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Belarus has one of the worlds’ highest suicide rates (48.5 and 9.1/100,000 for men and women, respectively). The country's first suicide prevention project (2009–2013) focuses on educational courses for all physicians employed in primary health care (N = 120) in two regions of the county of Minsk (Total population: 73,663).
The aim of this paper was to investigate physicians’ knowledge with regard to suicide prevention as well as their experience of suicidal behavior based on findings from the pilot study.
45 physicians (mean age 43.6; 31 women, 14 men; 35% of all physicians) had participated in the first training courses, including two educational seminars (24 hours, 2009–2010). All participating physicians answered the questionnaire with 40 items distributed before the training courses.
The preliminary findings indicate that half of the participating doctors (N = 22) considered mental disorders as being the main risk factor for suicide and equally many defined suicide as an expression of “spiritual weakness”. 48% considered that asking patients about suicidal thoughts can stimulate the act. As many as 47% (21 physicians) had experienced a patients’ suicide during their professional practice (14 of them more than once). About half of the doctors (N = 24) have been confronted with a patient's suicide attempt and 20 participants (44%) experienced suicidal behavior of close friends and relatives. 17 (38%) and 2 doctors reported suicidal thoughts and suicide attempts ever in life, respectively.
Improved suicidological knowledge is badly needed, particularly in the light of the frequent confrontation with suicidal patients.
Many multiple sclerosis (MS) patients suffer from psychiatric comorbidity, and 60% of patients of working age are on disability pension (DP). It is unknown how transition to DP affects MS patients’ mental health.
To investigate the risk for being prescribed psychiatric drugs before and after receiving full-time DP in MS patients compared to matched controls.
To examine the impact of transition of DP on MS patients' mental health.
Nationwide Swedish registers were used to identify all 3836 MS patients who were granted full-time DP in 2000-2012, along with 19,180 propensity matched controls also being granted DP in the same years. Patients and controls were organized into cohorts by year of DP, and adjusted odds ratios (ORs) with 95% confidence intervals (95%CIs) were calculated for being prescribed Selective Serotonine Reuptake Inhibitors (SSRIs), benzodiazepines and sleeping agents in 2006.
The risk for being prescribed psychiatric drugs increased in the years leading up to DP among both MS patients and controls. After DP, the risk for benzodiazepines increased among MS patients but was unchanged among controls (OR 1.72, 95%CI 1.16-2.57). MS patients had an increased risk for SSRIs after DP compared to controls (OR 1.76, 95%CI 1.44-2.15).
The risk for being prescribed psychiatric drugs after DP differs substantially between MS patients and other DP diagnoses. Possible reasons for the increased psychiatric illness among MS patients during and after transition to DP should be further investigated, as well as the role of DP as a rehabilitory measure.
Belarus has one of the worlds’ highest suicide rates (48.5/100000 men, 9.1/100000 women, 2008). The country's first suicide prevention project is carried out from 2009 to 2013 in two regions of the Minsk County (pop. 75,773) targeting on improving primary care physician's skills in diagnosing of depression and suicide risk assessment.
The aim of this paper was to investigate physician's attitudes changes towards work with suicidal patients through a training seminar and whether potential changes vary with the earlier experience of a patient's suicide.
90 physicians (60% of physician's stuff, 64.4% women) answered the questionnaire (40 items) before and after the 2 day courses (2009/2011) held by qualified psychiatrists. Chi-square test has been applied to investigate significance of pre/post differences.
Significant improvements regarding expectations, knowledge and collaboration for suicidal patients were noted after the training. Physicians more often perceived clarity in the organization of responsibilities for suicidal patients after the seminar than before (86% vs. 32%, p < 0.001). No improvements in the perceived possibility of preventing suicide were noted, still the vast majority (72%) considered suicide to be preventable before the seminar. There were no influence of patient's suicide experience (47% of the participants) on change in attitudes towards work with suicidal patients.
Job clarity and perceived knowledge were significantly improved through a 2-day educational training. No changes regarding the perceived possibility to prevent suicide were noted. Increased efforts to work with these issues are planned for the next round of training seminars.
