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Juel A, Erlangsen A, Berring LL, Larsen ER, Buus N. Re-constructing parental identity after parents face their offspring's suicidal behaviour: An interview study. Soc Sci Med 2023; 321:115771. [PMID: 36801752 DOI: 10.1016/j.socscimed.2023.115771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/28/2022] [Accepted: 02/10/2023] [Indexed: 02/13/2023]
Abstract
INTRODUCTION Parents are affected when their offspring engages in non-fatal suicidal behaviour. Although research exists on parents' mental and emotional state when they realise this behaviour, relatively little attention has been devoted to exploring how their parental identity is affected. PURPOSE To explore how parents re-constructed and negotiated their parental identity after realising that their offspring was suicidal. METHOD A qualitative exploratory design was adopted. We conducted semi-structured interviews with 21 Danish parents who self-identified as having offspring at risk of suicidal death. Interviews were transcribed, analysed thematically and interpreted by drawing on the interactionist concepts of negotiated identity and moral career. FINDINGS Parents' perspectives on their parental identity were conceptualised as a moral career encompassing three distinct stages. Each stage was negotiated through social interaction with other people and the wider society. Entry into the first stage, disrupted parental identity, occurred when parents realised that they could lose their offspring to suicide. At this stage, parents trusted their own abilities to resolve the situation and keep their offspring safe and alive. This trust was gradually undermined by social encounters, which caused career movement. In the second stage, impasse, parents lost faith in their ability to help their offspring and to change the situation. Whereas some parents gradually resigned entirely to impasse, others regained their trust in their own abilities through social interaction in the third stage, restored parental agency. CONCLUSION Offspring's suicidal behaviour disrupted parents' self-identity. Social interaction was fundamental if parents were to re-construct their disrupted parental identity. This study contributes with knowledge about the stages characterising the reconstructive process of parents' self-identity and sense of agency.
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Affiliation(s)
- A Juel
- Psychiatric Research Unit, Psychiatry Region Zealand, Fælledvej 6, 4, 4200 Slagelse, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 4, 2900, Hellerup, Denmark Copenhagen, Denmark; Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense, Denmark.
| | - A Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 4, 2900, Hellerup, Denmark Copenhagen, Denmark; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, S850, Baltimore, MD 21205, USA; Center of Mental Health Research, Building 63, The Australian National University, Canberra ACT 2601, Australia; Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 4, 2900 Hellerup, Denmark.
| | - L L Berring
- Psychiatric Research Unit, Psychiatry Region Zealand, Fælledvej 6, 4, 4200 Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense, Denmark.
| | - E R Larsen
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense, Denmark; Mental Health Department Odense, University Clinic, Mental Health Service, J. B. Winsløws Vej 18, 5000 Odense, Denmark.
| | - N Buus
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense, Denmark; School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health, Monash University, Clayton, Victoria, Australia.
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Høier N, Madsen T, Spira A, Hawton K, Jennum P, Nordentoft M, Erlangsen A. The association between melatonin and suicide: a nationwide cohort study. Eur Psychiatry 2022. [PMCID: PMC9567894 DOI: 10.1192/j.eurpsy.2022.2185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Melatonin is often prescribed to patients experiencing sleep disturbances, which has been linked to elevated risks of suicide. However, it remains to be assessed whether melatonin is associated with suicide and suicide attempts. Objectives We aimed to investigate whether individuals in treatment with melatonin had higher rates of suicide and suicide attempt when compared to individuals not in treatment. Methods Using longitudinal data on all persons aged 10+ years living in Denmark between 2007-2016 were obtained. Data from the National Prescription Register was used to identify periods of being in treatment with melatonin based on number of tablets and daily defined dose. Suicide and suicide attempt were identified in hospital and cause of death registries. Results Among 5,798,923 included individuals, 10,577 (0.18%) were in treatment with melatonin (mean treatment length 50 days). Out of 5,952 individuals who died by suicide, 22 (0.37%) were in melatonin treatment, while 134 (0.53%) out of 25,136 had a first suicide attempt. After adjustment for sex and age-group, people in treatment with melatonin were found to have a higher rate of suicide (IRR: 4.2; 95% CI, 2.7-6.4) and suicide attempt (IRR: 6.7-fold (95% CI, 5.7-7.9) when compared to those not in treatment. Conclusions Treatment with melatonin was associated with higher rates of suicide and suicide attempt. The association might be explained through mediators, such as psychiatric comorbidity and sleep disorders. Our findings indicate that attention towards these issues might be warranted. Disclosure No significant relationships.
