Louise Brådvik

Long-term suicide risk of depression in the Lundby cohort 1947-1997--severity and gender.

Objective:  The long‐term suicide risk of depression was evaluated in a community sample by severity and gender.

Risk factors for suicide in melancholia : a case-record evaluation of 89 suicides and their controls

Eighty‐nine inpatients with a primary severe depression and melancholia who had committed suicide were investigated. They were admitted to the Department of Psychiatry, Lund, Sweden between 1956–1969 and died before 1984. Matched controls were selected. Case records were evaluated at index admission to find suicidal risk factors in melancholia. Prospective ratings were compared. Women committing suicide had higher scores than their controls on the items unmarried, non‐compliance and suicide attempt but lower ratings on disharmonic childhood and non‐severe physical disease. Men committing suicide had higher scores on the items heredity for psychosis and a brittle or sensitive personality. For the latter item suicide was related to life‐weariness. Suicide attempt was related to acute onset and lack of psychomotor retardation. Two suicidal processes were proposed for men: one related to aggression and one not. Social factors seem less important in the prediction of suicide in melancholia than in depression in general.

Late mortality in severe depression

Objective: To assess late mortality among psychiatric in‐patients with severe depression/melancholia.

Mental disorders in suicide and undetermined death in the Lundby Study. The contribution of severe depression and alcohol dependence.

To evaluate the role of severe depression, i.e., depression with melancholic and/or psychotic features and alcohol dependence in suicide and undetermined death. The Lundby Study is a prospective, longitudinal study of a population consisting of 3563 subjects. In a long-term follow up 1947–2006 there were 66 suicide cases, including 19 undetermined deaths. Depression and alcoholism were as expected the major contributors to suicide (44% and 23% respectively). Severe depression with psychotic and/or melancholic features was diagnosed in 66% of all depressions and in 29% of all suicide cases, as compared to 15% for major depression only. Alcohol dependence was related to undetermined death. Major depressive disorder with melancholic and/or psychotic features appears to be an important contributor to accomplished suicide in the depression group, and alcohol dependence appears to be related to undetermined death.

Number of addictive substances used related to increased risk of unnatural death: a combined medico-legal and case-record study.

BackgroundSubstance use disorders have repeatedly been found to lead to premature death, i.e. drug-related death by disease, fatal intoxications, or trauma (accidents, suicide, undetermined suicide, and homicide). The present study examined the relationship between multi-drug substance use and natural and unnatural death.MethodsAll consecutive, autopsied patients who had been in contact with the Addiction Centre in Malmö University Hospital from 1993 to 1997 inclusive were investigated. Drug abuse was investigated blindly in the case records and related to the cause of death in 387 subjects.ResultsEvery substance apart from alcohol used previously in life added to the risk of unnatural death in a linear way. There were independent increased risks of fatal heroin overdoses or undetermined suicide. Death by suicide and violent death were unrelated to additional abuse.ConclusionThe number of drugs used was related to an increased risk of unnatural death by undetermined suicide (mainly fatal intoxications) and heroin overdose.

Factors associated with the history of attempted suicide.

BACKGROUND The present study examines a population of criminal justice clients for suspected substance-related problems. AIMS It aims to identify variables associated with a history of suicide attempt (SA). METHOD 6,836 clients were interviewed with the Addiction Severity Index (ASI). Attempters were compared to nonattempters regarding substance use, medical/psychiatric status, family history, and social relationships in a stepwise forward logistic regression. RESULTS Attempters (21%) were more likely to report binge drinking, intake of illicit drugs, injection of drugs, physical and mental illness, problematic family history, and history of being abused. After logistic regression, SA was independently associated with older age, female gender, binge drinking, delirium tremens, injection, overdose, medical problems, psychiatric symptoms, family history of alcohol or psychiatric problems, and sexual, physical, and emotional abuse. The psychiatric and family/social domains (including being abused) most strongly separated attempters from nonattempters. CONCLUSIONS Family background factors, psychiatric symptoms, severity of substance use, and sexual, physical, and emotional abuse appear to be factors associated with SA among criminal justice clients.

Repetition and severity of suicide attempts across the life cycle: a comparison by age group between suicide victims and controls with severe depression

BackgroundSuicide attempts have been shown to be less common in older age groups, with repeated attempts generally being more common in younger age groups and severe attempts in older age groups. Consistently, most studies have shown an increased suicide risk after attempts in older age. However, little is known about the predictive value of age on repeated and severe suicide attempts for accomplished suicide. The aim of the present study was to investigate the reduced incidence for initial, repeated, or severe suicide attempts with age in suicide victims and controls by gender.MethodsThe records of 100 suicide victims and matched controls with severe depression admitted to the Department of Psychiatry, Lund University Hospital, Sweden between 1956 and 1969, were evaluated and the subjects were monitored up to 2006. The occurrence of suicide attempts (first, repeated, or severe, by age group) was analysed for suicide victims and controls, with gender taken into consideration.ResultsThere was a reduced risk for an initial suicide attempt by older age in females (suicide victims and controls) and male controls (but not suicide victims). The risk for repeated suicide attempts appeared to be reduced in the older age groups in female controls as compared to female suicide victims. The risk for severe suicide attempts seemed reduced in the older age groups in female suicide victims. This risk was also reduced in male controls and in male controls compared to male suicide victims.ConclusionIn the older age groups repeated attempts appeared to be predictive for suicide in women and severe attempts predictive in men.

Repetition of suicide attempts across episodes of severe depression Behavioural sensitisation found in suicide group but not in controls

BackgroundThose who die by suicide and suffer from depression are known to have made more suicide attempts during their life-span as compared to other people with depression. A behavioural sensitisation or kindling model has been proposed for suicidal behaviour, in accordance with a sensitisation model of depressive episodes. The aim of the present study was to test such a model by investigating the distribution of initial and repeated suicide attempts across the depressive episodes in suicides and controls with a unipolar severe depression.MethodA blind record evaluation was performed of 80 suicide victims and controls admitted to the Department of Psychiatry between 1956 and 1969 and monitored to 2010. The occurrence of initial and repeated suicide attempts by order of the depressive episodes was compared for suicides and controls.ResultsThe risk of a first suicide attempt decreased throughout the later episodes of depression in both the suicide group (p < .000) and control group (p < .000). The frequencies of repetition early in the course were actually higher in the control group (p < .007). After that, the risk decreased in the control group, while the frequencies remained proportional in the suicide group. At the same time, there was a significantly greater decreased risk of repeated attempts during later episodes in the control group as compared to the suicide group (p < .000). The differences were found despite a similar number of episodes in suicides and controls.ConclusionRepeated suicide attempts in the later episodes of depression appear to be a risk factor for suicide in severe depression. This finding is compatible with a behavioural sensitisation of attempts across the depressive episodes, which seemed to be independent of a corresponding kindling of depression.

Seasonal distribution of suicide in alcoholism.

Brådvik L, Berglund M. Seasonal distribution of suicide in alcoholism. Acta Psychiatr Scand 2002: 106: 299–302.

Suicide in severe depression related to treatment Depressive characteristics and rate of antidepressant overdose.

AbstractThe objective of the present study was to assess the association between depressive characteristics and completed suicide despite adequate antidepressant therapy in severe depression and to investigate the frequency of lethal antidepressant overdoses. A record evaluation of 98 suicide victims with a primary severe depression had been performed. These had been admitted to the Department of Psychiatry, Lund University Hospital between 1956 and 1969 and followed up to 1998. Psychomotor retardation was related to completed suicide after ECT. The estimated frequency of lethal intoxication with antidepressants was low: 3% of the suicides.