Ellinor Salander Renberg

Why people engage in parasuicide: a-cross-cultural study of Intentions.

Information obtained at interview from 1,646 parasuicide patients in 14 regions in 13 European countries participating in the WHO/EURO Multicentre Study on Suicidal Behaviour was used to study self-reported intentions involved in parasuicide. Comparisons were made across cultures, genders, and age groups. Although some statistically significant differences were found, the effect sizes were very small. The main finding from this study is thus that parasuicide patients in different countries tend to indicate that similar types of intentions are involved in their acts of parasuicide, and that the intentions do not vary greatly with gender or age. The hypothesis that rates of suicide and parasuicide vary between regions with the frequency with which suicidal intention is indicated by the patients was also tested, but was supported only for women and in relation to national suicide rates. The findings from this study are likely to be generalizable to other settings and have implications for clinical practice.

Problem solving ability and repetition of deliberate self-harm: a multicentre study.

BACKGROUND While recent studies have found problem-solving impairments in individuals who engage in deliberate self-harm (DSH), few studies have examined repeaters and non-repeaters separately. The aim of the present study was to investigate whether specific types of problem-solving are associated with repeated DSH. METHOD As part of the WHO/EURO Multicentre Study on Suicidal Behaviour, 836 medically treated DSH patients (59% repeaters) from 12 European regions were interviewed using the European Parasuicide Study Interview Schedule (EPSIS II) approximately 1 year after their index episode. The Utrecht Coping List (UCL) assessed habitual responses to problems. RESULTS Factor analysis identified five dimensions--Active Handling, Passive-Avoidance, Problem Sharing, Palliative Reactions and Negative Expression. Passive-Avoidance--characterized by a pre-occupation with problems, feeling unable to do anything, worrying about the past and taking a gloomy view of the situation, a greater likelihood of giving in so as to avoid difficult situations, the tendency to resign oneself to the situation, and to try to avoid problems--was the problem-solving dimension most strongly associated with repetition, although this association was attenuated by self-esteem. CONCLUSIONS The outcomes of the study indicate that treatments for DSH patients with repeated episodes should include problem-solving interventions. The observed passivity and avoidance of problems (coupled with low self-esteem) associated with repetition suggests that intensive therapeutic input and follow-up are required for those with repeated DSH.

Attempted suicide among immigrants in European countries : an international perspective

PurposeThis study compares the frequencies of attempted suicide among immigrants and their hosts, between different immigrant groups, and between immigrants and their countries of origin.MethodsThe material, 27,048 persons, including 4,160 immigrants, was obtained from the WHO/EURO Multicentre Study on Suicidal Behaviour, the largest available European database, and was collected in a standardised manner from 11 European centres in 1989–2003. Person-based suicide-attempt rates (SARs) were calculated for each group. The larger immigrant groups were studied at each centre and compared across centres. Completed-suicide rates of their countries of origin were compared to the SARs of the immigrant groups using rank correlations.Results27 of 56 immigrant groups studied showed significantly higher, and only four groups significantly lower SARs than their hosts. Immigrant groups tended to have similar rates across different centres. Moreover, positive correlation between the immigrant SAR and the country-of-origin suicide rate was found. However, Chileans, Iranians, Moroccans, and Turks displayed high SARs as immigrants despite low suicide rates in the home countries.ConclusionsThe similarity of most immigrant groups’ SARs across centres, and the correlation with suicidality in the countries of origin suggest a strong continuity that can be interpreted in either cultural or genetic terms. However, the generally higher rates among immigrants compared to host populations and the similarity of the rates of foreign-born and those immigrants who retained the citizenship of their country of origin point to difficulties in the acculturation and integration process. The positive correlation found between attempted and completed suicide rates suggests that the two are related, a fact with strong implications for suicide prevention.

