Lars Mehlum

The longitudinal pattern of suicidal behaviour in borderline personality disorder: a prospective follow-up study.

The aim was to study the longitudinal course of suicidal behaviour and ideation in patients with borderline personality disorder (BPD) compared with patients with other diagnoses. Ninety‐seven patients (41 BPD, 33 other personality disorders, 23 no personality disorder) consecutively admitted to a day unit were given a prospective personal interview follow‐up with evaluations at admission, discharge and at follow‐up after 2–5 years. Even when controlled for Axis I disorders, BPD patients showed significantly more often a lifetime history of suicide attempts. BPD patients with a history of suicide attempts were more suicidal at index admission, continued to be so over the follow‐up period and differed systematically in an unfavourable direction from other BPD patients on the major outcome measures. BPD patients without suicidal behaviour had an outcome nearly as good as non‐BPD patients, and only 41% of them retained the BPD diagnosis at follow‐up. Suicidal behaviour and ideation are highly prevalent in BPD. These suicidal expressions are of an enduring nature and seem as a diagnostic criterion to enhance the predictive capacity of the BPD diagnosis.

Suicide in young Norwegians in a life course perspective: population-based cohort study

Background Suicide is a leading cause of death in young adults. Several risk factors are well known, especially those related to adult mental health. However, some risk factors may have their origin in the very beginning of life. This study examines suicide in the general Norwegian population in a life course perspective, with a main focus on early life factors. Methods In this study, several national registers were linked, supplying personal data on biological and social variables from childhood to young adult age. Participants were all Norwegians live born during the period 1967–1976, followed up through 2004. Persons who died or emigrated before the year of their 19th birthday, at which age follow-up started, were excluded. Thus, the study population comprised 610 359 persons, and the study outcome was completed suicide. Results 1406 suicides (0.23%) were recorded, the risk being four times higher in men than in women. Suicide risk factors included not being firstborn (adjusted HR in men and women (95% CIs): 1.19 (1.05 to 1.36) and 1.42 (1.08 to 1.88)), instability of maternal marital status during childhood, parental suicide (mainly in women), low body mass index (only investigated in men), low education and indications of severe mental illness. Conclusions Suicide in young adults may be rooted in early childhood, and the effect is likely to act through several mechanisms, some of which may be linked to the composition and stability of the parental home. A life course perspective may add to our understanding of suicide.

Personality disorders 2–5 years after treatment: a prospective follow‐up study

Ninety‐seven patients consecutively admitted to a day unit specializing in the treatment of personality disorders were included in a prospective follow‐up study. At follow‐up an average of 3 years after index admission, patients with borderline personality disorder (BPD) displayed a moderate symptom reduction and a fair global outcome. Patients with schizotypal personality disorder (STP) showed a similar reduction in symptoms but retained relatively poor global functioning. Individuals with cluster C personality disorders, in contrast, showed both a good global outcome and a marked symptom reduction. STP individuals were the least socially adjusted, employed and self‐supporting of all diagnostic subgroups. STP and BPD individuals had far more inpatient treatment in the follow‐up period than other groups. The overall suicide rate was low compared with most similar studies.

Predictors of posttraumatic stress reactions in Norwegian U.N. peacekeepers 7 years after service

A sample of 1,624 Norwegian veterans from the UNIFIL (United Nations Interim Force in Lebanon) was investigated on average 6.6 years after service, completing a questionnaire focusing on stress exposure and posttraumatic stress reactions. The prevalence of posttraumatic stress disorder (measured by the Posttraumatic Symptom Scale [PTSS-10]) was 5% overall, but 16% in the subgroup of personnel having been prematurely repatriated from UNIFIL. Multiple regression analyses showed that the following variables made separate and significant contributions to the explained variance of the PTSS-10: Service stress exposure, perceived lack of meaningfulness with respect to the military mission, and stressful life-events in life after service. These factors explained 25% (overall sample) and 37% (repatriated sample) of the variation in the posttraumatic symptom score.

