Safety Planning Intervention Training Among Early Career Mental Health Professionals: Perception of Self-Efficacy, Usefulness and Feasibility.

INTRODUCTION: In 2021, in Argentina there were 3,639 deaths by suicide, equivalent to one death every three hours. Evidence indicates that brief suicide preventive interventions in emergency services, such as the Safety Planning Intervention (SPI), effectively reduce future suicidal ideation and attempts in both adults and adolescents. OBJECTIVE: To evaluate the perception of self-efficacy, and the feasibility and usefulness of a training in SPI in early career mental health professionals. METHOD: Sixty-nine early career mental health professionals from Buenos Aires participated in a 3-hour SPI training. Through an online survey, measurements were taken in three times: before and after the training and 8-10 weeks after the training. RESULTS: All participants completed the pre- and post-training measures, and 43 of them completed the follow-up survey. Post-training measures showed an increase in self-efficacy, maintaining the effect at 8-10 weeks. The SPI was found useful and feasible to be implemented in clinical care. More than half of the participants reported having used the SPI during follow-up. CONCLUSION: Results suggest that training in SPI is associated with an increased perception of self-efficacy of early career mental health professionals; this is maintained after 2 months post-training. In addition, the intervention is perceived as feasible, acceptable and useful for professionals in training.

Suicide among immigrant population in Norway: a national register-based study.

OBJECTIVE: To investigate differences in suicide risk among immigrant population in Norway compared with native Norwegians, with respect to associated country group of origin. METHODS: Based on the entire national population, a nested case-control design was adopted using Norwegian national longitudinal registers to obtain 23 073 suicide cases having occurred in 1969-2012 and 373 178 controls. Odds ratios (ORs) for suicide were estimated using conditional logistic regression analysis adjusting for socio-economic factors. RESULTS: Compared with native Norwegians, suicide risk was significantly lower in first- and second-generation immigrants but higher in Norwegian-born with one foreign-born parent and foreign-born individuals with at least one Norwegian-born parent. When stratifying data by country group of origin, first-generation immigrants had lower ORs in most of the strata. Subjects born in Asia and in Central and South America with at least one Norwegian-born parent had a significantly higher risk of suicide. The observed results remained mostly unchanged in the analyses controlled for socio-economic status. CONCLUSIONS: Suicide risk is lower in first- and second-generation immigrants but higher in subjects born in Norway with one foreign-born parent and those born abroad with at least one Norwegian-born parent, with notable differences by country group of origin.

Feasibility of dialectical behavior therapy with suicidal and self-harming adolescents with multi-problems: training, adherence, and retention.

We evaluated the feasibility of DBT training, adherence, and retention preparing for a randomized controlled trial of Dialectical Behavior Therapy (DBT) adapted for Norwegian adolescents engaging in self-harming behavior and diagnosed with features of borderline personality disorder. Therapists were intensively trained and evaluated for adherence. Adherence scores, treatment retention, and present and previous self-harm were assessed. Twenty-seven patients were included (mean age 15.7 years), all of them with recent self-harming behaviors and at least 3 features of Borderline Personality Disorder. Therapists were adherent and 21 (78%) patients completed the whole treatment. Three subjects reported self-harm at the end of treatment, and urges to self-harm decreased. At follow up, 7 of 10 subjects reported no self-harm. DBT was found to be well accepted and feasible. Randomized controlled trials are required to test the effectiveness of DBT for adolescents.

Self-harm induced somatic admission after discharge from psychiatric hospital - a prospective cohort study.

BACKGROUND: Few studies have examined rate and predictors of self-harm in discharged psychiatric patients. AIMS: To investigate the rate, coding, timing, predictors and characteristics of self-harm induced somatic admission after discharge from psychiatric acute admission. METHOD: Cohort study of 2827 unselected patients consecutively admitted to a psychiatric acute ward during three years. Mean observation period was 2.3 years. Combined register linkage and manual data examination. Cox regression was used to investigate covariates for time to somatic admission due to self-harm, with covariates changing during follow-up entered time dependently. RESULTS: During the observation period, 10.5% of the patients had 792 somatic self-harm admissions. Strongest risk factors were psychiatric admission due to non-suicidal self-harm, suicide attempt and suicide ideation. The risk was increased throughout the first year of follow-up, during readmission, with increasing outpatient consultations and in patients diagnosed with recurrent depression, personality disorders, substance use disorders and anxiety/stress-related disorders. Only 49% of the somatic self-harm admissions were given hospital self-harm diagnosis. CONCLUSIONS: Self-harm induced somatic admissions were highly prevalent during the first year after discharge from acute psychiatric admission. Underdiagnosing of self-harm in relation to somatic self-harm admissions may cause incorrect follow-up treatments and unreliable register data.

Suicide in young Norwegians in a life course perspective: population-based cohort study.