Building models for the relationship between attitudes toward suicide and suicidal behavior: based on data from general population surveys in Sweden, Norway, and Russia

Our aim was to build a model delineating the relationship between attitudes toward suicide and suicidal behavior and to assess equivalence by applying the model on data from different countries. Representative samples from the general population were approached in Sweden, Norway, and Russia with the Attitudes Toward Suicide (ATTS) questionnaire. Data on experience of suicidal behavior among significant others and self-reported suicidal expressions were also collected. Structural equation modeling resulted in gender and country specific models where experience of suicidal behavior among significant others and self-reported suicidal expressions earlier in life predicted attitudes, and attitudes predicted current suicidal expressions. The models included the attitude factors acceptance of suicide, condemnation, and preventability; age and level of education were also incorporated. The different models reveal possible ways to better understand gender and culture-specific paths between attitudes and suicidal behaviors, and their relevance in a suicide prevention context is considered.

Borderline diagnosis from hospital records : reliability and validity of Gunderson's diagnostic interview for Borderlines (DIB)

Two trained and experienced clinical psychologists and two nontrained students rated the sections in Gundersons Diagnostic Interview for Borderlines (DIB) on the basis of hospital records for 16 patients (DIB-R). The results showed that both reliability and validity, i.e., correlations with an actual interview, were unexpectedly high, around .80 for the trained judges and around .55 for the nontrained judges. The conclusion is that the DIB may be used for retrospective diagnosis of borderline patients from hospital records.

An empirical study of borderline personality disorder and psychiatric suicides.

Borderline personality disorder (BPD) is closely related to suicidal behavior, and suicide attempts per se are considered a diagnostic criterion. However, there has been no previous study of completed suicides and BPD. The present study is based on a population of 134 consecutive psychiatric suicides from 1961 to 1980 in a catchment area of 250,000 inhabitants. Clinical records were retrospectively diagnosed according to the Diagnostic Interview for Borderlines and DSM-III. There was a progressive increase in proportion of borderline suicides during the time period. The overall proportion of BPD, however, was only 12%, indicating that borderline patients are not seriously overrepresented among patients committing psychiatric suicides. Demographic variables, earlier psychiatric care, and suicidal behavior in the borderline group are described and analyzed.

Season of birth associated with the age and method of suicide

A recent study reported season of birth variation in CSF levels of 5-HIAA and HVA, with low 5-HIAA for February to April and high HVA for October to January (Chotai & Åsberg, 1999). We therefore analysed data on all completed suicides during 1952--1993 in the county of Västerbotten in northern Sweden (1466 cases), regarding these birth seasons in relation to suicide method and sociodemographic variables. Those with suicide age under 45 years were more likely than older suicides to have been born during February to April, significantly so compared to October to January. This was more pronounced for the later birth-year cohort (born in 1931 or later). Those who preferred hanging rather than poisoning or petrol gases were significantly more likely born during February to April. Those who preferred poisoning rather than hanging were significantly more likely born during October to January, particularly for the later birth-year cohort. The results regarding suicide method were somewhat more pronounced for males. The results of the study are compatible with a hypothesis of season of birth variation in CSF monoamine metabolites.

Season of birth variations in suicide methods in relation to any history of psychiatric contacts support an independent suicidality trait

BACKGROUND Due to reports on season of birth variations in suicidal behaviour as well as in cerebrospinal fluid levels of monoamine metabolites, we investigated season of birth variations in suicide methods for completed suicides in relation to any history of psychiatric contacts. Relationships with the psychiatric diagnoses for those with psychiatric contacts were also studied. METHODS Sociodemographic variables and suicide methods were examined for all the 693 suicide victims during 1961-1980 in Västerbotten, Sweden. Information on any history of psychiatric contacts was obtained from psychiatric in-patient and out-patient records. RESULTS Gender differences in the choice of suicide method were found in the group without any history of psychiatric contacts, but not in those with such a history. Only those without a history of psychiatric contacts showed season of birth variations for suicide methods -- those born during February to April were significantly more likely, and those born during October to January significantly less likely, to have preferred hanging rather than poisoning or petrol gases. These associations were stronger for the determined suicides, for males, and for urban residence. Suicide victims with a history of psychiatric contacts were significantly younger than those without. LIMITATIONS No psychological autopsies for those without psychiatric contacts. No information on eventual contacts with general practitioners. No measures of monoamine neurotransmitters were available. CONCLUSIONS Season of birth association for suicide methods is likely to be mediated by a suicidality trait independently of specific major psychiatric disorders. Monoamine neurotransmitters, particularly serotonin, are likely to underlie such a trait.