Suicide in peacekeepers: A cohort study of mortality from suicide in 22,275 Norwegian veterans from international peacekeeping operations

Abstract.Objective:Several studies have investigated post-traumatic stress reactions and other psychosocial problems in former peacekeepers. The question has also been raised as to whether such veterans might be at increased risk of suicide. This study investigated the suicide mortality in Norwegian former peacekeepers.Methods:Cause-specific mortality was identified in the population of Norwegian peacekeepers having participated in army missions in the years 1978–95. General population data were used for comparison. Standardized Mortality Ratios (SMRs) were calculated for different suicide methods and certain peacekeeping-related variables. Marital status was available for each year and controlled for by using separate suicide rates for unmarried, married and divorced.Results:A moderately, but significantly, increased SMR of 1.4 for suicide was found among the former peacekeepers (95% confidence interval = 1.1–1.8). After adjusting for marital status, the SMR was reduced to insignificance (SMR = 1.1, 95% confidence interval = 0.9–1.4). There was a significant increase in suicide by means of firearms and carbon monoxide poisoning.Conclusions:The increased risk of suicide in former peacekeepers was related to the peace-keepers’ lower marriage rate compared to the general population. This finding may indicate that the personnel were characterized by certain vulnerability factors before entering peacekeeping service, resulting in a reduced ability to enter into and remain in stable love relations. However, it cannot be excluded that stress reactions following peacekeeping may have contributed to possible strains on interpersonal relationships. Preventative work should, thus, include improved personnel selection routines and preferably also psychosocial support for veterans and their families. The increased number of suicides by use of firearms indicates that gun control might be an important prevention measure in this group.

Suicide mortality trends in the Nordic countries 1980–2009

Abstract Background and aim: The Nordic countries provide a suitable setting for comparing trends in suicide mortality. The aim of this report is to compare suicide trends by age, gender, region and methods in Denmark, Finland, Iceland, Norway and Sweden 1980–2009. Methods: Suicide statistics 1980–2009 were analyzed for men and women aged 15 years and above and the age group 15–24 years. Regional suicide rates in 2009 were presented in maps. Results: The suicide rates across the Nordic countries declined from 25–50 per 100,000 in 1980 to 20–36 in 2009 for men and from 9–26 in 1980 to 8–11 in 2009 for women. The rates in Finland were consistently higher than those of the other countries. A significant increase of suicides in young women in Finland and Norway and a lack of a decline among young women in Sweden were noted. The male– female ratio of suicide converged to approximately 3:1 across the region during the study period. Rural areas in Finland, Norway and Sweden saw the highest suicide rates, whereas the rates in the capital regions of Denmark, Norway and Sweden were lower than the respective national rates. Conclusions: We hold that the overall decline of suicide rates in the Nordic countries reflects the socio-economic development and stability of the region, including the well-functioning healthcare. The increasing rates in Finland and Norway and the unchanged rate in Sweden of suicide in young women are an alarming trend break that calls for continued monitoring.

Outpatient group psychotherapy: A valuable continuation treatment for patients with borderline personality disorder treated in a day hospital?: A 3-year follow-up study

Our objective was to investigate, in a naturalistic, prospective study, the follow-up status of patients with borderline personality disorder (BPD) treated with a combination of day treatment and subsequent outpatient group psychotherapy (G-group, n=12) and compare their status with that of patients with BPD treated in the same day hospital but without subsequent outpatient group therapy (Non-G-group, n=31). At follow-up an average of 34 months after discharge from the day hospital, the G-group patients had a moderate impairment in global health (HSRS), a low level of symptoms (GSI), a low rate of rehospitalization and suicide attempts, and a high rate of remission from substance use disorders. Compared with the Non-G-group, the G-group patients had a significantly higher HSRS and a significantly lower GSI at follow-up. In multivariate analyses controlling for background and treatment variables, number of months in work last year before admission and outpatient group therapy predicted a better HSRS at fol...

Dialectical Behavior Therapy Compared With Enhanced Usual Care for Adolescents With Repeated Suicidal and Self-Harming Behavior: Outcomes Over a One-Year Follow-Up.