Studies on the individual gender-specific risk and familial co-aggregation of suicidal behaviour in autism spectrum disorder (ASD) are lacking.
We conducted a matched case-cohort study applying conditional logistic regression models on 54 168 individuals recorded in 1987–2013 with ASD in Swedish national registers: ASD without ID n = 43 570 (out of which n = 19035, 43.69% with ADHD); ASD + ID n = 10 598 (out of which n = 2894 individuals, 27.31% with ADHD), and 270 840 controls, as well as 347 155 relatives of individuals with ASD and 1 735 775 control relatives.
The risk for suicidal behaviours [reported as odds ratio OR (95% confidence interval CI)] was most increased in the ASD without ID group with comorbid ADHD [suicide attempt 7.25 (6.79–7.73); most severe attempts i.e. requiring inpatient stay 12.37 (11.33–13.52); suicide 13.09 (8.54–20.08)]. The risk was also increased in ASD + ID group [all suicide attempts 2.60 (2.31–2.92); inpatient only 3.45 (2.96–4.02); suicide 2.31 (1.16–4.57)]. Females with ASD without ID had generally higher risk for suicidal behaviours than males, while both genders had highest risk in the case of comorbid ADHD [females, suicide attempts 10.27 (9.27–11.37); inpatient only 13.42 (11.87–15.18); suicide 14.26 (6.03–33.72); males, suicide attempts 5.55 (5.10–6.05); inpatient only 11.33 (9.98–12.86); suicide 12.72 (7.77–20.82)]. Adjustment for psychiatric comorbidity attenuated the risk estimates. In comparison to controls, relatives of individuals with ASD also had an increased risk of suicidal behaviour.
Clinicians treating patients with ASD should be vigilant for suicidal behaviour and consider treatment of psychiatric comorbidity.
Self-harm among young adults is a common and increasing phenomenon in many parts of the world. The long-term prognosis after self-harm at young age is inadequately known. We aimed to estimate the risk of mental illness and suicide in adult life after self-harm in young adulthood and to identify prognostic factors for adverse outcome.
We conducted a national population-based matched case-cohort study. Patients aged 18-24 years (n = 13 731) hospitalized after self-harm between 1990 and 2003 and unexposed individuals of the same age (n = 137 310 ) were followed until December 2009. Outcomes were suicide, psychiatric hospitalization and psychotropic medication in short-term (1-5 years) and long-term (>5 years) follow-up.
Self-harm implied an increased relative risk of suicide during follow-up [hazard ratio (HR) 16.4, 95% confidence interval (CI) 12.9–20.9). At long-term follow-up, 20.3% had psychiatric hospitalizations and 51.1% psychotropic medications, most commonly antidepressants and anxiolytics. There was a six-fold risk of psychiatric hospitalization (HR 6.3, 95% CI 5.8–6.8) and almost three-fold risk of psychotropic medication (HR 2.8, 95% CI 2.7–3.0) in long-term follow-up. Mental disorder at baseline, especially a psychotic disorder, and a family history of suicide were associated with adverse outcome among self-harm patients.
We found highly increased risks of future mental illness and suicide among young adults after self-harm. A history of a mental disorder was an important indicator of long-term adverse outcome. Clinicians should consider the substantially increased risk of suicide among self-harm patients with psychotic disorders.
Social workers report high levels of stress and have an increased risk for hospitalisation with mental diagnoses. However, it is not known whether the risk of work disability with mental diagnoses is higher among social workers compared with other human service professionals. We analysed trends in work disability (sickness absence and disability pension) with mental diagnoses and return to work (RTW) in 2005–2012 among social workers in Finland and Sweden, comparing with such trends in preschool teachers, special education teachers and psychologists.
Records of work disability (>14 days) with mental diagnoses (ICD-10 codes F00–F99) from nationwide health registers were linked to two prospective cohort projects: the Finnish Public Sector study, years 2005–2011 and the Insurance Medicine All Sweden database, years 2005–2012. The Finnish sample comprised 4849 employees and the Swedish 119 219 employees covering four occupations: social workers (Finland 1155/Sweden 23 704), preschool teachers (2419/74 785), special education teachers (832/14 004) and psychologists (443/6726). The reference occupations were comparable regarding educational level. Risk of work disability was analysed with negative binomial regression and RTW with Cox proportional hazards.