BACKGROUND: Suicide is a leading cause of death in young adults. Several risk factors are well known, especially those related to adult mental health. However, some risk factors may have their origin in the very beginning of life. This study examines suicide in the general Norwegian population in a life course perspective, with a main focus on early life factors. METHODS: In this study, several national registers were linked, supplying personal data on biological and social variables from childhood to young adult age. Participants were all Norwegians live born during the period 1967-1976, followed up through 2004. Persons who died or emigrated before the year of their 19th birthday, at which age follow-up started, were excluded. Thus, the study population comprised 610 359 persons, and the study outcome was completed suicide. RESULTS: 1406 suicides (0.23%) were recorded, the risk being four times higher in men than in women. Suicide risk factors included not being firstborn (adjusted HR in men and women (95% CIs): 1.19 (1.05 to 1.36) and 1.42 (1.08 to 1.88)), instability of maternal marital status during childhood, parental suicide (mainly in women), low body mass index (only investigated in men), low education and indications of severe mental illness. CONCLUSIONS: Suicide in young adults may be rooted in early childhood, and the effect is likely to act through several mechanisms, some of which may be linked to the composition and stability of the parental home. A life course perspective may add to our understanding of suicide.

[Psychosocial follow up after parasuicide at hospital departments in Norway]. / Psykososial oppfølging etter parasuicid ved medisinske sykehusavdelinger i Norge.

BACKGROUND: Routines and standards of care for parasuicide patients in general hospitals in Norway were reviewed in relation to international and national recommendations. MATERIAL AND METHODS: Telephone interviews were conducted with personnel at all Norwegian general hospitals with emergency units. 55 of a total of 58 hospitals participated (95%). RESULTS: Two thirds of the hospitals reported that most parasuicide patients were routinely psychiatrically evaluated and then referred to psychiatric or community aftercare. At almost half of the hospitals (46%) the staff had not received any specific training in clinical management of parasuicide patients during the last three years. Structured collaboration with external aftercare providers was non-existent in 43% of the hospitals. Hospitals with projects aimed at psychosocial follow up of parasuicide patients or hospitals with a team or a person responsible for the follow-up, had, however, routines more in accordance with the recommendations than hospitals without projects or teams. INTERPRETATION: The study shows great variations between Norwegian general hospitals in their routines and standards of care for psychosocial follow-up of parasuicide patients. Increasing the staff's competence, developing written routines and establishing mutually binding co-operation between the hospital and external caregivers are important areas for further development.

Alcohol and stress in Norwegian United Nations peacekeepers.

Peacekeepers are frequently exposed to dangerous, provoking, or humiliating situations and have limited possibilities to express the resulting anger and frustrations. Self-medication with alcohol and drugs to calm down may result. A representative sample (N = 888) of Norwegian United Nations veterans who served in South Lebanon completed a questionnaire regarding service-related stress and the role of alcohol in stress management. A total of 43.5% of the respondents reported that they had increased their consumption of alcohol during the mission. Overall, only a minority gave reasons such as tension, restlessness, anxiety, and stress to explain the increase. Respondents who had been exposed to the highest levels of stress, however, reported significantly more frequently these potentially pathological reasons for increased drinking. To prevent such outcomes, personnel need to be screened for risk reactions and to be educated in alternative stress management measures. Furthermore, management of both stress and the destructive use of alcohol is clearly a leadership issue.

[Prevention of suicide among young people--recent experiences from the armed forces]. / Forebygging av selvmord blant unge--nyere erfaringer fra forsvaret.

Each year about 70% of all 19-year old males are enlisted to the Norwegian Armed Forces. The rapid rise in the number of suicides among young people will therefore inevitably be reflected among conscripts. Studies of epidemiology and risk factors have led to the development of a specific suicide prevention programme which includes educational, leadership and welfare elements, as well as efforts initiated through the military health care service. In addition, an emergency telephone service is available 24 hours a day. This suicide prevention programme, which has its origins in the military chain of command rather than the medical service, has so far been very well received and implemented throughout the Armed Forces.

Patterns of short-term course in patients treated in a day unit for personality disorders.

The objectives of the study were (1) to explore differences in the course for patients treated in a day unit specializing in personality disorders (PDs), and (2) to determine characteristics of patients with different courses and predictors of various courses. K-mean cluster analysis was applied to partition a sample of 128 patients, 101 with various PDs and 27 with axis I disorders only, into four groups representing different courses. The course was defined on the basis of global functioning (Health Sickness Rating Scale [HSRS]) at admission, discharge, and 3-years follow-up evaluation. The four courses were labeled good, fair, late improvement, and poor, demonstrating great variation in the short-term course among patients with PDs. Predictors were studied by means of polychotomous logistic regression using the patients with a fair course as the reference group. The dichotomy no PD/cluster C versus cluster A/B predicted a good versus a fair course. A poor work status the last year before admission and irregular discharge predicted a poor or late improvement course versus a fair course, also when controlling for PD clusters. None of the included variables discriminated between patients with a poor versus late improvement course.

Suicidal ideation and sense of coherence in male conscripts.