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Høier N, Madsen T, Spira A, Hawton K, Jennum P, Nordentoft M, Erlangsen A. The association between benzodiazepine and non-benzodiazepine and suicide: a nationwide cohort study. Eur Psychiatry 2022. [PMCID: PMC9567099 DOI: 10.1192/j.eurpsy.2022.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Benzodiazepines and non-benzodiazepines have been linked to a variety of adverse effects including addiction. Long term use of these drugs has been associated with an increased risk of suicide. Objectives We assessed if individuals in treatment with non-benzodiazepine (n-BZD) and benzodiazepine (BZD) had higher rates of suicide when compared to individuals not in treatment with these drugs. Methods We utilized a cohort design and national longitudinal data on all individuals aged 10 or above who lived in Denmark between 1995 and 2018. Treatment with either n-BZD or BZD was identified via the Danish National Prescription Registry and suicide deaths were identified in the national cause of death registries. Results In a total of 6,494,206 individuals, 10,862 males and 4,214 females died by suicide. Of these, 1,220 (11.2%) males and 792 (18.8%) females had been in treatment with n-BZD, resulting in adjusted IRR for suicide of 4.2 (95% CI, 4.0 – 4.5) and 3.4 (95% CI, 3.1 – 3.7) for males and females, respectively, when compared to those not in treatment. In all, 529 (4.8%) males and 395 (9.3%) females who died by suicide had been in treatment with BZD. The IRRs for suicide were 2.4 (95% CI, 2.2 – 2.6) and 2.5 (95% CI, 2.3 – 2.8) for males and females, respectively, and compared to those not in treatment. Conclusions In this study we find that those in treatment experienced higher suicide rates than those not in treatment, this persisted when also adjusting for a large variety of covariates. Disclosure No significant relationships.
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Høier N, Madsen T, Spira A, Hawton K, Benros M, Nordentoft M, Erlangsen A. Association of hospital-diagnosed sleep disorders with suicide: a nationwide cohort study. Eur Psychiatry 2022. [PMCID: PMC9564148 DOI: 10.1192/j.eurpsy.2022.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Sleep disorders and psychiatric disease are closely related, and psychiatric diseases are associated with elevated suicide risks. Yet, the association between sleep disorders and suicide remains to be assessed using a consistent measure of sleep disorders. Objectives The aim of this study was to examine whether people with a hospital-diagnosis of sleep disorders had higher suicide rates than people with no diagnosis. Methods In a cohort study, nationwide data on all persons aged 15+ years living in Denmark during 1980-2016 were analysed. Sleep disorders were identified through diagnoses recorded during contacts to somatic hospitals. Incidence Rate Ratios (IRR) were estimated using Poisson regression models and adjusted for relevant covariates. Results In all, 3,674,563 males and 3,688,164 females were included, of whom 82,223 (2.2%, mean age: 50.2, SD: 17.5) males and 40,003 (1.1%, mean age: 50.6, SD: 19.9) females had sleep disorder diagnoses. Compared to those with no sleep disorders, the adjusted IRRs for suicide were 1.6 (95% CI, 1.4-1.7) and 2.2 (95% CI, 1.8-2.6) for males and females with sleep disorders, respectively. Excess rates for narcolepsy were found for males (IRR:1.2, 95% CI, 1.0-1.5) and females (IRR:3.3, 95% CI, 3.0-4.1), and for sleep apnea in males (IRR:1.8, 95% CI, 1.5-2.2). Males and females had IRRs of 4.1 (95% CI, 3.1-5.5) and 7.0 (95% CI, 4.8-10.1), respectively, 6 months after being diagnosed with a sleep disorder. Conclusions Sleep disorders were associated with higher suicide rates even after adjusting for pre-existing mental disorders. Our findings suggest attention towards suicidal ideation in patients suffering from sleep disorders is warranted. Disclosure Disclosures and Acknowledgements: Adam Spira has received honoraria for serving as a consultant to Merck and from Springer Nature Switzerland AG for guest editing special issues of Current Sleep Medicine Reports. The other authors report no conflict of in
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Madsen T, Erlangsen A, Hjorthøj C, Nordentoft M. High suicide rates during psychiatric inpatient stay and shortly after discharge. Acta Psychiatr Scand 2020; 142:355-365. [PMID: 32715465 DOI: 10.1111/acps.13221] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Over recent decades, intense efforts to address suicides in psychiatric admitted people have been initiated. The aim was to calculate suicide rates, rate ratios, population attributable risks (PAR) and trends among people admitted to or recently discharged from psychiatric wards. METHODS Using a cohort design, we obtained nationwide register data on 6 292 932 individuals aged 15+ living in Denmark during 1995-2016. Of these, 178 703 (5.73%) males and 201 033 females (6.33%) had been admitted to psychiatric hospital. Incidence rate ratios (IRR) were obtained using Poisson regression analyses while adjusting for age and calendar period. Trends were assessed using joinpoint analyses. RESULTS In total, 15 075 persons died by suicide, of which 6174 had been psychiatrically admitted. Among males, the suicide rate during the first week of admission and after discharge was 3409 and 3148 per 100 000 person-years, respectively. The corresponding values for females were 1267 and 1631. Generally, estimated suicide rates were highest in those with affective or anxiety stress disorders. During first week of hospitalization, the IRR was 237 for males and of 322 for females when compared with those never hospitalized. In first week after discharge, the IRR was 225 and 425 for males and females, respectively. PAR estimates indicated 6% of male suicides and 13% of female suicides attributes to first week of admission and discharge. The inpatient suicide rate decreased annually 2.5% until 2009 followed by a 7.5% annual percentage increase. The suicide rate after discharge decreased steadily annually over the study period. CONCLUSION Despite finding declining post-discharge suicide rates, the period surrounding a psychiatric admission was still associated with extremely high suicide rates.
