A 12-year National Study of Suicide by Jumping From Bridges in Norway.

Studies from several countries suggest that erecting fences on bridges more commonly used for suicide by jumping may be an effective way of reducing the risk of suicide by jumping from these bridges. Distribution of suicides by jumping off bridges has not yet been studied on a national level in any country. This study included all suicides by jumping from high places registered in the Norwegian Cause of Death Registry (COD) in the period 1999-2010 (n = 319). Combining data from the COD registry and information from police records, 71 cases of suicide by jumping off a bridge were identified involving 36 bridges. This form of suicide constituted approximately 1% of all suicides in Norway in the period 1999-2010. Almost half of these suicides were registered at only 6 bridges. Three Norwegian bridges were secured during the observation period of this study. Two bridges had barriers installed on the full length of the bridge with 11 suicides registered before barriers were installed, and none after. On the 1 bridge that was only partially secured, no change in numbers of suicides was observed after barriers were installed. One-third of jumps from bridges occurred over land. We found that although suicide by jumping off bridges was a relatively rare event, there is a potential for saving lives by installing physical barriers on bridges that are more commonly used for suicide by jumping.

Prognosis and psychosocial outcomes of attempted suicide by early adolescence: a 6-year follow-up of school students into early adulthood.

Adulthood psychiatric and psychosocial outcomes of early adolescence suicidal acts were studied. A representative sample of school adolescents (T1, mean age, 13.7 years; n = 2464; 50.8% female; 88.3% participation) was followed up a year later with the same questionnaire (T2). High scorers of depression were matched with low or moderate scorers and interviewed using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (mean age, 14.9 years; n = 345; 94% participation). They were reassessed after 5 years (T3, mean age, 20.0 years; n = 242; 73% participation). Those who attempted suicide before the age of 14 years and repeated suicidal acts between ages 14 and 15 years had worser prognostic profiles than incident cases between ages 14 and 15 years. Male attempters had better psychiatric prognosis than female attempters. Attempters were more likely to have contacted child protection services but not mental health services. Clinicians need to be aware of long-term pervasive outcomes of adolescent suicidality.

Suicide mortality trends in the Nordic countries 1980-2009.

BACKGROUND AND AIM: The Nordic countries provide a suitable setting for comparing trends in suicide mortality. The aim of this report is to compare suicide trends by age, gender, region and methods in Denmark, Finland, Iceland, Norway and Sweden 1980-2009. METHODS: Suicide statistics 1980-2009 were analyzed for men and women aged 15 years and above and the age group 15-24 years. Regional suicide rates in 2009 were presented in maps. RESULTS: The suicide rates across the Nordic countries declined from 25-50 per 100,000 in 1980 to 20-36 in 2009 for men and from 9-26 in 1980 to 8-11 in 2009 for women. The rates in Finland were consistently higher than those of the other countries. A significant increase of suicides in young women in Finland and Norway and a lack of a decline among young women in Sweden were noted. The male- female ratio of suicide converged to approximately 3:1 across the region during the study period. Rural areas in Finland, Norway and Sweden saw the highest suicide rates, whereas the rates in the capital regions of Denmark, Norway and Sweden were lower than the respective national rates. CONCLUSIONS: We hold that the overall decline of suicide rates in the Nordic countries reflects the socio-economic development and stability of the region, including the well-functioning healthcare. The increasing rates in Finland and Norway and the unchanged rate in Sweden of suicide in young women are an alarming trend break that calls for continued monitoring.

Suicide attempters and repeaters: depression and coping: a prospective study of early adolescents followed up as young adults.

Relationships between depression and coping among nonattempters, attempters, and repeaters of suicidal acts were examined across adolescence. A representative sample of students (T1: n = 2464; mean age, 13.7 years; 50.8% female; 88.3% participation) was reassessed with the same questionnaire after 1 year (T2). High scorers on the Mood and Feelings Questionnaire were gender- and age-matched randomly with low and middle scorers. This subset was assessed using diagnostic interviews at T2 (n = 345, 94% participation) and 5 years later using the same interview and questionnaire (T3, n = 252; mean age, 20.0 years; 73% participation). The Coping Inventory for Stressful Situations measured coping as three stable traits. Coping changed partly with age, depression, and attempt status. Differences in depression emerged before coping differences and remained stable. Consistently, repeaters reported higher depression and lesser task-oriented coping. Antecedent depression predicted decreased task-oriented coping and increased emotional coping at age 20 years.

Is organizational change associated with increased rates of readmission to general hospital in suicide attempters? A 10-year prospective catchment area study.

The objective of this study was to examine predictors for readmissions in patients admitted to a general hospital emergency ward for suicide attempts before and after organizational changes potentially affecting the chain of care. Socio-demographic and clinical variables were collected by clinicians from 1997 thru 2007. Data from the periods before and after 2004--when the hospital changed its catchment area--were compared. A substantial increase in readmission rates in the period after the organizational change was observed. This increase was not associated with any of the socio-demographic or clinical patient characteristics. Although no causal connection can be inferred, the observed association between organizational change and readmission rates could indicate that established post-discharge care systems for suicide attempters may be vulnerable to such change.