Antonovsky's Sense of Coherence (SOC) scale, reflecting a dispositional orientation which, according to theory, is associated with coping and resiliency, was highlighted in a study focusing on the association between stressful life events and the development of suicidal ideation and behaviour in the young. During their first stressful week of basic training, 663 male Norwegian conscripts answered a questionnaire focusing on their lifetime and current suicidal ideation and behaviour. The lifetime prevalence of suicidal ideation and attempted suicide was 21.7% and 2.6%, respectively. Suicide ideators and attempters had on average significantly lower SOC scores compared to respondents with no suicidal ideation or behaviour. Furthermore, a stepwise multiple regression analysis revealed SOC to be a good predictor of current suicidal ideation in this non-clinical population, accounting for 21% of the total variance.

[Suicidal process and suicidal motives. Suicide illustrated by the art, life and illness of Vincent van Gogh]. / Suicidal prosess og suicidale motiver. Selvmord i lys av Vincent van Goghs kunst, livsløp og sykehistorie.

A suicide will naturally be a shock to the surroundings, unexpected and brutal as it is. Suicide survivors will often emphasize the unexpected. Nevertheless a suicide must be regarded as the end result of a long process. In this paper the extremely well-documented case of Vincent van Gogh is used to study suicidal processes and suicidal motives. In van Gogh's case, an early childhood trauma initiated a life-long suicidal process. His difficulties as regards attachment to and separation from his parents continued throughout his life and his emotional instability, intensity and lowered tolerance to frustration seem to portray a borderline personality. Vincent van Gogh's chronic suicidal ideation and behaviour led to a series of crises throughout his life, escalating during the last 18 months before his suicide in 1890. It is possible to identify at least three prominent suicidal motives in van Gogh's case. The first is unbearable emotional pain related to personal experience of loss which reactivated the childhood trauma. The second is introverted murderous rage arising from conflicts with other persons. The third motive described is the need for a cathartic release of energy and emotion.

The longitudinal pattern of suicidal behaviour in borderline personality disorder: a prospective follow-up study.

The aim was to study the longitudinal course of suicidal behaviour and ideation in patients with borderline personality disorder (BPD) compared with patients with other diagnoses. Ninety-seven patients (41 BPD, 33 other personality disorders, 23 no personality disorder) consecutively admitted to a day unit were given a prospective personal interview follow-up with evaluations at admission, discharge and at follow-up after 2-5 years. Even when controlled for Axis I disorders, BPD patients showed significantly more often a lifetime history of suicide attempts. BPD patients with a history of suicide attempts were more suicidal at index admission, continued to be so over the follow-up period and differed systematically in an unfavourable direction from other BPD patients on the major outcome measures. BPD patients without suicidal behaviour had an outcome nearly as good as non-BPD patients, and only 41% of them retained the BPD diagnosis at follow-up. Suicidal behaviour and ideation are highly prevalent in BPD. These suicidal expressions are of an enduring nature and seem as a diagnostic criterion to enhance the predictive capacity of the BPD diagnosis.

Young male suicide attempters 20 years later: the suicide mortality rate.

In a 20-year, register-based follow-up of a group of 51 young male conscripts who had made a suicide attempt during their service, 2 were found to have committed suicide during the follow-up period. These figures gave a 20-year accumulated suicide mortality of 3.92%, whereas the corresponding value in the cohort of Norwegian males who reached the age of 20 in the period 1968-1972 was 0.40%. In spite of this clear difference, the study indicates that the long-term suicide mortality is relatively low for young suicide-attempters in this type of setting compared to figures from other follow-up studies.

[Suicide among inpatients in Gaustad Hospital 1954-1991]. / Selvmord blant innlagte pasienter i Gaustad sykehus 1954-91.

We present results from a retrospective study of 31 suicides committed during the years 1954-1991 among inpatients at Gaustad Hospital. There was a radical increase in the suicide rate during the period, an increase that was higher than expected from the increase among the general population. The patients suffered from serious psychopathological conditions. Hanging was found to be the most frequent method of suicide, reflecting that psychiatric inpatients use methods that are easily available. Changes in the routines for admission, discharge and treatment of patients are discussed as possible factors explaining the increase. Improved evaluation of risk of suicide, more active antipsychotic and antidepressive treatment and improved control when risk of suicide is assessed to be high are discussed as important prophylactic measures.

Prodromal signs and precipitating factors in attempted suicide.

What characterizes the presuicidal phase of suicide attempters in a military population? And what precipitates their suicidal action? These questions were investigated in a sample of 112 male suicide-attempting conscripts serving in the Norwegian Armed Forces. One-half of the subjects had shown behavioral signs such as isolation or aggression, over 80% displayed psychiatric symptoms. A majority verbally expressed their psychic problems, but few had explicitly stated suicidal ideas. Two major clusters of suicide precipitants were identified. Loss traumas were recorded in one-third of cases, some sort of conflict situation in 40% of cases. Implications for suicide preventive measures are discussed.