antidepressant use as a method of suicide in completed self-poisoning suicides in patients with affective disorders during a 23-year follow up period. The data consisted of 483 completed self-poisoning suicides from 1988 to 2011 in the province of Oulu in Northern Finland (286 men and 197 women). Of the self-poisoning victims, 26.9% (n=130) had hospital-treated unipolar depression and 3.1% (n=15) hospital-treated bipolar disorder. Further, 53.8% (n=70) of those with unipolar depression and 53.3% (n=8) of those with bipolar depression died by suicide using antidepressants. During the 23-year follow-up period, the proportion of those using antidepressants doubled among all self-poisoning victims of suicide. A significant decline was observed in the use of tricyclic antidepressants in self- poisoning suicides while a linear increase was found in the use of SSRIs (selective serotonin reuptake inhibitors) and other antidepressants. During recent years one in five self-poisoning suicides involved the use of antiepileptics. A limitation of our study was that the psychiatric diagnoses only include hospital inpatient episodes. In conclusion, the use of new antidepressants has increased rapidly, but the risk of their use in self-poisoning suicide has perhaps been underestimated.

Insomnia among brain tumor patients: a population-based prospective study of tumor patients in northern Finland.

Patients with neurological diseases often suffer from sleep disturbances. Insomnia among adult brain tumor patients has usually been studied as part of quality-of-life studies, or some case reports on insomnia in these patients have been described. The authors aimed to study insomnia in a prospective study setting among patients with primary brain tumors and evaluate whether insomnia is related to tumor laterality. Entire study population consisted of 70 patients with a solitary primary supratentorial brain tumor treated surgically at the Clinic for Neurosurgery, Oulu University Hospital. The overall functional state of the patients was assessed by the Karnofsky Performance Scale, depression was measured by Beck Depression Inventory, and insomnia by Nottingham Health Profile. Repeated measurements were assessed before tumor operation as well as 3 months and one year after surgery. Prevalence of insomnia among patients with a primary brain tumor waiting for surgery was higher compared to general population, but level of insomnia significantly decreased as soon as 3 months after tumor operation. Patients with a bilateral primary brain tumor had significantly more often insomnia without comorbid depression compared to patients with a left or right tumor for up to one year after operation. The authors suggest that insomnia among patients with a bilateral brain tumor may not be associated with depression but have other biological background.

Characteristics of suicide among diabetes patients: a population based study of suicide victims in Northern Finland.

OBJECTIVE: Recent case reports of insulin suicides have raised the need to study in detail the suicides among diabetes patients. METHODS: The data consisted of 2489 suicides (2030 men, 459 women) in Northern Finland during 1988 to 2010. The suicide victims with hospital-treated type 1 (n=27) or type 2 diabetes (n=51) were compared with those without diabetes (n=2411). RESULTS: Of all suicide victims, 3.1% had diabetes (34.6% type 1 and 65.4% type 2 diabetes). 24.0% of victims with type 2 diabetes were under the influence of alcohol when they died from suicide, while the proportion was 44.4% in type 1 diabetes and 46.6% in victims without diabetes (P=0.007). Compared to those with type 2 diabetes or without diabetes, victims with type 1 diabetes had suffered more commonly from depression (44.4%, 23.5%, 19.9%, respectively) (P=0.006) and chosen self-poisoning as suicide method (48.1%, 31.4%, and 18.0%) (P<0.001). In victims with type 1 diabetes insulin as a suicide method covered half of the self-poisoning cases, while the proportion in type 2 diabetes was 13%. CONCLUSION: We suggest that physicians who treat diabetes patients should evaluate co-occurring depression and substance abuse, both of which are major risk factors of suicide.

Depression in relation to anxiety, obsessionality and phobia among neurosurgical patients with a primary brain tumor: a 1-year follow-up study.