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Affiliation(s)
- T Madsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.,CORE-Copenhagen Research Center for Mental Health Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - A Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.,CORE-Copenhagen Research Center for Mental Health Mental Health Centre Copenhagen, Copenhagen, Denmark.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - C Hjorthøj
- CORE-Copenhagen Research Center for Mental Health Mental Health Centre Copenhagen, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - M Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.,CORE-Copenhagen Research Center for Mental Health Mental Health Centre Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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6
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Petersen B, Stenager E, Mogensen CB, Erlangsen A. Response to letter regarding Tobacco smoking. J Intern Med 2020; 288:607. [PMID: 32367596 DOI: 10.1111/joim.13068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 11/27/2022]
Affiliation(s)
- B Petersen
- From the, Psychiatric Research Unit, Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - E Stenager
- From the, Psychiatric Research Unit, Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - C B Mogensen
- Acute Medicine Research Unit, Department of Regional Health Research, University Hospital of Southern Denmark, University of Southern Denmark, Abenraa, Denmark
| | - A Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen, Denmark.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center of Mental Health Research, Australian National University, Canberra, ACT, Australia
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Juel A, Berring LL, Hybholt L, Erlangsen A, Larsen ER, Buus N. Relatives' experiences of providing care for individuals with suicidal behaviour conceptualized as a moral career: A meta-ethnographic study. Int J Nurs Stud 2020; 113:103793. [PMID: 33161331 DOI: 10.1016/j.ijnurstu.2020.103793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/21/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND An increasing number of qualitative research articles have reported on relatives' experiences of providing care for individuals displaying suicidal behaviour. To contribute more fully to theory and practice, these reported experiences must be synthesized. OBJECTIVES To identify original qualitative studies of relatives' experiences of providing care for individuals with non-fatal suicidal behaviour and to systematically review and synthesize this research using a meta-ethnographic approach. DESIGN Systematic review and meta-ethnography. DATA SOURCES Literature searches were undertaken in six bibliographic databases (PubMed, CINAHL, Embase, PsycINFO, Web of Science and Scopus) and limited to peer-reviewed original studies. Eligible studies reported relatives' experiences of providing care for individuals with suicidal behaviour, published in English or a Scandinavian language. REVIEW METHODS One reviewer screened the titles, abstracts and full texts and then collaborated with another reviewer on excluding ineligible studies. A two-step strategy was used while reviewing publications: 1) appraising study quality, and 2) classifying study findings according to degree of data interpretation. This strategy was used for each study by two independent reviewers who subsequently reached a shared decision on inclusion. Noblit and Hare's methodology for translation and synthesis was followed in developing a novel theoretical interpretation of relatives' experiences. The concept of moral career was adopted in producing this synthesis. RESULTS Of 7,334 publications screened, 12 studies were eligible for inclusion. The synthesis conveyed relatives' moral career as comprising four stages, each depicting relatives' different perspectives on life and felt identities. First, relatives negotiated conventional ideas about normalcy and positioned themselves as living abnormal family lives in the stage from normal to abnormal. The first career movement could be mediated by social interactions with professionals in the stage feeling helpful or feeling unhelpful. For some relatives, this negotiated perspective of abnormality got stuck in an impasse. They did not interact with their surroundings in ways that would enable them to renegotiate these fixed views, and this stage was named stuck in abnormality. For other relatives, career movement took place as relatives re-positioned themselves as negotiating an alternative perspective of normalcy in the stage from abnormal to normal. CONCLUSIONS Interactions with other people facing similar difficulties enabled relatives to shift perspectives and alleviated experiences of distress.
