Martti E. Heikkinen

Recent life events, Social support and suicide

The occurrence of recent life events during the last 3 months, and Social support received were studied in a nationwide suicide population (N = 1,067) in Finland. Recent life events were reported in 80 % of the suicides. Job problems (28 %), family discord (23 %), somatic illness (22 %), financial trouble (18 %), unemployment (16 %), separation (14 %), death (13 %) and illness in family (12 %) were the most common life events. Sex differences were found in recent life events: any life event, separation, financial trouble, job problems and unemployment were more common among males. The mean number of life events was also higher among males.

The 12‐month prevalence and risk factors for major depressive episode in Finland: representative sample of 5993 adults

Objective: This study reports the 12‐month prevalence of major depressive episode and its risk factors in a representative nationwide sample.

Mental disorders in elderly suicide.

The purpose of this study was to investigate the prevalence and comorbidity of current mental disorders defined by DSM-III-R among elderly suicide victims and to compare them with the mental disorders among younger victims. Using a psychological autopsy method, we collected comprehensive data on all suicides in Finland during 1 year. Retrospective Axis I-III consensus diagnoses were assigned to a random sample consisting of 43 victims aged 60 years or over and 186 victims aged under 60 from the nationwide suicide population. At least one Axis I diagnosis was made for 91% of the elderly victims. Major depression as the principal diagnosis was more common among the elderly victims. Almost all elderly female victims were major depressives. Psychiatric comorbidity was more common among elderly male than among elderly female victims. More of the elderly victims (88%) than the younger (36%) received Axis III diagnoses. Suicide among the elderly without a diagnosable mental disorder and somatopsychiatric comorbidity seems to be rare.

Suicide among female adolescents: characteristics and comparison with males in the age group 13 to 22 years.

OBJECTIVE To characterize female suicides (n = 19) in an unselected nationwide youth suicide population aged 13 to 22 years (n = 116) and to compare them with male suicides with respect to variables indicating psychopathology and psychosocial functioning. METHOD The data were collected in a psychological autopsy study of all suicides (N = 1,397) in Finland during a 12-month period. Data collection included interviews of next of kin and professionals and information from records after the suicide. RESULTS Two thirds (68%) of the female victims had suffered from a mood disorder, and 73% had communicated their suicidal intent. Half (47%) of the female subjects had been in psychiatric care at some point in their lives, and 42% had been hospitalized. Compared with young male suicides, the young female victims more often had made previous suicide attempts (63% versus 30%), received more often a diagnosis of major depression (37% versus 14%), and had more often been in psychiatric care (47% versus 21%) during the year preceding the suicide. The females were more often incapable of working, and their psychosocial impairment was more severe during the final week. Alcohol abuse was almost as common among the female as the male victims (21% versus 26%). CONCLUSION The results suggest that young females who commit suicide may have suffered from more severe psychopathology than young male victims. Substance abuse seems to be a major factor also in female suicides. Preventive efforts within psychiatric care are likely to reach a higher proportion of the young females than males at high risk for suicide.

Recent Life Events in Elderly Suicide: A Nationwide Study in Finland

The primary objectives of this study were to examine recent stressful life events and to explore possible social interaction factors across age groups in a population of suicides. Life events during the last 3 months preceding suicide (32 items) and factors related to social interaction (6 items) among 219 suicide victims aged 60 years and older were compared with those of 803 victims aged 20 to 59 years. The study population comprised all adult suicides who had life events interview data assessed as reliable by the interviewers in a nationwide total suicide population (1,397) of 1 year in Finland. Differences in life events were found across age groups: Family discord, loss (separation, death), financial trouble, job problems, unemployment, and residence change were more common among younger victims, and somatic illness was more common among elderly victims. Age groups were similar with regard to proportions of persons living alone, availability of confidants and friends with common interests, and reports of loneliness. Similarly, few differences were found among persons aged 60-74 compared to age 75+ with regard to rates of life events, living alone, opportunities for social interaction, and complaints of loneliness. loneliness was reported for persons who experienced loss among both younger and older suicides. In terms of age differences, younger men were more likely to have experienced job-related events, whereas older men were more likely to have had a somatic illness. Somatic illness appeared to be the most important stressor in elderly suicides, particularly for men. Living alone and diminished opportunity for social interaction were not common factors in late-life suicides. Controlled studies with age-matched comparisons are needed to further investigate how life events and social interaction factors vary in their risk for suicide across the life course.

Mental disorders in young and middle aged men who commit suicide.

