Risk and protective factors for suicidal ideation and suicide attempts among deployed Danish soldiers from 1990 to 2009.

OBJECTIVE: The study was undertaken to identify risk and protective factors for suicidal ideation and suicide attempts among deployed Danish soldiers. Research on suicide among Danish veterans has only been conducted to a limited degree. METHOD: The method applied was a questionnaire survey administered to a population of 1,264 Danish soldiers deployed from 1990 to 2009. The data were analyzed using backward logistic regression modeling in SAS 9.2. RESULTS: In the logistic regression analysis, the following were significant risk factors for suicidal ideation: drug abuse, a poor financial situation before deployment, a heavy workload and/or repatriation during deployment, and attending a poor athletic and recreation program after deployment. Significant protective factors against suicidal ideation were support from friends at home during deployment and appreciation by the general population after deployment. Significant risk factors for suicide attempts were an unhappy childhood and pointless tasks during deployment. No significant protective factors against suicide attempts were identified. CONCLUSION: On the basis of the results presented in this study, intervention against suicidal behavior would benefit from screening for certain childhood issues, drug abuse, and poor financial situation before deployment. During deployment, measures should be taken to minimize the amount of meaningless tasks and heavy workloads. At the same time, efficient ways of communicating with home should be ensured. After deployment, good athletic and recreation programs should be warranted for all military personnel-including repatriated soldiers. Finally, priority should be given to ensure public appreciation of what deployed soldiers accomplish.

Suicide attempts in chronic pain patients. A register-based study.

Background There are several studies about the relationship between depression and chronic non-malignant pain. These studies have shown that up to 50% of chronic pain patients are suffering from depression. It is, therefore, reasonable to expect that pain patients would also have an increased risk of suicidal behaviour. This problem is not well studied. Since 1990 the Centre for Suicide Research, Odense, Denmark has registered all suicide attempts in patients residing in the Region of Funen, Denmark. The Pain Clinic, Odense University Hospital receives patients with chronic pain from the entire Region of Southern Denmark. Purpose The purpose of the study has been: To investigate, whether patients treated in the Pain Clinic during the period from 1 January 2004 to 31 December 2009 had an increased risk of suicide attempts compared with the background population. Materials and methods The Register for Suicide Attempts (RSA) is a product of the WHO research programme WHO/EURO Multicentre Study on Para suicide. The RSA is a longitudinal person-based register. It contains information about people who have been in contact with the health care system in the County of Funen as a result of a suicide attempt. The Pain Clinic, Odense University Hospital receives patients with non-malignant chronic pain from the Region of Southern Denmark with 1,194,659 inhabitants. Data about age, sex, and time of treatment for patients treated in the Pain Clinic during the period were registered. Time and method of the suicide attempts were registered in the RSA. By registry linkages between the patient registers it was possible to calculate any excess risk of suicide attempts in chronic pain patients in the study period. We used a cohort design and calculated incidence rates (IR) and incidence rate ratios (IRRs) for suicide attempts, based on data from RSA. Poisson Regression analyses were used for calculation of IR and IRR for suicide attempts. Results In the study period from 1 January 2004 to 31 December 2009 1871 patients residing in the Region of Funen in Denmark were referred to The Pain Clinic. In the patient group 258 suicide attempts in 110 persons were registered. In all 6% of the patient group had attempted suicide. An increased risk of suicide attempts was found in the pain population as the incidence rate ratio (IRR) was 3.76 95% CI (3.22; 4.40). No statistical significant differences between men and women were found. Conclusion In a chronic non-malignant pain population, referred to a pain clinic, the risk of suicide attempts was increased. Implications It is important to be aware of risk factors for suicidal behaviour, i.e. pain history, depression, anxiety, abuse problems, and social problems when caring for patients with chronic pain. More knowledge and training of the staff caring for chronic pain patients are needed to decrease the risk of suicidal behaviour.

Suicide attempts in multiple sclerosis.

The purposes of the study were (1) to estimate the risk of suicide attempts in multiple sclerosis (MS) patients in Denmark and compare the risk to the background population in the County of Funen, Denmark; (2) to estimate the risk of suicide attempts in MS patients receiving immunomodulating therapy compared with untreated patients. The Danish MS Registry, the Danish MS Treatment Registry and the Suicide Attempt Registry are linked and merged together using a person identification number given to all persons residing in Denmark. Among 404 MS patients, 15 patients had attempted suicide, although no increased risk for suicide attempts was found in MS patients. No difference in number of suicide attempts in treated and untreated patients was found.

A nested case-control study of the risk of suicide attempts after discharge from psychiatric care: the role of co-morbid substance use disorder.