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Affiliation(s)
- A Juel
- Center for Relationships and De-escalation, Psychiatry Region Zealand, Fælledvej 6, 1, Slagelse 4200, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 4, Hellerup, Copenhagen 2900, Denmark; Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, Odense 5000, Denmark.
| | - L L Berring
- Center for Relationships and De-escalation, Psychiatry Region Zealand, Fælledvej 6, 1, Slagelse 4200, Denmark; Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, Odense 5000, Denmark.
| | - L Hybholt
- Center for Relationships and De-escalation, Psychiatry Region Zealand, Fælledvej 6, 1, Slagelse 4200, Denmark.
| | - A Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 4, Hellerup, Copenhagen 2900, Denmark; Department of mental health, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, S850, Baltimore, MD 21205, United States; Center of Mental Health Research, The Australian National University, Building 63, Canberra ACT 2601, Australia; Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 4, Hellerup 2900, Denmark.
| | - E R Larsen
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, Odense 5000, Denmark; Mental Health Department Odense, University Clinic, Mental Health Service, J. B. Winsløws Vej 18, Odense 5000, Denmark.
| | - N Buus
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, Odense 5000, Denmark; Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, 88 Mallett St, Camperdown, NSW 2050, Australia; The Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital. 390 Victoria St, Darlinghurst, NSW 2010, Australia; St. Vincent's Hospital Sydney, 390 Victoria St., Darlinghurst, NSW 2010, Australia.
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Abstract
OBJECTIVE To assess the association between specific heart diseases and suicide. DESIGN Nationwide retrospective cohort study. PARTICIPANTS A total of 7 298 002 individuals (3 640 632 males and 3 657 370 females) aged ≥15 years and living in Denmark during 1980-2016. MAIN OUTCOME MEASURES Incidence rate ratios (IRR) with 95% confidence intervals. In multivariate analysis, we adjust for sex, period, age group, living status, income level, Charlson Comorbidity Index, psychiatric disorders prior to heart disease and self-harm prior to heart disease. RESULTS Excess suicide rate ratios were found for following disorders: heart failure (IRR: 1.48; 95% CI: 1.38-1.58); cardiomyopathy (IRR: 1.41; 95% CI: 1.16-1.70); acute myocardial infarction (IRR: 1.28; 95% CI: 1.21-1.36); cardiac arrest with successful resuscitation (IRR: 4.75; 95% CI: 3.57-6.33); atrial fibrillation and flutter (IRR: 1.42; 95% CI: 1.32-1.52); angina pectoris (IRR: 1.19; 95% CI: 1.12-1.26); and ventricular tachycardia (IRR: 1.53; 95% CI: 1.20-1.94). A higher rate of suicide was noted during the first 6 months after the diagnosis of heart failure (IRR: 2.38; 95% CI: 2.04-2.79); acute myocardial infarction (IRR: 2.24; 95% CI: 1.89-2.66); atrial fibrillation and flutter (IRR: 2.70; 95% CI: 2.30-3.18); and angina pectoris (IRR: 1.83; 95% CI: 1.53-2.19) when compared to later. CONCLUSION Several specific disorders were found to be associated with elevated rates of suicide. Additionally, we found temporal associations with higher suicide rates in the first time after diagnosis. Our results underscore the importance of being attentive towards psychological distress in individuals with heart disease.