Suicidality among Norwegian youth: review of research on risk factors and interventions.

BACKGROUND AND AIM: Published research on suicidality among Norwegian youth and publications describing interventions were summarized in order to access the current status of knowledge building via empirical research. METHOD: A systematic Medline search identified 29 studies on risk factors on the entire spectrum of suicidal phenomena from self-harm without suicidal ideation to completed suicide with the mean age at/under 25 years. A specialist Norwegian journal, Suicidologi, was searched for additional matter, especially interventions. RESULT: Most studies focussed on psychological and psychiatric risk factors of attempted suicide. Other suicidal phenomena, psychosocial and societal risk factors, and impact of interventions were hardly studied. Depression, previous suicidal behaviour, alcohol use and non-intact parental unit were consistent significant risk factors found in suicide and attempted suicide studies. CONCLUSION: Supporting non-intact parental units and the maintenance of intact parental units along with early detection and management of suicide attempts, depression and alcohol use should be targeted as suicide prevention interventions among adolescents.

Associations between attempted suicide, violent life events, depressive symptoms, and resilience in adolescents and young adults.

Were violent/nonviolent traumatic life events and victimization by/witnessing violence associates of attempted suicide among depressed adolescents who were also less resilient at early adulthood? The present study examined a subset of mainly depressed, age- and gender-matched, adolescents derived from a representative sample of 2464 students (T1, mean age = 13.7 years) followed up after 1 year (T2Q) and reassessed 5 years later (T3, n = 252, mean age = 20.0 years, 73% participation), with a questionnaire, including the Connor-Davidson Resilience Scale and The Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version psychiatric interviews, which also tapped traumatic life events. Logistic regression analyses revealed that attempters were victims, not witnesses of violence, more depressed, and less resilient than nonattempters, and that resilience was a moderator of lifetime violent events and attempted suicide, even in the presence of antecedent depression.

Specific depressive symptoms and disorders as associates and predictors of suicidal acts across adolescence.

OBJECTIVE: To examine the role of depressive symptoms and disorders as associates and predictors of suicidal acts across adolescence. METHOD: A representative sample of Norwegian school students (N = 2464, mean age 13.7 years) in grades 8 and 9 was reassessed after one year (T2) with the same questionnaire. All high scorers of depressive symptoms on the Mood and Feelings Questionnaire (MFQ) at T2 were defined as cases. One control from low or middle scorers, matched for age and gender, was randomly assigned to every two cases. This subset (n = 345) was diagnostically assessed by face-to-face K-SADS-PL interviews (mean age = 14.9 years). The same subset was reassessed after 5 years (T3) by using the same questionnaire (n = 252, mean age = 20.0 years) and telephone K-SADS-PL interviews (n = 242). The participation rate was 76.9% (n = 265). RESULTS: Cognitive symptoms dominated the depressive symptom profile among suicide attempters, irrespective of age and time. Among younger adolescents, suicidal thoughts and acts of self-harm without suicidal intent were associated with suicidal acts. Recurrent thoughts about death, hopelessness, disturbed concentration and middle insomnia were associates of suicidal acts among older adolescents. Worthlessness by 15 years was a significant predictor of suicidal acts between 15 to 20 years. MDD and a depressive episode, not otherwise specified, continued to be significant associates among younger adolescents, while dysthymia by 15 years remained a predictor of suicidal acts between 15 to 20 years, even when controlled for depressive symptoms. CONCLUSIONS: Self-harm without suicidal intent, middle insomnia, cognitive depressive symptoms and a formal psychiatric diagnosis of any depressive disorder should alert professionals in the risk assessment of suicidal adolescents.

Predictors of suicidal acts across adolescence: influences of familial, peer and individual factors.

OBJECTIVE: To examine the influences of familial, peer and individual predictors of suicidal acts in a longitudinal study with a subset of school adolescents reporting high levels of depressive symptoms. METHOD: A representative sample of Norwegian school students (N=2464, mean age 13.7 years, T1) was reassessed after 1 year (T2) with the same questionnaire. All high scorers of depressive symptoms on the Mood and Feelings Questionnaire (MFQ) at T2 were defined as cases. One control from low or middle scorers, matched for age and gender, was randomly assigned to every two cases. This subset (n=345) was diagnostically assessed by face-to-face K-SADS-PL interviews (mean age=14.9 years). The same subset was reassessed after 5 years (T3) by using the same questionnaire (n=252, mean age=20.0 years) and telephone K-SADS-PL interviews (n=242). The participation rate at T3 was 76.9% (n=265). The questionnaire explored various relationships with family members, peers and individual factors such as lifestyle habits, and physical health. RESULTS: Irrespective of time, history of a suicidal act significantly predicted a later suicidal act. Not living with both biological parents and a diagnosis of any depressive disorder were significant predictors for younger and older adolescents, respectively. CONCLUSIONS: In line with the findings of previous clinical studies, our results underline the importance of identifying previous suicidal acts, depressive disorders, broken homes and risk behaviours such as smoking and intoxication in the assessment of suicidal risk across adolescence.