The literature suggests that the risk of suicide is high within the first weeks after discharge from psychiatric care, but practically no studies have estimated the risk of suicide attempt after discharge from psychiatric care. The aim of this study was to examine the risk level for suicide attempt after discharge from psychiatric care, and to control for effects from psychiatric diagnoses, number and length of previous admission. An analysis of the role of co-morbid substance use disorder in suicide attempts risk was completed. The study is a Danish register-based nested case-control study; 3037 cases were identified from Register for Suicide Attempts, and 60,295 individuals, matched by gender and age, were identified for comparison. Retrospective personal data on psychiatric care was obtained from the Danish Psychiatric Central Register. Risk of suicide attempts was estimated by the use of conditional logistic regression. We found a significant high peak in risk of suicide attempts in the first weeks after discharge from psychiatric care. The risk was lowered as time passed by. Suicide attempt risk was not equally distributed across various psychiatric diagnoses, and co-morbidity of substance abuse with mental illness raised risk in an additive way. We found only small gender differences in risk. In order to lower the risk of suicide attempts, we need to improve after-care when discharging from psychiatric care. A differentiation between the possibilities of after-care for different mental illnesses is needed.

Risk of repetition of suicide attempt, suicide or all deaths after an episode of attempted suicide: a register-based survival analysis.

OBJECTIVE: This study was undertaken in order to estimate the incidence of repetition of suicide attempt, suicide and all deaths, and to analyse the influence of psychiatric illness and socio-demographic factors on these. METHOD: The study is a Danish register-based survival analysis that retrieved personal data on socio-economic, psychiatric and mortality conditions from various registers. Hazards were estimated using Cox regression with a time-dependence covariate. Suicide-attempters (2.614) and non-attempters (39.210)were analysed being matched by gender, age and place of residence. RESULTS: The average follow-up period for suicide-attempters was 3.88 years, during which 271 (10.37%) of them died. By comparison, death occurred four times more often among suicide-attempters than among non-attempters. Suicide was far more common among attempters (61, 2.33%) than among non-attempters (16, 0.04%). A proportion of the attempters (31.33%) repeated their attempt within the follow-up period. The most reliable predictors for suicide and death were repetition, suicide attempt method and treatment for mental illness. The most reliable predictors for repetition were age, gender and mental illness. DISCUSSION: Individuals with a history of suicide attempts form a well-defined high-risk group for suicide, and are in need of treatment immediately after the episode. Somatic and psychiatric staff must be informed about the risk factors for subsequent suicidal behaviour after an episode of attempted suicide. Furthermore, departments that are in contact with suicidal individuals need action plans to ensure that all such individuals are discharged to proper treatment immediately after the suicide attempt.

[Suicide attempters' contacts with the primary health care system]. / Selvmordsforsøgeres kontakt til den primaere sundhedssektor.

INTRODUCTION: We examined suicide attempters' use of health insurance services as part of an effort to prevent suicidal behaviour. MATERIALS AND METHODS: The research project was a register-based case control study, where cases were persons residing in the County of Funen, Denmark, who made a suicide attempt resulting in contact with a hospital. Controls were matched with respect to gender, age and county of residence on the date of the first registered suicide attempt (index attempt). Data about services paid for by the public health insurance program were collected from the Prevention Register. The data were analyzed using conditional logistic regression. RESULTS: In the calendar year prior to an index attempt, suicide attempters consulted health professionals, i.e., general practitioners, psychologists or psychiatrists, more often. Gender and age differences were small. DISCUSSION: Suicide attempters consult health insurance professionals, especially GPs, more often, and GPs' specific role in the prevention of attempted suicide is discussed.

Register for Suicide Attempts.

BACKGROUND: The Register for Suicide Attempts (RSA) is a product of the WHO research project "WHO/Euro Multicentre Study on Parasuicide", which, among other things, had the purpose of collecting data on suicide attempts from 13 European countries. Data is collected in order to calculate trends and identify high-risk groups. Data collection for the RSA started in 1989. METHODS: The RSA is a longitudinal, person-based register. It contains information about people who have been in contact with the health care system in the County of Funen as a result of a suicide. The RSA contains 11 variables, which describe the incident in detail, and a number of variables describing the person. The RSA contains data covering the period April 1989 to December 2001 and is updated annually. Data is collected from somatic and psychiatric hospitals in an administrative district (County of Funen). The data collection is done manually by going through all the records in which a contact to the health care system, i.e. a potential suicide attempt, is described. Only incidents matching the WHO definition of an attempted suicide are registered. CONCLUSION: Data from the RSA has been used in national and international studies. The RSA is the most suitable register in Denmark for analyses of suicide attempts.