Erkki Väisänen

Cyclic time patterns of death from suicide in northern Finland

BACKGROUND Time patterns of suicide have been attributed not only to social and psychological factors but also to direct geophysical effects. Seasonal variations in day length and temperature seem likely to contribute to the timing of the suicide process. METHODS We analysed all suicides (n=1658) committed in a northern province of Finland during a period of 153 months. Daily data on the number of suicides, local weather conditions and geomagnetic storms were compiled and modelled with Poisson regression using the province population as the denominator, and with the means of harmonic series for seasonal variation. Time series analysis of monthly numbers of suicides was carried out using the seasonal-trend decomposition procedure based on loess. RESULTS Marked fluctuations in the number of suicides occurred during the study period (P=0.01). There was significant seasonal variation in death from suicide (P=0.01), but analysis of the meteorological data showed no evidence of effect on the risk of suicide. LIMITATIONS Assessment of mental disorder or alcohol consumption was missing, since only data derived from death certificate was available for each case. CONCLUSIONS The seasonal effect was significant, but remained modest compared to sex and age as risk factors for suicide. Preventive measures need to be tailored according to time of the year.

Is seasonality of suicides stronger in victims with hospital-treated atopic disorders?

The aim of the present study was to test whether the seasonal distribution of suicides differed between atopic and non-atopic suicide victims. A cross-sectional comparison of the semi-annual and seasonal distribution of suicides was made by using a 13-year database of all suicides (1296 males, 289 females) committed during the years 1988-2000 in the province of Oulu in Northern Finland. During the first half of the year, the proportion of suicides among atopic patients was significantly higher than that linked with non-atopic patients. Of all atopic patients, 72% committed suicide during the first and 28% during the second half of the year. Suicides among victims without any atopic disorders followed a uniform seasonal distribution throughout the year (50 vs. 50%). The exacerbation of an atopic disorder may increase the risk of suicide in spring; something that should be taken note of in clinical work.

The role of the sympathetic nervous system in anxiety: Is it possible to relieve anxiety with endoscopic sympathetic block?

The function of the autonomic nervous system is divided so that the parasympathetic system spares central nervous system energy and the sympathetic system makes extra energy available and consumes it. The sympathetic nervous system then prepares our body for emergency and it always functions when our conscious or even unconscious mind notices a need for defence or to provide energy. A surgical procedure, where the upper thoracic sympathetic ganglions are ablated, either with cauterization or clamping with metallic clips, has been used to treat sweating of the hands and facial blushing for decades. Instead of ablating large areas of sympathetic trunk, which can cause severe side-effects such as reflex sweating of the body, the surgical procedure is nowadays carried out in a more precise symptom-mediating level of uppermost thoracic sympathetic ganglia. Blushing, hyperhidrosis of palms and head, and trembling are common in social phobia, and they seem to be provoked by the activation of the sympathetic nervous system. Preliminary studies show that some social phobia patients may benefit from the endoscopic sympathetic block (ESB). If the patient with generalized social phobia has not received help with adequate medication or psychotherapy, the ESB may be a new possible treatment of choice.

Alexithymia, hypochondriacal beliefs, and psychological distress among frequent attenders in primary health care.

Frequent use of health services has been associated with such concepts as alexithymia, hypochondriasis, and psychological distress. The aim of this case-control study was firstly to assess whether alexithymia, hypochondriasis, and psychological distress are associated with frequent attendance and secondly to assess the gender differences of these associations in a primary health care setting. A sample of 304 frequent attenders (eight or more visits during 1 year), including all of the frequent attenders during 1994, and 304 randomly selected age- and sex-matched controls were selected. Half of the sample (every second individual selected in date-of-birth order) was invited for an interview, 113 frequent attenders and 107 controls completed a questionnaire during the interview. Alexithymia was measured with the Toronto Alexithymia Scale-20 (TAS-20), hypochondriasis was screened with the Whiteley Index (WI), and Symptom Checklist-36 (SCL-36) was used to determine psychological distress. We found a distinct gender difference in the associations of these characteristics with frequent attending. Significant associations of alexithymia, hypochondriasis, and psychological distress with frequent attending were found among men, but not among women. Alexithymia, hypochondriasis, and psychological distress should be considered when treating frequent attenders, especially males.