Depression is found to be present in up to 44% of brain tumor patients during their illness process. Anxiety as a comorbid psychiatric disorder with depression has formerly been studied, but phobia or obsessive-compulsive symptoms among brain tumor patients have not yet been noticed. By using a clinical prospective database of primary brain tumor patients (n=77) we studied the level of depression, anxiety, obsessionality (traits and symptoms) and phobic anxiety symptoms. Psychiatric symptoms were assessed before tumor operation as well as at three months and at one year after operation. The presence of comorbid anxiety, obsessionality and phobic anxiety symptoms was assessed before operation and at follow-ups in depressed and non-depressed patients, separately. Before tumor operation 16% of the patients had depression according to Beck Depression Inventory (BDI), while 10% had depression at three months and 15% at one year after operation. The depressed patients had statistically significantly higher anxiety scores and phobic scores at all three measurement points compared to corresponding scores among non-depressed brain tumor patients. The mean obsessionality scores among depressed brain tumor patients were significantly higher when measured before operation and at one year after the operation compared to non-depressed patients. To our knowledge, this is the first study so far in which comorbidity of psychiatric symptoms has been shown among depressive brain tumor patients. Concurrent comorbid conditions have been shown to be associated with increased severity, morbidity and chronicity of depression. It is recommended that treatment of depressive patients complicated with comorbid psychiatric disorders be planned by psychiatric units.

Suicide among persons with back pain: a population-based study of 2310 suicide victims in Northern Finland.

STUDY DESIGN: A population-based study of suicides and linkage with national hospital discharge registers. OBJECTIVE: To investigate the prevalence of hospital-treated musculoskeletal diseases, particularly back pain (BP), among suicide victims to compare suicide characteristics between victims with and without musculoskeletal diseases, to analyze comorbidity between musculoskeletal diseases and psychiatric disorders, and to evaluate whether specific drugs have a role in suicides by poisoning. SUMMARY OF BACKGROUND DATA: Depression, other psychiatric disorders, and suicidal behavior are common comorbid conditions in patients with diseases of the musculoskeletal system. METHODS: The data consisted of 2310 suicides (1885 men and 425 women) committed in the province of Oulu in Northern Finland during 1988 to 2007. The information on hospital-treated musculoskeletal diseases (MSD) was extracted from the Finnish Hospital Discharge Registers. The suicide victims with a diagnosis of BP, including sciatica (BP, n = 133), and victims with MSD other than BP/MSD, n = 357) were compared with those of having no history of MSD (reference group, n = 1820). The data on suicides were based on death certificates that were taken from official medicolegal investigations. RESULTS: A total of 490 (21.3%) of suicide victims had a history of hospital-treated MSD. The age of death of the victims with BP was about 11 years higher compared with the reference group. After adjusting for age, nonviolent suicide methods and use of analgesics in poisoning suicides in both genders and hospital-treated depression/substance-related disorders in men were also more common in the BP and MSD groups. Women with BP had been more often under the influence of alcohol when committing suicide compared with the other groups. CONCLUSION: Victims with a history of hospital-treated MSD committed suicide at older age. However, the older the person is, the more is the chance that he or she needs to have a treatment for some MSD at some point of life. Use of analgesics as a potential suicide method should be kept in mind when treating patients with musculoskeletal system diseases.

Cardiovascular Diseases among Suiciders: A Population-Based Study in Northern Finland Population.

Objective. Depression has been found to be an independent risk factor with cardiovascular diseases (CVDs) and also associated with increased mortality among these patients. Method. We used a comprehensive database of all suicides (n = 2, 283) committed in Northern Finland with information on all hospital-treated cardiovascular diseases and psychiatric disorders. Results. Coronary artery disease (CAD) had been present in 7.7% and other cardiovascular diseases (CVDs) in 11.6% of the suiciders. The likelihood of suicide for patients with hospital-treated CAD was estimated to be two-fold compared to the general population while likelihood for suicide was not elevated among those with other CVDs. Males with CAD and females with CAD or any CVD had been hospitalized significantly more often with depression compared to reference group. Conclusions. Suicidality among patients with cardiovascular diseases has been suggested to associate with depression. Psychiatric consultation is highly recommended in clinical practice for cardiac patients with depression or alcohol-related disorders.

Suicide in patients with stroke: a population-based study of suicide victims during the years 1988-2007 in northern Finland.

The authors studied the prevalence of stroke among suicide victims and whether prestroke depression had influence on suicide process. The authors used a comprehensive database of all suicides (N=2,283) committed in Northern Finland over a period of 15 years with information on all hospital-treated somatic and psychiatric disorders. Of the total suicide data population, 3.4% had suffered from stroke. After adjusting for age and sex, prestroke depression in stroke victims increased the hazard of suicide up to 2.2-fold compared to victims with stroke but without any lifetime depression. The high-risk period for suicide was 2 years after stroke.

