Cargando…

Suicides in Mood Disorders in Psychiatric Settings in Nordic National Register–Based Studies

OBJECTIVE: Although risk factors for nonfatal suicidal behavior in mood disorders have been vastly investigated, rate and risk factors of suicide deaths are less well known. Extensive health care and other population registers in the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) a...

Descripción completa

Detalles Bibliográficos
Autor principal: Isometsä, Erkki T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7390882/
https://www.ncbi.nlm.nih.gov/pubmed/32848909
http://dx.doi.org/10.3389/fpsyt.2020.00721
_version_ 1783564534621929472
author Isometsä, Erkki T.
author_facet Isometsä, Erkki T.
author_sort Isometsä, Erkki T.
collection PubMed
description OBJECTIVE: Although risk factors for nonfatal suicidal behavior in mood disorders have been vastly investigated, rate and risk factors of suicide deaths are less well known. Extensive health care and other population registers in the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) allow national-level studies of suicide rates and risk factors. This systematic review examined Nordic studies of suicide in mood disorders. METHODS: National Nordic studies published after 1.1.2000 reporting on suicide mortality or relative risk in diagnosed unipolar depression or bipolar disorder treated in psychiatric settings; temporal variations in suicide risk after discharge, or risk factors for suicide were systematically reviewed. RESULTS: Altogether 16 longitudinal studies reported on rate and risk of suicide in depression. They found 2%–8% of psychiatric inpatients with depression to have died by suicide. However, in Finland suicide risk among depressive inpatients halved since the early 1990s. Nine studies investigated suicide risk in bipolar disorder, finding 4–8% of patients having died by suicide in long term. The relative risk of suicide was consistently found extremely high (SMR > 100) during the first weeks postdischarge, declining steeply over time to approximately SMR of five after five years. Male gender, preceding suicide attempts, high severity of depression and substance abuse were found risk factors for suicide in depression, with only minor gender differences in risk factors, but major differences in lethal methods. Three studies investigated risk factors for suicide in bipolar disorder, finding male gender, preceding suicide attempts, and depressive episodes and psychiatric comorbidity to be associated with risk. CONCLUSIONS: Overall, of psychiatric inpatients with depressive of bipolar disorders in the Nordic countries, 2%–8% have died by suicide in the last few decades, but current rates may be lower. Suicide risk is approximately similar or somewhat higher among patients with bipolar disorder, risk factor studies of whom are fewer. Risk of suicide is remarkably high immediately after discharge, and higher among males than females, those with preceding suicide attempts, high severity of depression, or concurrent substance abuse. Generalizability of findings from these Nordic studies to other countries need to be investigated, and their methodological limitations understood.
format Online
Article
Text
id pubmed-7390882
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-73908822020-08-25 Suicides in Mood Disorders in Psychiatric Settings in Nordic National Register–Based Studies Isometsä, Erkki T. Front Psychiatry Psychiatry OBJECTIVE: Although risk factors for nonfatal suicidal behavior in mood disorders have been vastly investigated, rate and risk factors of suicide deaths are less well known. Extensive health care and other population registers in the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) allow national-level studies of suicide rates and risk factors. This systematic review examined Nordic studies of suicide in mood disorders. METHODS: National Nordic studies published after 1.1.2000 reporting on suicide mortality or relative risk in diagnosed unipolar depression or bipolar disorder treated in psychiatric settings; temporal variations in suicide risk after discharge, or risk factors for suicide were systematically reviewed. RESULTS: Altogether 16 longitudinal studies reported on rate and risk of suicide in depression. They found 2%–8% of psychiatric inpatients with depression to have died by suicide. However, in Finland suicide risk among depressive inpatients halved since the early 1990s. Nine studies investigated suicide risk in bipolar disorder, finding 4–8% of patients having died by suicide in long term. The relative risk of suicide was consistently found extremely high (SMR > 100) during the first weeks postdischarge, declining steeply over time to approximately SMR of five after five years. Male gender, preceding suicide attempts, high severity of depression and substance abuse were found risk factors for suicide in depression, with only minor gender differences in risk factors, but major differences in lethal methods. Three studies investigated risk factors for suicide in bipolar disorder, finding male gender, preceding suicide attempts, and depressive episodes and psychiatric comorbidity to be associated with risk. CONCLUSIONS: Overall, of psychiatric inpatients with depressive of bipolar disorders in the Nordic countries, 2%–8% have died by suicide in the last few decades, but current rates may be lower. Suicide risk is approximately similar or somewhat higher among patients with bipolar disorder, risk factor studies of whom are fewer. Risk of suicide is remarkably high immediately after discharge, and higher among males than females, those with preceding suicide attempts, high severity of depression, or concurrent substance abuse. Generalizability of findings from these Nordic studies to other countries need to be investigated, and their methodological limitations understood. Frontiers Media S.A. 2020-07-23 /pmc/articles/PMC7390882/ /pubmed/32848909 http://dx.doi.org/10.3389/fpsyt.2020.00721 Text en Copyright © 2020 Isometsä http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Isometsä, Erkki T.
Suicides in Mood Disorders in Psychiatric Settings in Nordic National Register–Based Studies
title Suicides in Mood Disorders in Psychiatric Settings in Nordic National Register–Based Studies
title_full Suicides in Mood Disorders in Psychiatric Settings in Nordic National Register–Based Studies
title_fullStr Suicides in Mood Disorders in Psychiatric Settings in Nordic National Register–Based Studies
title_full_unstemmed Suicides in Mood Disorders in Psychiatric Settings in Nordic National Register–Based Studies
title_short Suicides in Mood Disorders in Psychiatric Settings in Nordic National Register–Based Studies
title_sort suicides in mood disorders in psychiatric settings in nordic national register–based studies
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7390882/
https://www.ncbi.nlm.nih.gov/pubmed/32848909
http://dx.doi.org/10.3389/fpsyt.2020.00721
work_keys_str_mv AT isometsaerkkit suicidesinmooddisordersinpsychiatricsettingsinnordicnationalregisterbasedstudies