Social workers in Finland and Sweden had a higher risk of work disability with mental diagnoses compared with preschool teachers and special education teachers (rate ratios (RR) 1.43–1.91), after adjustment for age and sex. In Sweden, but not in Finland, social workers also had higher work disability risk than psychologists (RR 1.52; 95% confidence interval 1.28–1.81). In Sweden, in the final model special education teachers had a 9% higher probability RTW than social workers. In Sweden, in the final model the risks for work disability with depression diagnoses and stress-related disorder diagnoses were similar to the risk with all mental diagnoses (RR 1.40–1.77), and the probability of RTW was 6% higher in preschool teachers after work disability with depression diagnoses and 9% higher in special education teachers after work disability with stress-related disorder diagnoses compared with social workers.
Social workers appear to be at a greater risk of work disability with mental diagnoses compared with other human service professionals in Finland and Sweden. It remains to be studied whether the higher risk is due to selection of vulnerable employees to social work or the effect of work-related stress in social work. Further studies should focus on these mechanisms and the risk of work disability with mental diagnoses among human service professionals.
The aim of this study was to analyse a possible synergistic effect between back pain and common mental disorders (CMDs) in relation to future disability pension (DP).
All 4 823 069 individuals aged 16–64 years, living in Sweden in December 2004, not pensioned in 2005 and without ongoing sickness absence at the turn of 2004/2005 formed the cohort of this register-based study. Hazard ratios (HRs) and 95% confidence intervals (CIs) for DP (2006–2010) were estimated. Exposure variables were back pain (M54) (sickness absence or inpatient or specialized outpatient care in 2005) and CMD (F40-F48) [sickness absence or inpatient or specialized outpatient care or antidepressants (N06a) in 2005].
HRs for DP were 4.03 (95% CI 3.87–4.21) and 3.86 (95% CI 3.68–4.04) in women and men with back pain. HRs for DP in women and men with CMD were 4.98 (95% CI 4.88–5.08) and 6.05 (95% CI 5.90–6.21). In women and men with both conditions, HRs for DP were 15.62 (95% CI 14.40–16.94) and 19.84 (95% CI 17.94–21.94). In women, synergy index, relative excess risk due to interaction, and attributable proportion were 1.24 (95% CI 1.13–1.36), 0.18 (95% CI 0.11–0.25), and 2.08 (95% CI 1.09–3.06). The corresponding figures for men were 1.45 (95% CI 1.29–1.62), 0.29 (95% CI 0.22–0.36), and 4.21 (95% CI 2.71–5.70).
Co-morbidity of back pain and CMD is associated with a higher risk of DP than either individual condition, when added up, which has possible clinical implications to prevent further disability and exclusion from the labour market.
The aim of the present study was to investigate trajectories of suicide attempt risks before and after granting of disability pension in young people.
The analytic sample consisted of all persons 16–30 years old and living in Sweden who were granted a disability pension in the years 1995–1997; 2000–2002 as well as 2005–2006 (n = 26 624). Crude risks and adjusted odds ratios for suicide attempt were computed for the 9-year window around the year of disability pension receipt by repeated-measures logistic regressions.
The risk of suicide attempt was found to increase continuously up to the year preceding the granting of disability pension in young people, after which the risk declined. These trajectories were similar for women and men and for disability pension due to mental and somatic diagnoses. Still, the multivariate odds ratios for suicide attempts for women and for disability pension due to mental disorders were 2.5- and 3.8-fold increased compared with the odds ratios for men and disability pension due to somatic disorders, respectively. Trajectories of suicide attempts differed for young individuals granted a disability pension during 2005–2006 compared with those granted during 1995–1997 and 2000–2002.
We found an increasing risk of suicide attempt up until the granting of a disability pension in young individuals, after which the risk decreased. It is of clinical importance to monitor suicide attempt risk among young people waiting for the granting of a disability pension.
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