Somatization symptoms are related to right-hemispheric primary brain tumor: a population-based prospective study of tumor patients in northern Finland.

BACKGROUND: Somatization symptoms have been found to be early symptoms of tumor among brain tumor patients. OBJECTIVE: The authors followed patients through diagnosis of brain tumor and subsequent surgery. METHOD: Patients with a supratentorial tumor were given repeated measurements for somatization with the Crown-Crisp Experiential Index. RESULTS: Before tumor operation, the patients with a tumor in the right hemisphere had significantly higher somatic anxiety scores than those with a tumor located in the left hemisphere. The specific symptoms were dizziness and palpitation among patients with a right hemispheric tumor. CONCLUSION: It is important to remember possible very unusual causes behind somatization symptoms.

Season of tumor surgery in relation to deaths among brain tumor patients: does sunlight and month of surgery play a role in brain tumor deaths?

The objective of this study is to investigate the effect at the season of the time of surgery on the survival of brain tumor patients. The population studied consisted of 101 patients (39 males and 62 females), gathered from a geographically large area in northern Finland (from 64 degrees N to 70 degrees N), aged between 20 and 82 years, with a solitary primary brain tumor treated surgically at the Oulu Clinic for Neurosurgery, Oulu University Hospital. The distribution of tumor surgery dates and mean hours of sunshine hours was analyzed by bimonthly periods. When comparing the proportion of deceased patients of all patients operated in each bimonthly period, a significant bimonthly peak in deaths was found in patients operated during the period of February to March (ratio 1.7, 95% CI 1.1-2.3). More than half of the patients who died during the peak period had grade III-IV gliomas. In 40% of the cases, the surgery time of deceased brain tumor patients occurred in the bimonthly period following the four darkest months of the year with the lowest amount of sunshine in northern Finland. The relation of low vitamin D level in the etiology and course of the disease as well as in treatment settings deserves further study.

Parkinson's disease and suicide: a profile of suicide victims with Parkinson's disease in a population-based study during the years 1988-2002 in Northern Finland.

OBJECTIVE: We studied the prevalence of hospital-treated Parkinson's disease (PD) among suicide victims and the profile of these persons, taking into account suicide attempts, timing of depression and comorbid somatic diseases. METHODS: The database of this study consisted of suicide victims aged 50 years of age or older (n = 555) during a fourteen-year period in the province of Oulu in Northern Finland. RESULTS: Hospital-treated Parkinson's disease occurred in 1.6% of the subjects, indicating a rather low prevalence of suicide in this group of patients. The persons with PD had attempted suicide earlier in 44% of the cases, while the corresponding percentage for other victims in older age was 9.9% (p = 0.009 Fischer exact test). CONCLUSIONS: Based on the case characteristics of our study the profile of PD person who completed suicide was as follows: male subject with recently diagnosed disease, living in rural area, having multiple physical illnesses, and having attempted suicide earlier. Psychiatric consultation is thus highly recommended for the PD patients with this disease profile.

Traumatic brain injury, psychiatric disorders and suicide: a population-based study of suicide victims during the years 1988-2004 in Northern Finland.

BACKGROUND: Depression and substance abuse are common among patients with traumatic brain injury (TBI). However, previous studies have not examined the temporal association between psychiatric disorders, TBI and suicide. OBJECTIVE: To study the prevalence of TBI injury among suicide victims; to determine the association of suicide, psychiatric disorders and TBI severity; and to examine the effect of pre- and post-traumatic psychiatric disorders on their remaining life-time. METHODS: This study examined all suicides (n = 1,877) committed during a 16-year period in the province of Oulu, Finland. The information of suicide victims was extracted from the official death certificates and the National Hospital Discharge Registers. RESULTS: TBI was found in 5.5% (n = 103) of the victims. Compared to the victims without TBI, those with TBI had significantly more hospital-treated psychiatric and alcohol disorders. If TBI subjects had comorbid psychiatric disorders, the time period between TBI and suicide was under 3 years in approximately 90% of victims in this suicide population. CONCLUSIONS: Seriousness of injury, male gender, older age, being unemployed and presence of psychiatric and alcohol disorders are important to identify as possible predictors for suicidal behaviour in TBI patients. Further studies are required to shed light on interventions aimed at better life management.