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Affiliation(s)
- B D Petersen
- From the, Psychiatric Research Unit, Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - E Stenager
- From the, Psychiatric Research Unit, Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - C B Mogensen
- Acute Medicine Research Unit, Department of Regional Health Research, University of Southern Denmark, University Hospital of Southern Denmark, Abenraa, Denmark
| | - A Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen, Denmark.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center of Mental Health Research, Australian National University, Canberra, ACT, Australia
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Søndergård S, Vaegter HB, Erlangsen A, Stenager E. Ten-year prevalence of mental disorders in patients presenting with chronic pain in secondary care: A register linkage cohort study. Eur J Pain 2017; 22:346-354. [PMID: 28971547 DOI: 10.1002/ejp.1124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Prevalence rates of mental disorders in patients with chronic pain vary and may be overestimated when assessed by screening instruments only. Objectives were to estimate the 10-year prevalence of different mental disorders diagnosed by psychiatrists in patients with chronic pain compared with the Danish general population. METHODS Patients (n = 7197) consulted in the interdisciplinary Pain Clinic South at Odense University Hospital, Denmark, from 2005 to 2015 were included. Data from the Pain Clinic were linked to the Danish National Patient Register-Psychiatry and the Danish Civil Registration System. Age and gender standardized prevalence ratios (SPR) were calculated. RESULTS In all, 17.8% of patients with chronic pain had been diagnosed with a mental disorder. The most frequent diagnoses were adjustment disorders (subcategory of anxiety disorders) (8.9%), depression (6.1%), personality disorders (3.8%), and substance abuse disorders (3.5%). Women and men with chronic pain had higher rates of anxiety disorders (SPR 3.1; 95% CI 2.9-3.4) and depression (SPR 2.5; 95% CI 2.3-2.8), whereas men had higher rates of substance abuse disorders (SPR 1.6; 95% CI 1.3-1.9) than found for the general population. CONCLUSIONS Although depression and anxiety were noted more frequently among patients with chronic pain than the general population, prevalence rates were lower than previously reported. The most frequent diagnoses were adjustment disorders. SIGNIFICANCE Prevalence rates of anxiety and depression diagnosed by psychiatrists in patients with chronic pain were found to be lower than previous findings using screening instruments. Adjustment disorders were the most frequent disorders diagnosed, as this study is the first to investigate.
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Affiliation(s)
- S Søndergård
- Research Unit in Mental Health, Institute for Regional Health Services, University of Southern Denmark, Aabenraa, Denmark
| | - H B Vaegter
- Pain Research Group, Pain Centre South, Odense University Hospital, Denmark.,Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - A Erlangsen
- Research Unit in Mental Health, Institute for Regional Health Services, University of Southern Denmark, Aabenraa, Denmark.,Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Denmark.,Department of Mental Health, Bloomberg Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - E Stenager
- Research Unit in Mental Health, Institute for Regional Health Services, University of Southern Denmark, Aabenraa, Denmark
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Birkbak J, Stuart EA, Lind BD, Qin P, Stenager E, Larsen KJ, Wang AG, Nielsen AC, Pedersen CM, Winsløv JH, Langhoff C, Mühlmann C, Nordentoft M, Erlangsen A. Psychosocial therapy and causes of death after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching. Psychol Med 2016; 46:3419-3427. [PMID: 27654845 DOI: 10.1017/s0033291716001872] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychosocial therapy after deliberate self-harm might be associated with reduced risk of specific causes of death. METHOD In this matched cohort study, we included patients, who after an episode of deliberate self-harm received psychosocial therapy at a Suicide Prevention Clinic in Denmark between 1992 and 2010. We used propensity score matching in a 1:3 ratio to select a comparison group from 59 046 individuals who received standard care. National Danish registers supplied data on specific causes of death over a 20-year follow-up period. RESULTS At the end of follow-up, 391 (6.9%) of 5678 patients in the psychosocial therapy group had died, compared with 1736 (10.2%) of 17 034 patients in the matched comparison group. Lower odds ratios of dying by mental or behavioural disorders [0.54, 95% confidence interval (CI) 0.37-0.79], alcohol-related causes (0.63, 95% CI 0.50-0.80) and other diseases and medical conditions (0.61, 95% CI 0.49-0.77) were noted in the psychosocial therapy group. Also, we found a reduced risk of dying by suicide as well as other external causes, however, not by neoplasms and circulatory system diseases. Numbers needed to treat were 212.9 (95% CI 139.5-448.4) for mental or behavioural disorders as a cause of death, 111.1 (95% CI 79.2-210.5) for alcohol-related causes and 96.8 (95% CI 69.1-161.8) for other diseases and medical conditions. CONCLUSIONS Our findings indicate that psychosocial therapy after deliberate self-harm might reduce long-term risk of death from select medical conditions and external causes. These promising results should be tested in a randomized design.