In most European countries men account for about three quarters of people who commit suicide. Suicide rates have generally risen among men under 35 but remained more stable among older men. To our knowledge, no studies specifically compare mental disorders among men of different ages who have committed suicide, although the association between mental disorders and suicide is strong and different secular trends in suicide rates have been reported. We compared the prevalences of mental disorders central to suicide—depressive syndromes, alcoholism, personality disorders, and non-affective psychotic disorders—in men of 20-34 and 35-59 who committed suicide in Finland. In the research phase of the national suicide prevention project in Finland all deaths between 1 April 1987 and 31 March 1988 that were officially classified as suicide (n=1397) were recorded and carefully analysed retrospectively by the psychological autopsy method.1 The definition of suicide was based on Finnish law—in every case of …

Mental disorders and suicide prevention

Abstract In the research phase of the National Suicide Prevention Project, all suicides (n= 1397) in Finland between March 1987 and April 1988 were examined retrospectively using the psychological autopsy method. Careful retrospective diagnostic evaluation of the victims according to DSM‐III‐R criteria was done by weighing and integrating all available information. A series of studies addressing the mental disorders among suicide victims, the treatment received before death and the life events is now reviewed.

Recent life events and completed suicide in bipolar affective disorder. A comparison with major depressive suicides

While recent psychosocial stress has been shown to be associated with the initiation of both first and subsequent illness episodes in bipolar affective disorder, its relationship to completed suicide in bipolar disorder is not known. As a part of a nationwide psychological autopsy study, two populations representing all suicides in Finland in DSM-III-R bipolar disorder or unipolar major depression were comprehensively examined and compared. Recent life events were retrospectively examined by interviewing next of kin using a 32-item Recent Life Change Questionnaire. Life event data was available on 25 bipolar and 56 unipolar cases. In about two-thirds of both bipolar (64%) and unipolar (66%) victims, at least one life event was reported to have occurred during the last 3 months and in 42% of both groups during the final week. The events of bipolar victims were more commonly classified as possibly dependent on their own behaviour (bipolars 88% vs. unipolars 63%, P = 0.004). Among bipolars, more males than females had had recent life events (males 86% vs. females 37%, P = 0.03). The majority of completed suicides in both bipolar and unipolar affective disorders seem to be associated with recent psychosocial stress; however, the stressors are commonly likely to be dependent on the victims behaviour.

Cigarette smoking, alcohol intoxication and major depressive episode in a representative population sample

OBJECTIVE This study investigated the associations of cigarette smoking and alcohol intoxication with major depressive episode. DESIGN Major depressive episode during the past 12 months was assessed in a national representative cross sectional study using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form). SUBJECTS A random sample of 5993 non-institutionalised Finnish people aged 15–75 years was interviewed as a part of the 1996 Finnish Health Care Survey. RESULTS In logistic regression models the factors associated with major depressive episode in the past 12 months were smoking 10 or more cigarettes daily (odds ratio (OR) 2.26; 95% confidence intervals (95% CI) 1.68, 3.04) and alcohol intoxication at least once a week (OR 2.99; 95%CI 1.70, 5.25). Their effects were independent of each other, and remained significant even after adjusting for other major risk factors (marital status, education, unemployment and chronic diseases). The attributable proportion (a measure of the impact of the risk factors of the disease on the population) for daily smoking of 10 or more cigarettes was 0.15, and for alcohol intoxication at least once a week 0.04. CONCLUSION Cigarette smoking and alcohol intoxication seem to be important risk factors for major depressive episode. In this population the impact of smoking was greater.

Use of health services for major depressive episode in Finland.

BACKGROUND A universal finding in psychiatric epidemiology is that only a minority of currently depressed people seek or receive treatment. AIMS To investigate the predictors of use of health care services for depression. METHODS A representative random sample of 5993 non-institutionalised Finnish individuals aged 15-75 years was interviewed in 1996. Major depressive episode during the last 12 months was assessed using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form). Characteristics and health service use of the 557 depressed individuals were assessed. RESULTS The proportion of people classified as having a major depressive episode who used any health services for their depression during the past 12 months was only 31% for men and 25% for women. Use of services was not predicted by sociodemographic factors. Longer duration, and greater severity and perceived disability predicted overall health service use for depression, but not significantly whether treatment was sought from primary or psychiatric care. CONCLUSIONS The probability of use of health services for major depression increases with duration, severity and perceived disability related to depression. Only 59% of those suffering from even the most severe major depressive episodes use health services for depression. Use appears to be unrelated to sociodemographic factors in Finland.