Depression and suicide in epileptic victims: a population-based study of suicide victims during the years 1988-2002 in northern Finland.

Patients with epilepsy are known to have comorbid affective disorders and a higher risk for suicide compared with the general population. Epilepsy, depression, and suicidal behavior have been shown to have common pathogenic mechanisms in their etiology. We evaluated the association between epilepsy, suicidal behavior, and depression by using the comprehensive database of all suicides (n=1877) committed in northern Finland during the years 1988-2002 with information on all hospital-treated somatic and psychiatric disorders. Hospital-treated epilepsy occurred in 1.3% of the victims. Compared with other suicide victims, those with epilepsy were more often female, were older, and had significantly more often suffered from depression. Epilepsy was first diagnosed 8.8 (3.9-11.6) years before suicide, and depression, about 1 year after epilepsy diagnosis. Interictal depression among patients with chronic epilepsy is often classified as atypical or chronic depression, or it can mimic a dysthymic disorder. Therefore, diagnosis and treatment of depression among patients with epilepsy constitute a great challenge in clinical practice.

Decreased quality of life and depression as predictors for shorter survival among patients with low-grade gliomas: a follow-up from 1990 to 2003.

OBJECTIVES: To assess the long-term survival of brain tumor patients, and in particular to evaluate the relation of quality of life (QOL) to survival among low-grade glioma patients. METHODS: The postoperative survival of 101 brain tumor patients was followed from surgery (1990-1992) until the end of the year 2003. Depression was evaluated by the Beck Depression Inventory (BDI) and QOL with Sintonen's 15D scale before operation and at one year as well as at five years after operation. RESULTS: The mean survival times in years (SD) were significantly related to tumor malignancy, being the shortest, 1.9 (0.6), for patients with high-grade gliomas, while patients with low-grade gliomas or a benign brain tumor had mean survival times of 9.1 (1.0) and 11.6 (0.5), respectively. At all follow-ups, depressed low-grade glioma patients had a significantly shorter survival time, 3.3-5.8 years, compared to non-depressed low-grade glioma patients, 10.0-11.7 years. A decreased level of QOL in low-grade glioma patients was significantly related to the shorter survival. CONCLUSIONS: The results suggest that depression and decreased QOL among low-grade glioma patients is related to shorter survival at long-term follow-up. Decreased QOL may serve as an indicator for poor prognosis in low-grade glioma patients.

Winter birth in association with a risk of brain tumor among a Finnish patient population.

The aim of this study was to analyze whether winter birth is related to risk of brain tumor in a clinical sample of patients from northern Finland. The study group comprised 101 patients suffering from a primary brain tumor. When comparing births in winter to births in other seasons, a 1.39-fold (95% CI 1.01-1.77) excess of winter births among patients was observed compared to respective births in the general population (p = 0.026). Especially patients with pituitary adenomas exhibited a 2.5-fold (95% CI 1.5-4.4) excess of winter births. The authors conclude that the season-of-birth effect in brain tumor patients should not be neglected when the actual and important tumorigenesis is investigated.

Gender difference in relation to depression and quality of life among patients with a primary brain tumor.

OBJECTIVE: We studied the relationship between depressive symptoms and quality of life (QOL) as well as functional status in primary brain tumor patients at recurrent measurements. Differences in QOL between depressive and non-depressive samples by gender were controlled for tumor characteristics and patients' psychosocial factors. MATERIALS AND METHODS: The data consisted of 77 patients with a primary brain tumor, 30 males and 47 females. Depression of the patients was assessed by Beck Depression Inventory (BDI) and Crown-Crisp Experiential Index (CCEI), functional status by Karnofsky Performance scale (KPS) and QOL by Sintonen's 15D before tumor operation as well as at 3 months and at 1 year from surgical operation of the tumor. RESULTS: The level of QOL in females was lower compared to that of males. Depression was the main predictor for worse QOL in the patients at all measurements. Depressive patients with a benign brain tumor had significantly worse QOL versus non-depressive ones. DISCUSSION AND CONCLUSION: Decreased QOL was strongly related to depression, especially among patients with a benign brain tumor. Further studies are needed to find whether sufficient depression therapy improves the QOL of patients.