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Affiliation(s)
- J Birkbak
- Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark
| | - E A Stuart
- Department of Mental Health,Johns Hopkins Bloomberg School of Public Health,Baltimore, MD,USA
| | - B D Lind
- Department of Psychiatry,Clinic of Suicide Prevention and Treatment for Adults,Region of Southern Denmark,Denmark
| | - P Qin
- National Centre for Suicide Research and Prevention, University of Oslo,Oslo,Norway
| | - E Stenager
- Psychiatric Research Unit,Aabenraa,University of Southern Denmark,Odense,Denmark
| | - K J Larsen
- Department of Child and Adolescent Psychiatry,Clinic of Suicide Prevention and Treatment for Children and Adolescents,Region of Southern Denmark,Denmark
| | - A G Wang
- Competence Centre for Suicide Prevention,Amager,Capital Region of Denmark,Denmark
| | - A C Nielsen
- Competence Centre for Suicide Prevention,Copenhagen,Capital Region of Denmark,Denmark
| | - C M Pedersen
- Clinic for Suicide Prevention, Aarhus University Hospital Risskov,Aarhus,Central Denmark Region,Denmark
| | - J-H Winsløv
- Unit for Suicide Prevention,Aalborg University Hospital,North Denmark Region,Denmark
| | - C Langhoff
- Clinic for Suicide Prevention,Herning,Central Denmark Region,Denmark
| | - C Mühlmann
- Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark
| | - M Nordentoft
- Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark
| | - A Erlangsen
- Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark
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11
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Erlangsen A. Media reporting on suicide: challenges and opportunities. Acta Psychiatr Scand 2013; 128:316-7. [PMID: 23952290 DOI: 10.1111/acps.12132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- A Erlangsen
- Mental Health Centre Copenhagen, Capital Region of Denmark, Denmark; Department of Mental Health, Johns Hopkins School of Public Health, USA.
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Erlangsen A, Canudas-Romo V, Conwell Y. Increased use of antidepressants and decreasing suicide rates: a population-based study using Danish register data. J Epidemiol Community Health 2008; 62:448-54. [PMID: 18413459 DOI: 10.1136/jech.2007.061580] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The objective of the present study was to examine if the change in the suicide rate is associated with individuals' use of antidepressants as has been suggested by ecological studies. DESIGN Decomposition of suicide rates by antidepressant treatment group. SETTING Population-based record linkage. PARTICIPANTS All individuals aged 50 years and older living in Denmark between 1 January 1996 and 31 December 2000 (N = 2,100,808). MAIN OUTCOME MEASURES Suicide rates are calculated according to current antidepressant treatment status (no treatment, tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRI), other antidepressants). The change in the suicide rate during 1996-2000 was decomposed by treatment group. RESULTS Only one in five older adults dying by suicide was in treatment at the time of death. Whereas the male suicide rate declined by 9.7 suicides per 100,000, recipients of antidepressants contributed to the decline by 0.9 suicides. Women redeeming antidepressant prescriptions accounted for 0.4 suicides of the observed reduction of 3.3 per 100,000. The average suicide rates for men receiving TCA and SSRI were 153.3 and 169.0 per 100,000 person-years, respectively. Among older women, both TCA and SSRI users had an average suicide rate of 68.8 per 100,000 over the period examined. CONCLUSIONS Just a small proportion of older adults dying by suicide were found to be in treatment with antidepressants at the time of death. Individuals in active treatment with antidepressants seem to account for 10% of the decline in the suicide rate. Nevertheless, suicides might be prevented by more effective treatment.
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Affiliation(s)
- A Erlangsen
- National Centre for Register-based Research, University of Aarhus, Aarhus, Denmark.
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