Self-reported suicidal and help seeking behaviours in the general population in Latvia

Abstract.Background: The aims of this study were to assess the prevalence of suicidal behaviours in the general population in Latvia, to identify risk groups for suicidal behaviour, to examine a possible continuous sequence of suicidal behaviours with underlying gradient of severity, to assess patterns of help seeking behaviours and preferences of different types of services for suicidal persons. Method: A postal survey of a stratified proportional sample of the general population aged 18 and older was carried out. Results: The last year and lifetime prevalence of any type of suicidal behaviours was 52.6 and 60.2 %. The incidence of self-reported suicide attempts was 1.8 and 5.1 %, respectively. Females reported significantly less serious types (includes ideation, plans and/or attempts) of suicidal behaviours (OR 0.04, p = 0.001) during last year than males. Younger age, lower level of education, urban residency and Latvian ethnicity were identified as risk factors for serious types of suicidal behaviours in both genders. Non-cohabitation status (OR 5.3, p = 0.01) and lower level of education for males, but higher levels of education for females were identified as significant risk factors for mild types (solely life-weariness and/or death wishes) of suicidal behaviours. The results indicated no simple cumulative relationship between the suicidal behaviours. Age, gender, previous help seeking experience and severity of self-reported suicidal behaviours influenced help seeking behaviours. The overall acceptance of professional services was high, but people who reported suicidal behaviours ranked them lower. Conclusions: A postal survey can provide a reasonable coverage of suicidal behaviours and description of risk groups in the general population. Higher prevalence of suicidal behaviours among males might indicate that nowadays males are under certain stress in Latvia.

Gender distribution of suicide attempts among immigrant groups in European countries-an international perspective

BACKGROUND Studies report high rates of suicide attempts for female immigrants. This study assesses variations in the distribution of suicide attempts across gender in immigrant and non-immigrant groups in Europe. METHOD Data on 64 native and immigrant groups, including 17,662 local and 3755 immigrant person-cases collected, between 1989 and 2003, in 24 million person-years were derived from the WHO/EURO Multicentre Study on Suicidal Behaviour. Female-to-male ratios of suicide attempt rates (SARs) were calculated for all groups. RESULTS The cases were combined into four major categories: hosts; European and other Western immigrants; non-European immigrants; and Russian immigrants. The non-European immigrants included higher female SARs than the Europeans, both hosts and immigrants. Unlike the other groups, the majority of suicide attempters among the Russian immigrants in Estonia and Estonian hosts were male. This was also true for immigrants from Curaçao, Iran, Libya and Sri Lanka. When the single groups with a male majority were excluded, the correlation between female and male SARs was relatively high among the European immigrants (r = 0.74, P < 0.0005) and lower among the non-European immigrants (r = 0.55, P < 0.03). Generalized estimating equation analysis yielded a highly significant difference (P < 0.0005) in gender ratios of suicide attempts between hosts (ratio 1.52) and both non-European immigrants (ratio 2.32) and Russian immigrants (0.68), but not the European immigrants. CONCLUSIONS The higher suicide attempt rates in non-European immigrant females compared with males may be indicative of difficulties in the acculturation processes in Europe. Further understanding of factors underlying suicidal behaviour in immigrant and minority groups is necessary for planning effective prevention strategies.