Is occupation relevant in suicide

BACKGROUND The seasonality of suicide rates and methods of suicide may be related to changes in weather and conditions of employment. Particularly the amount of occupational outdoor exposure could show differences in the distribution of suicides by season and the selection of suicide method, in addition to age at the time of death. METHODS The data consisted of all death certificates (n=1359) of completed suicides in the province of Oulu, Finland, during the years 1988-1999. For male subjects included in this study, four occupational groups were identified according to decreasing occupational outdoor exposure. The mean ages, the distribution of suicide methods and the seasonal variation in suicides for each occupational group were analyzed. RESULTS Farmers were significantly older at the time of suicide than construction or indoor workers, and farmers employed significantly more violent methods than the other occupational groups. In the spring, farmers had a significant peak in the rate of suicides. In the winter, forest workers had a significant trough in the rate of suicides. In the summer, indoor workers had a significant peak in the rate of suicides. LIMITATIONS The analyses were restricted to males due to the low number of females in the study population. CONCLUSIONS The novel finding in this study was that the seasonality of violent suicides was most strongly seen as a spring peak and a winter trough among outdoor workers. The recognition of typical risk factors of different occupations, such as outdoor exposure, and occupational-related susceptibility towards certain suicide methods could benefit in the prevention of suicides.

ARSON TREND INCREASING : A REAL CHALLENGE TO PSYCHIATRY

This research evaluated the arson trend in Finland since the 1960s by analyzing the Official Crime Statistics of Finland registered by the police and examined more detailed about arsonists (n = 98), who had been in the forensic psychiatric pretrial examination by using homicide offenders (n = 55) as control subjects. From 1965 to 1991 the percentage of arson in relation to all crimes increased fivefold and in the same timeframe the amount of arson increased nearly tenfold. According to the police in Finland there are committed over 700 arsons every year, of which 90% are committed by men. The percentage of women has however increased 0.2% yearly. Women today commit about 10% and juveniles 10 to 15% of all arsons. The arsonists differed from the homicide offenders regarding rural residence (P = 0.009), poor education (P = 0.004), absence of regular work at the time of the crime (P = 0.004), suicidality (P = 0.001), alcohol problems (P = 0.002), psychiatric care (P = 0.000.02) and arsonists more commonly found to be not responsible for the crime committed (P = 0.01).

Suicide among medical doctors: Psychological autopsy data on seven cases

Suicide mortality among medical doctors is significantly higher compared with other professionals and the general population in Finland as well as in many other industrialized countries, concerning especially female doctors. The National Suicide Prevention Project in Finland covered all suicides that happened during one year (1.4.1987–31.3.1988). The data were collected and analysed by the psychological autopsy method. It is possible that the physicians who committed suicide tended to have an emphasized reliance on professional identity, in which case a crucial internal resource would have been a sense of autonomy. A variety of problems (physical or mental illness, professional setbacks) could then be perceived as threats to the doctor identity and a sense of autonomy. Moreover, doctors often preferred to medicate themselves instead of seeking outside medical help. It is possible that medical professionals easily resort to chemical forms of coping, which increase the risk of suicide.

A portrait of the juvenile arsonist

In this study we evaluated if juvenile arsonists (n = 34) differ from juvenile criminals of violence (n = 33) in regard to suicide and mental problems in forensic psychiatric examination. Both arsonists and violent offenders were mostly male, poorly educated, unskilled and unemployed at the times of committing their crimes; and 79% of the arsonists and 58% of the control group had used public health services for treatment of their mental symptoms before the crime. This difference was significant (p = 0.05). Suicide was more common among the arsonists than the control subjects (p = 0.02); 74% of the arsonists had suicidal thoughts and 44% had tried to commit suicide before setting a fire. In the forensic psychiatric examination the arsonists were more often relieved from responsibility than the comparison group (p = 0.02).

Fire-Setting From the Viewpoint of an Arsonist

1. Arsonists have more psychiatric symptoms, such as self-destructive behavior and alcohol dependency, than other criminal offenders. 2. Arsonists are found to have poor social competence with low social status and a high unemployment rate. 3. The act of arson could be like an attempted suicide, a cry for help.

Family systems medicine: A new field of medicine

Family systems medicine is a relatively new and interesting field of medicine which developed mainly from the integration of systems theory, family therapy, general practice, and modern clinical medicine. The authors describe its concepts and present a literature review documenting the issues related to the subject. Family systems medicine ideas have been applied in practice and taught to physicians principally in the United States and Canada during the past 10 years. The first 2-year continuing education course in family systems medicine for general practitioners in Finland was started at the University of Oulu in 1989. The authors have collaborated with family therapists and family physicians of the University of Rochester in the USA for improving further Finnish courses.