Depression and functional outcome in patients with brain tumors: a population-based 1-year follow-up study.

OBJECT: The authors analyzed changes in depression and contemporary functional states by using valid tools in a population-based study sample during a 1-year follow-up period. METHODS: The study population consisted of 77 patients with a solitary primary brain tumor treated surgically at the Oulu Clinic for Neurosurgery. Each patient's depressive status, according to the Beck Depression Inventory (BDI), and functional outcome, based on the Karnofsky Performance Scale (KPS), were evaluated before the tumor was surgically treated as well as 3 months and 1 year after surgery. Before surgery 27 patients (35%) had BDI scores indicating the presence of depression. These scores were significantly higher in patients with a history of depression (p = 0.017) and in those with a lower functional outcome (p = 0.015). In the entire study sample the severity of depression decreased statistically significantly (p = 0.031) at 3 months postsurgery. A lower functional status (KPS score < or = 70) in patients was significantly associated with high depression scores at the 3-month (p = 0.000) and 1-year (p = 0.005) assessments. The decrease in the level of depression was significant in patients with an anterior tumor (p = 0.049) and those with a pituitary adenoma (p = 0.019). CONCLUSIONS: Affective disorders among patients with brain tumors must be considered immediately after surgery, especially in persons with a depression history and in those with a coincident physical disability.

Level of obsessionality among neurosurgical patients with a primary brain tumor.

Obsessive-compulsive symptoms have been associated with different types of damages or dysfunctions in the brain. However, the accumulated evidence on obsessive-compulsive symptoms among patients with a primary brain tumor is so far based on case reports only. The study population consisted of 59 neurosurgical patients with a primary brain tumor. One preoperative and two postoperative assessments for the level of obsessionality were done with the Crown-Crisp Experiential Index (CCEI)-instrument. Mean obsessionality scores increased significantly among the patients with a tumor in the left anterior region of the brain measured at 3 months after operation, especially in women, compared to the patients with a tumor in other regions of the brain. The level of obsessionality seemed to increase immediately after operation among patients with a primary tumor left anteriorly in the brain. This increase may be linked with the lesion caused by the tumor itself or the neurosurgical operation.

Depression in relation to survival among neurosurgical patients with a primary brain tumor: a 5-year follow-up study.

OBJECTIVE: The adverse impact of depression in relation to survival among cancer patients is currently a subject of great interest in research. In a 5-year follow-up study, we investigated the association of depression with survival of patients with a primary brain tumor. METHODS: The study population consisted of 75 patients with a solitary primary brain tumor treated surgically at the Oulu Clinic for Neurosurgery, Oulu University Hospital, in Northern Finland. The patients were interviewed during admission to the hospital for the tumor surgery. Assessment of depression was made using the Beck Depression Inventory and the Crown-Crisp Experiential Index. Information on all deaths within 60 months after tumor operation was collected from the Cause of Death Register, provided by Statistics Finland. RESULTS: The patients with a high-grade glioma had a survival time of 22.5 months (standard deviation, 21.4 mo), whereas the corresponding time was 50.2 months (standard deviation, 19.9 mo) for patients with a low-grade glioma and 58.2 months (standard deviation, 9.4 mo) for the patients with a histologically benign tumor (P < 0.001, difference between groups, Kruskal-Wallis test). In the subgroup of patients with low-grade gliomas, depressive patients had a significantly shorter survival time compared with nondepressive subjects (P = 0.031, Kaplan-Meier survival analysis). A corresponding difference was not found in patients with high-grade gliomas or benign tumors. Tumor location in one hemisphere compared with bilateral location and wider extent of tumor surgery was associated with better survival in patients with low-grade gliomas and benign tumors but not in patients with high-grade gliomas. CONCLUSION: Preoperative depression seemed to be a significant prognostic factor for worse survival in low-grade glioma patients. In clinical practice, an evaluation of depression among brain tumor patients by structured and standardized diagnostic methods is needed to distinguish the patients whose depression actually needs treatment. The effective treatment of clinical depression among brain tumor patients and the impact of treatment on the patients' chances of survival should be a focus of future research.