OBJECTIVE We conducted a 1-year prospective follow-up study of posttreatment clinical outcomes in adolescents with recent and repetitive self-harm who had been randomly allocated to receive 19 weeks of either dialectical behavior therapy adapted for adolescents (DBT-A) or enhanced usual care (EUC) at community child and adolescent psychiatric outpatient clinics. METHOD Assessments of self-harm, suicidal ideation, depression, hopelessness, borderline symptoms, and global level of functioning were made at the end of the 19-week treatment period and at follow-up 1 year later. Altogether 75 of the 77 (97%) adolescents participated at both time points. Frequencies of hospitalizations, emergency department visits and other use of mental health care during the 1-year follow-up period were recorded. Change analyses were performed using mixed effects linear spline regression and mixed effect Poisson regression with robust variance. RESULTS Over the 52-week follow-up period, DBT-A remained superior to EUC in reducing the frequency of self-harm. For other outcomes such as suicidal ideation, hopelessness, and depressive or borderline symptoms and for the global level of functioning, inter-group differences apparent at the 19-week assessment were no longer observed, mainly due to participants in the EUC group having significantly improved on these dimensions over the follow-up year, whereas DBT-A participants remained unchanged. CONCLUSION A stronger long-term reduction in self-harm and a more rapid recovery in suicidal ideation, depression, and borderline symptoms suggest that DBT-A may be a favorable treatment alternative for adolescents with repetitive self-harming behavior. CLINICAL TRIAL REGISTRATION INFORMATION Treatment for Adolescents With Deliberate Self Harm; http://clinicaltrials.gov/; NCT00675129.

Traumatic stress and suicidal ideation in Norwegian male peacekeepers

To investigate the association between war zone stress exposure during international military operations and later suicidal ideation, a follow-up study of 1172 Norwegian male peacekeepers was conducted 7 years, on average, after redeployment. Suicidal ideation was reported in 6% of the veterans, while it was reported in 17% of the subsample of those who were prematurely repatriated. Suicidal ideation was significantly associated with service stress exposure level, even when background factors, repatriation status, negative life events, social support, alcohol consumption, and marital and occupational status were controlled for. Results indicate that the association between service stress exposure and suicidal ideation was mediated by posttraumatic stress symptoms and general mental health problems combined.

AIDS/HIV Infection, Comorbid Psychiatric Illness, and Risk for Subsequent Suicide: A Nationwide Register Linkage Study

OBJECTIVE To explore socioeconomic and psychiatric characteristics of persons with acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus (HIV) infection and to assess the effect of AIDS/HIV infection on risk for subsequent suicide in the context of psychiatric comorbidity and socioeconomic status. METHOD In this study based on the entire population of Denmark, we interlinked 5 national registers to retrieve personal data on AIDS/HIV infection and covariates for 9,900 men who died of suicide during 1986-2006 and 189,037 controls matched for sex and date of birth. Suicide risk associated with AIDS/HIV infection was assessed using a conditional logistic regression model. RESULTS People with AIDS/HIV infection, especially those who died of suicide, mostly lived as single people, had low income, and were dwellers of the Capital area of Denmark (Copenhagen and Frederiksberg). While presence of other physical illness was common in these patients, 38.6% of suicide and 29.0% of control patients developed psychiatric illness after being diagnosed with AIDS or HIV infection. Meanwhile, AIDS/HIV infection constituted a significant risk factor for subsequent suicide (adjusted incidence rate ratio [IRR] = 3.84; 95% confidence interval, 2.53-5.81); the risk was substantially higher for persons who were diagnosed for the first time recently, were treated as inpatients, had a recent hospital contact, or had multiple hospital contacts because of the illness. The increased suicide risk associated with AIDS/HIV infection was slightly stronger before the introduction in 1997 of highly active antiretroviral therapy (HAART) (adjusted IRR = 5.55; 95% CI, 3.07-10.06), but remained highly significant in the HAART era (adjusted IRR = 2.77; 95% CI, 1.55-4.94). Moreover, AIDS/HIV infection significantly interacted with psychiatric illness (P < .0001), and their comorbidity increased the risk of suicide substantially. CONCLUSIONS Suicide risk is increased in individuals with AIDS/HIV infection, particularly those with a recent diagnosis, more intensive and frequent hospital care, or comorbid psychiatric illness. The findings call for improvement of clinical capacities to address psychosocial and existential needs in the treatment of patients with AIDS/HIV infection.